Cholesterol levels: LDL, HDL, triglycerides, total cholesterol

You've heard of cholesterol, but did you know just how important it is in your body? Or that it's a significant factor in keeping your heart healthy as you age?

Bringing your cholesterol levels into a healthy range and keeping them there is an essential part of lowering your risk of cardiovascular disease and a host of other health problems in the future. 

Here’s what you need to know about the cholesterol in your body, optimum blood cholesterol levels, and how you can maintain those levels.

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Cholesterol is a fatty, waxy molecule found in all of your tissues and your bloodstream. It’s essential to many of the structures and functions of your body, including (Janapala, 2021):

• Hormones

• Vitamin D

• Cell membranes

• Bile acid (helps with digestion)

Your body makes cholesterol in your liver and intestines. The liver combines this cholesterol with a particular type of protein so that it can circulate through the body. This combination is called a lipoprotein (Craig, 2020).

When you talk to your healthcare provider about your cholesterol, they’ll usually mention three different types of cholesterol called:

• Low-density lipoprotein (LDL) cholesterol

• High-density lipoprotein (HDL) cholesterol

• Very low-density lipoprotein (VLDL) cholesterol

Not all cholesterol is created equally. These three different types of cholesterol have vastly distinct impacts on your body and mean different things for your health.

Low-density lipoprotein (LDL) cholesterol

You may know LDL as "bad cholesterol" because elevated levels can lead to dangerous plaque build-up in your blood vessels called atherosclerosis. This build-up can slow down or even stop blood flow through your arteries (U.S. National Library of Medicine, 2021).

High-density lipoprotein (HDL) cholesterol

HDL is often called “good cholesterol'' because it carries cholesterol back to the liver from elsewhere in the body to be removed. Unlike the other types of cholesterol, you want higher levels of HDL cholesterol. Having a low HDL can increase the risk of heart disease (U.S. National Library of Medicine, 2021).

Very low-density lipoprotein (VLDL) cholesterol

VLDL is also often referred to as a type of “bad cholesterol'' because it carries triglycerides. Chronically high triglyceride levels can cause heart disease. VLDL cholesterol isn’t measured directly, but it's estimated from the amount of triglycerides in your blood (U.S. National Library of Medicine, 2021).

Your healthcare provider can monitor your cholesterol levels with a blood test called a lipid profile. This test will give you the total cholesterol levels in your blood and specific values for your LDL cholesterol, HDL cholesterol, and triglycerides (Sundjaja, 2021).

You will likely need to fast before having your cholesterol levels tested. Fasting means that you can't have anything to eat or drink except water for at least eight hours before your test. The reason you need to fast is that your triglyceride levels become elevated after meals. Your healthcare provider will want to know your baseline levels, uninfluenced by any particular meal (Sundjaja, 2021).

A phlebotomist will draw a small sample of your blood from the vein on the inside of your elbow to do your lipid blood test. You'll usually get your cholesterol test results back quickly, but the exact amount of time will depend on the lab service that you use (Sundjaja, 2021).

The guidelines that healthcare providers currently use to assess your  levels of cholesterol are as follows (Lee, 2020):

• Fasting triglyceride level:

  • Normal: less than 150 mg/dL 

  • Mild hypertriglyceridemia: 150 to 499 mg/dL

  • Moderate hypertriglyceridemia: 500 to 886 mg/dL 

  • Very high or severe hypertriglyceridemia: greater than 886 mg/dL

• LDL cholesterol level:

  • Optimal: less than 100 mg/ dL

  • Near optimal/above optimal:100 to 129 mg/dL

  • Borderline high: 130 to 159 mg/dL

  • High: 160 to 189 mg/dL

  • Very high: greater than 190 mg/dL 

• HDL cholesterol level:

  • Low: less than 40 mg/dL

  • High: greater than or equal to 60 mg/dL

An imbalance in your lipid levels is called dyslipidemia, a condition that gets more common with age. Approximately one-third of adults over 20 years old have elevated LDL cholesterol. Believe it or not, only about half of those people are getting sufficient treatment. That's a problem because untreated dyslipidemia can harm a person's future heart health (Pappan, 2021).

Several lifestyle factors can increase your cholesterol levels. These include (Pappan, 2021):

• Tobacco use

• Physical inactivity

• Obesity

• Not eating enough high fiber foods, such as fruits, nuts/seeds, and vegetables

• High consumption of saturated fats

Your genetic family history can also cause elevated cholesterol. Familial hypercholesterolemia (FH) is an autosomal dominant condition. That means you only need to inherit one copy of the gene from a parent to be affected. (In simple terms, that just means it runs very strongly in families). FH can cause a person to have extremely high LDL cholesterol levels, often starting at a very young age. Other less common hereditary conditions can cause high triglycerides (Pappan, 2021).

High blood cholesterol doesn't usually cause any immediate physical symptoms, leading many people to ignore their cholesterol numbers. Ignoring your levels isn't a good idea because imbalanced cholesterol levels can lead to many health concerns (Hill, 2021).

In particular, elevated LDL levels (hypercholesterolemia) are a significant risk factor for heart disease. The main benefit of lowering your cholesterol is that it can decrease this risk (Hill, 2021).

Complications from untreated dyslipidemia can include (Hill, 2021):

• Coronary artery disease

• Peripheral artery disease

• Cerebrovascular accidents (stroke)

• Heart attack

• Type II diabetes

• Hypertension (high blood pressure)

Preventing elevated lipid levels before they happen is the best way to avoid health consequences. However, it's not too late to lower your levels if they’re already elevated. You can make changes in your life to get your cholesterol back into the optimal range.

Diet

Current dietary guidelines recommend avoiding trans fats, a type of fat usually found in heavily processed foods that adversely affect how your body processes lipids. It would be best if you also tried to limit saturated fats to less than 10% of your daily calories. If you already know that you are at high risk for heart disease, you should aim for saturated fats to make up less than 5–6% of your diet. This will help to decrease the total amount of cholesterol in your diet (Janapala, 2021).

Lifestyle

An unhealthy lifestyle is the most common cause of high cholesterol levels. Fortunately, specific lifestyle changes can help optimize your lipid levels and decrease your risk of heart disease, including (U.S. National Library of Medicine, 2021):

• Get regular physical activity

• Don’t smoke (or quit as soon as you can)

• Maintain a healthy weight

• Reduce your stress levels

Medications

Diet and healthy lifestyle changes alone may not be enough to control your cholesterol levels. In that case, you and your healthcare provider can consider medications. The most commonly prescribed class of medicines for lowering cholesterol levels is statins. Other common medicines are (Pappan, 2021): 

• Ezetimibe, which prevents your body from absorbing dietary cholesterol

• Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, which encourage the body to break down LDL particles

To learn more about lowering cholesterol levels, click here.

Having high cholesterol is often a lifelong, progressive condition, but it can be managed and improved. Consuming a heart-healthy diet, making positive lifestyle changes, and taking cholesterol-lowering medication if needed, can all help lower your risk of heart disease due to high lipid levels. Speak with your healthcare provider about when to have your cholesterol levels tested and how to keep them in a healthy range.

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Editorial Guidelines | Medical Review Process

Current version

July 16, 2021

Written by

Ellyn Vohnoutka, BSN, RN

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.