What is a good LDL cholesterol level for your age?

LDL levels by age at a glance

The CDC explains that high levels of LDL cholesterol can lead to plaque build-up in your arteries and result in heart disease or stroke. US guidance uses different cut points for young people and adults:

• Children and teenagers (19 and under): below 110 mg/dL acceptable, 110 to 129 mg/dL borderline, 130 mg/dL or above abnormal (2018 AHA/ACC guideline). MedlinePlus gives below 110 mg/dL as healthy for anyone 19 or younger.
• Young adults 20 to 24: below 120 mg/dL acceptable, 120 to 159 mg/dL borderline high, 160 mg/dL or above high (NHLBI expert panel for paediatric care providers).
• Adults 20 and over: below 100 mg/dL optimal, 100 to 129 mg/dL near or above optimal, 130 to 159 mg/dL borderline high, 160 to 189 mg/dL high, 190 mg/dL or above very high (NHLBI ATP III). MedlinePlus gives below 100 mg/dL as healthy for men and women 20 and over.

The young adult cut points are higher because they reflect the 95th percentile for people aged 20 to 24, rather than the combined adult data behind ATP III. The NHLBI panel provides them for paediatric providers caring for this age group.

Why your target depends on risk, not age alone

Age changes your LDL goal mainly because it changes your overall risk. In the NHLBI ATP III guideline, age is one of the major risk factors that modify LDL goals, alongside cigarette smoking, high blood pressure, low HDL cholesterol and a family history of early heart disease. Age counts from 45 in men and from 55 in women. ATP III treats diabetes as equivalent to having heart disease.

ATP III then sets the LDL goal by risk category:

• Heart disease or an equivalent risk, such as diabetes: below 100 mg/dL.
• Two or more risk factors: below 130 mg/dL.
• None or one risk factor: below 160 mg/dL.

So two 50-year-olds with the same LDL of 140 mg/dL can be in very different places. The newer 2018 AHA/ACC guideline builds decisions around a clinician and patient discussion of your overall risk, but the principle is the same. The CDC says your health care team looks at your cholesterol numbers along with your family history, age, sex and other factors, and MedlinePlus notes that the numbers best for you may depend on your age, race, blood pressure, weight and family history.

Children and teenagers

The CDC says children should have their cholesterol checked at least once between ages 9 and 11, and again between 17 and 21. Children with obesity or diabetes may need checks more often, and MedlinePlus notes that some children are tested from age 2 if there is a family history of high cholesterol.

Cholesterol moves with growth. The NHLBI expert panel explains that after age 2, levels are fairly stable until adolescence. During puberty, total and LDL cholesterol fall, then rise again in the late teens and again in the twenties. A borderline result in a young teenager is best read with that in mind.

For children, teenagers and young adults, the 2018 AHA/ACC guideline puts the priority on lifetime risk and on lifestyle. It says drug treatment is needed only in selected young people with moderately high LDL of 160 mg/dL or more, or very high LDL of 190 mg/dL or more.

Young adults, 20 to 39

For people in their twenties and thirties, the 2018 AHA/ACC guideline recommends an assessment of lifetime risk to guide the conversation with your clinician, with the emphasis on intensive lifestyle efforts. That makes LDL at this age more about where you are heading than where you are.

Two findings change the picture. An LDL of 160 to 189 mg/dL, or a family history of early heart disease (a male relative before 55 or a female relative before 65), is a risk-enhancing factor in the 2018 guideline. An LDL of 190 mg/dL or more counts as severe primary hypercholesterolaemia, and for that group the guideline does not wait for a 10-year risk calculation.

The CDC says most healthy adults should have their cholesterol checked every 4 to 6 years.

Adults 40 to 75

From 40, the 2018 AHA/ACC guideline uses a clinician and patient risk discussion built around your calculated 10-year risk of heart attack or stroke. It describes 5% to 7.5% as borderline risk and 7.5% to 19.9% as intermediate risk, and treats 20% or more as the highest band. The same LDL means different things in each band.

Risk-enhancing factors can push a borderline or intermediate result upwards. Besides LDL of 160 to 189 mg/dL and family history, the guideline lists metabolic syndrome, chronic kidney disease, a history of preeclampsia or menopause before 40, chronic inflammatory conditions such as rheumatoid arthritis or psoriasis, South Asian ancestry and triglycerides that stay at 175 mg/dL or more. Adults 40 to 75 with diabetes are handled as a separate higher-risk group.

Testing often becomes more frequent with age. MedlinePlus advises men aged 45 to 65 and women aged 55 to 65 to have cholesterol tested every 1 to 2 years.

Adults over 75

For people over 75, the 2018 AHA/ACC guideline notes that trial evidence for statin therapy is not strong, so decisions rest on a careful assessment of risk status and a discussion with your clinician. MedlinePlus advises yearly cholesterol tests for adults over 65.

When to speak to a doctor

Speak to your doctor about any LDL result in the high or very high range, any result of 130 mg/dL or more in a child or teenager, or a family history of early heart disease or very high cholesterol. Your doctor will set your own target from your full risk picture. The 2018 guideline says screening can use fasting or non-fasting lipid tests, so follow the instructions you are given and keep them the same for each test.