Cholesterol & Heart Health
What does high total cholesterol mean?
The short answer
Total cholesterol is the combined amount of cholesterol in your blood, including LDL ('bad') and HDL ('good') cholesterol. US guidelines call below 200 mg/dL desirable, 200 to 239 mg/dL borderline high and 240 mg/dL or above high. A high result usually means more LDL in circulation and a higher long-term risk of heart attack and stroke.
What Total cholesterol measures
Cholesterol is a fatty substance carried in your blood inside particles called lipoproteins. Total cholesterol adds up all of it (CDC): LDL, which can build up in artery walls, HDL, which carries cholesterol back to the liver, and the cholesterol in VLDL, the particles that also carry triglycerides.
High cholesterol usually has no symptoms, so a blood test is the way to know your level. High LDL can lead to plaque build-up in the arteries and raise the risk of heart disease and stroke (CDC). On its own, total cholesterol does not give a complete picture of risk (testing.com), which is why your report also shows HDL, LDL and the ratios built from them.
Total cholesterol ranges
These bands come from the National Cholesterol Education Program's ATP III guideline (NIH), also used by MedlinePlus and testing.com; the optimal figure is from the CDC.
| Result | Range |
|---|---|
| Optimal (CDC) | About 150 mg/dL |
| Desirable | Below 200 mg/dL |
| Borderline high | 200 to 239 mg/dL |
| High | 240 mg/dL or above |
| Healthy, age 19 or younger (MedlinePlus) | Below 170 mg/dL |
These figures are for adults unless stated. Your own target depends on your overall risk of heart disease, judged from your LDL, HDL, blood pressure, smoking, diabetes and family history. Reference ranges vary between laboratories, and the range printed on your own report takes priority. Ranges vary between laboratories, and the range printed on your own report takes priority.
What a high total cholesterol result means
A high total cholesterol usually means more LDL is in circulation, and LDL is the part that builds up in artery walls. The risk builds over years, so one high reading is a reason to look at the full lipid profile, not a cause for alarm.
A high HDL can also raise the total, which carries a different meaning. Doctors read the breakdown and combine it with your age, blood pressure, smoking and family history to estimate your 10-year risk of heart disease (ATP III).
Common causes
- A diet high in saturated and trans fats
- Too little physical activity
- Overweight or obesity
- Type 2 diabetes
- A family history of high cholesterol, including inherited familial hypercholesterolaemia
- Alcohol, which can raise total cholesterol
- Pregnancy, acute illness and some medicines, such as corticosteroids and anabolic steroids
What a low total cholesterol result means
A low total cholesterol is usually good news for heart risk, and people on cholesterol-lowering medicine often have low results by design. An unusually low level without treatment is less common and is most often tied to an underlying health condition or malnutrition (testing.com). If yours is well below the range on your report, mention it to your doctor.
What moves Total cholesterol
Nutrition
Limit saturated fat, trans fat and added sugars, and eat foods naturally high in fibre, plus unsaturated fats from vegetable oils, nuts and avocados (CDC). The ATP III lifestyle diet keeps saturated fat below 7% of calories and adds 10 to 25 g of soluble fibre a day.
Training
Aim for 150 minutes of moderate-intensity exercise a week, the US Surgeon General's recommendation (CDC). ATP III pairs more activity with weight management as core lifestyle treatment for raised cholesterol.
Sleep and stress
MedlinePlus lists stress among the factors that affect cholesterol, because it can raise hormones such as corticosteroids. Poor sleep and high stress also make the food and activity changes harder to keep up.
Habits
If you smoke, quitting lowers your heart disease risk (CDC). Keep alcohol to no more than two drinks a day for men and one for women (CDC), since alcohol can raise total cholesterol (MedlinePlus).
How fast Total cholesterol can change
Total cholesterol responds to sustained change over weeks to months. For people without heart disease, ATP III gives lifestyle change about 3 months before doctors consider adding medicine, so a Day 90 re-test is a meaningful checkpoint. Compare like with like: a high-fat meal, alcohol in the previous 24 hours or an acute illness can each skew a lipid result (testing.com), so take both tests under the same conditions.
