How to Read Cholesterol Test Results: The Cut-Points

A cholesterol test, also called a lipid panel, measures your LDL level, HDL level, total cholesterol and triglyceride level, which are usually measured in milligrams per deciliter (mg/dL) of blood. For men and women age 20 or older, the MedlinePlus medical test page on cholesterol levels lists healthy levels of total cholesterol less than 200 mg/dL and LDL less than 100 mg/dL, and says an HDL of 60 mg/dL or higher is best. The MedlinePlus triglycerides test page lists a healthy triglyceride level in adults of less than 150 mg/dL. In general, low LDL levels and high HDL cholesterol levels are good for heart health.

What does each line on the report measure?

A cholesterol test is a blood test that measures the amount of cholesterol and triglycerides in your blood. Lipid profile is another name for the test. There are two main types of cholesterol: LDL, or "bad" cholesterol, and HDL, or "good" cholesterol.

LDL cholesterol is the main source of blockages in the arteries. HDL cholesterol helps get rid of LDL cholesterol. Total cholesterol is a measure of the total amount of cholesterol in your blood, and it includes HDL and LDL cholesterol. Triglycerides are a type of fat found in your blood.

A lipoprotein panel may also provide your non-HDL cholesterol. It is total cholesterol minus HDL cholesterol, as the NHLBI page on diagnosing high blood cholesterol defines it. That page gives remnant LDL as total cholesterol minus LDL and HDL cholesterol.

VLDL (very low-density lipoprotein) mainly carries triglycerides. It isn't usually included in routine cholesterol tests because it's difficult to measure. A lab can use your triglycerides level to estimate your VLDL level.

The LDL on your results may say "calculated." That means the LDL level is an estimate based on your total cholesterol, HDL and triglycerides. LDL may also be measured "directly" from your blood sample. Either way, you want your LDL number to be low.

What are the cut-points for each number?

The table sets out the healthy levels and triglyceride categories from the two pages named in its caption. For adults age 20 or older, HDL levels less than 40 mg/dL in men and less than 50 mg/dL in women are considered low. A healthy cholesterol level for you may depend on your age, family history, lifestyle and other risk factors for heart disease. Your provider can explain what's right for you.

The diagnosis page cited above states a goal for a healthy lipid profile. The goal is non-HDL levels below 130 mg/dL with an HDL of at least 40 mg/dL for men and 50 mg/dL for women.

The triglycerides test page gives four categories for adults: healthy, borderline high, high and very high. High blood triglyceride levels usually don't cause any symptoms, so routine testing is important. Very high triglyceride levels increase your risk of sudden pancreatitis.

How do the numbers on one report fit together?

The list below works through one example lipid panel for an adult. Its four values are made-up example inputs, invented only to show the arithmetic, and they are not anyone's results: total cholesterol 212, LDL 131, HDL 48 and triglycerides 165, all in mg/dL.

1. Total cholesterol, 212. The adult healthy level is less than 200. 212 is not less than 200, and 212 − 200 = 12.
2. LDL, 131. The adult healthy level is less than 100. 131 is not less than 100, and 131 − 100 = 31.
3. HDL, 48. 60 or higher is best, and 60 − 48 = 12. 48 is not less than 40, so it is not in the range considered low for men. 48 is less than 50, so it is in the range considered low for women.
4. Triglycerides, 165. 165 falls between 150 and 199, the range the table lists as borderline high.
5. Non-HDL. Total cholesterol minus HDL cholesterol: 212 − 48 = 164. The adult healthy level is less than 130. 164 is not less than 130, and 164 − 130 = 34.

Why can your LDL goal differ from the table?

The MedlinePlus encyclopedia page on cholesterol testing and results says your LDL goal is based on your risk for heart disease and whether you have health conditions that increase your risk. It lists three goals: under 100 mg/dL if you are at borderline or moderate risk and do not have diabetes or heart disease, under 70 mg/dL if you are at high risk, have diabetes or have other risk factors, and under 55 mg/dL if you have had a heart attack or stroke.

The same page gives a normal VLDL level of less than 30 mg/dL and says a total cholesterol of less than 200 mg/dL is considered best. It says the ideal values for all cholesterol results depend on whether you already have heart disease, diabetes or other risk factors. Your provider can tell you what your goal should be.