Before your test
- Some labs ask for a 9 to 12 hour fast (MedlinePlus). Triglycerides are the value most affected by recent food (testing.com), so fasting matters less for total cholesterol itself. Follow your lab's instructions and keep them the same for each test.
- Avoid alcohol for 24 hours and a high-fat meal before the test, and test when you are well, as acute illness can skew results (testing.com).
- Pregnancy raises total cholesterol, and some medicines shift lipid results (testing.com). Never stop a medicine to change a result; tell your doctor what you take.
When to speak to your doctor
Speak to your doctor about a result above the range on your report, and sooner if heart disease or high cholesterol runs in your family. A total cholesterol of 240 mg/dL or above is in the high band, and an LDL of 190 mg/dL or above on the same report, which ATP III classes as very high, needs prompt review. High cholesterol is not an emergency in itself, but chest pain, sudden weakness on one side, a drooping face or slurred speech are: call emergency services straight away.
On the Wolfburgh panel
Total Cholesterol is one of the 17 markers on the Wolfburgh blood panel. Your sample is collected at home with RedDrop One, an FDA-cleared collection device, and a licensed physician reviews every panel before your care team sees it.
The Nutritionist works on saturated fat and fibre, the Trainer on activity and the Behaviour Specialist on the habits behind both, while the Partner Physician reads total cholesterol alongside HDL, LDL, triglycerides, VLDL and the cholesterol ratios on the same report. Members re-test at Day 90 to see how the whole profile has moved. Members re-test at Day 90, backed by the 90-Day Results Guarantee.
Common questions about Total cholesterol
What is a healthy total cholesterol level?
Under the US ATP III guideline, total cholesterol below 200 mg/dL is desirable, 200 to 239 mg/dL is borderline high and 240 mg/dL or above is high. The CDC describes about 150 mg/dL as optimal. Your own target depends on your overall heart risk, and the range printed on your lab report takes priority.
How can I lower my total cholesterol naturally?
Limit saturated fat, trans fat and added sugars, and eat more fibre-rich foods and unsaturated fats from vegetable oils, nuts and avocados. Aim for 150 minutes of moderate exercise a week, keep to a healthy weight, quit smoking and keep alcohol to two drinks a day or fewer for men and one for women, as the CDC advises. Re-test after about 3 months.
Do I need to fast before a cholesterol test?
It depends on the lab. testing.com says fasting is not required but is often recommended, and MedlinePlus says you may need to fast for 9 to 12 hours. Triglycerides are the value most affected by recent food, so fasting matters less for total cholesterol itself. Whatever you do, keep it the same for each test so results compare fairly.
Is total cholesterol or LDL more important?
LDL and HDL tell you more. Total cholesterol adds together LDL, HDL and VLDL cholesterol, so a high total can come from high LDL, which raises heart risk, or from high HDL, which means something different. Doctors judge risk from the breakdown, the ratios and factors such as blood pressure, smoking and family history.
Sources
- MedlinePlus (NIH). Cholesterol Levels
- CDC. About Cholesterol
- CDC. Preventing High Cholesterol
- National Heart, Lung, and Blood Institute (NIH). ATP III Guidelines At-A-Glance Quick Desk Reference
- testing.com. Cholesterol test
- testing.com. Lipid Panel
This page is general information, not medical advice, and it does not replace a consultation with your own doctor. Never start, stop or change a medicine or supplement because of something you read here.
All 17 markers on the Wolfburgh panel
Cholesterol & Heart Health
- Total Cholesterol
- HDL Cholesterol
- LDL Cholesterol
- Triglycerides
- VLDL CholesterolCalculated
- LDL to HDL RatioCalculated
- Triglyceride to HDL RatioCalculated
- Total Cholesterol to HDL RatioCalculated
Blood Sugar
Inflammation
Iron
Liver Function
Proteins
Vitamins & Hormones
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