This site's page High Blood Cholesterol - What You Need to Know is marked "Reproduced as archived reference, not current guidance." Its description carries the line "Newly revised in 2005!" and the words "Find out what your cholesterol numbers mean." The description also says the publication "includes a tool to estimate the risk for having a heart attack."

Does fasting change the results?

The cholesterol test page says you may need to fast, meaning not eat or drink, for 9 to 12 hours before the test, and that this is why the tests are often done in the morning. The diagnosis page says a provider may ask you to fast for 8 to 12 hours. Your provider will let you know if you need to fast.

When you eat and drink, your bloodstream absorbs sugar, fat, protein and other nutrients. These nutrients can change the levels of various substances in your blood and affect the accuracy of your test results, according to MedlinePlus: Fasting for a Blood Test. That page lists cholesterol levels tests (lipid panel) among its examples of common blood tests that usually require fasting. It also says you should not fast if your provider doesn't tell you to do so.

Fasting means you should not eat or drink anything, except plain water, for several hours before your test. Juice, coffee, soda and other beverages can get in your bloodstream and affect your results. While fasting you should also not chew gum, smoke or exercise.

Ask your provider whether it's okay to take your usual prescription and over-the-counter medicines, and don't stop taking your medicines unless your provider tells you to stop. If you eat or drink before your test, tell your provider. You may need to reschedule the test for another time when you can fast.

What does the 10-year risk estimate add?

Your provider may use a risk calculator to estimate your cardiovascular risk score. Risk scores indicate the chances of having a heart attack, having a stroke, or dying from heart disease in the next 10 years or more, as the NHLBI page on diagnosing coronary heart disease explains. That page says understanding your risk will help you and your provider decide on healthy lifestyle changes, and possibly medicines, to help prevent coronary heart disease.

A risk score uses data from many people who have similar risk factors. A 10-year risk score of 15% means that, on average, 15 out of 100 people in that risk category will have a heart problem within 10 years. Even if a risk calculator says your risk score is high, it does not mean that something bad will happen.

One calculator described on that page uses your cholesterol levels, age, sex, race and blood pressure. It also considers whether you smoke or take medicines to manage your high blood pressure or blood cholesterol, and it is for people between ages 20 and 79 who have not had a heart problem. Another tool on that page is for adults between ages 30 and 79.

The page says there are several different risk calculators, and no single risk calculator is right for everyone. Risk assessments should be repeated every four to six years in adults who do not have heart disease.

This site's 10-year CVD Risk Calculator page says it "reproduces the ATP III (2001) Framingham point tables as they were published." It says the risk factors included in the Framingham calculation are age, total cholesterol, HDL cholesterol, systolic blood pressure, treatment for hypertension, and cigarette smoking. The page also carries the quick desk reference issued with the ATP III guidelines, which it says is reproduced "from an archived 2011 copy."

This site's page Your Guide to Lowering Cholesterol With Therapeutic Lifestyle Changes (TLC) is also marked "Reproduced as archived reference, not current guidance." Its description says the guide includes "helpful lists and charts, sample menus, a 10-year coronary heart disease risk calculator, and many tips for success."

How often is the test repeated, and when should you call 911?

Your provider may order a cholesterol test as part of a routine exam. The general recommendations on the cholesterol test page are every 5 years for younger adults, every 1 to 2 years for men ages 45 to 65 and women ages 55 to 65, and every year for people older than 65. For people age 19 or younger, the first test should be between ages 9 and 11, and children should have the test again every 5 years.

You may be able to use an at-home kit to check your cholesterol levels. Tell your provider if your at-home test shows that your total cholesterol level is higher than 200 mg/dL.

Any time you think you might be having a heart attack, don't ignore it. Call 911 for emergency medical care, even if you are not sure that you're having a heart attack, as the NHLBI heart attack symptoms page instructs.

The cholesterol test page lists eating a healthy diet among the actions you can take to lower your LDL levels: reduce or avoid foods high in saturated fat and cholesterol to help lower the cholesterol levels in your blood. On this site, a page from the 2007 National Cholesterol Education Month Kit, Questions and Answers About the New Food Label, says saturated fat, trans fat, and cholesterol in the diet all raise the level of LDL "bad" cholesterol in the blood. See also the cholesterol topic page.