Cholesterol Testing: What Do Your Results Mean?
Interpreting blood test results
Did you receive your cholesterol test results but now you aren’t really sure what they mean?
Heart disease, also called coronary artery disease, leads to 1 in 4 deaths in adults in the U.S., or about 655,000 people each year. Controlling your cholesterol is important to help prevent or treat heart disease, often caused by atherosclerosis (a build-up of fat and cholesterol on the artery walls).
Your doctor may have recommend that you have a lipid profile test (often called a cholesterol test) to help determine if your cholesterol levels (LDL, HDL, and triglycerides) are high. High cholesterol has no symptoms so you need to measure it to determine your risk.
A lipid profile is just one factor your doctor may look at to decide if you need to adjust your lifestyle with diet and exercise or add medications to lower cholesterol. Follow along here to learn about cholesterol test results.
How is cholesterol measured?
The primary way to measure your cholesterol levels is with a blood test from your arm, usually done in a laboratory. This test is frequently performed in adults, it takes only a few minutes, and it's relatively painless.
Your doctor may ask you to fast (not eat food or consume liquids other than water for 9 to 12 hours prior to your blood test) if you are having a complete lipid profile that includes your LDL. If you are only having a total cholesterol test, you do not need to fast. If you are not sure if you should fast, call your doctor or the lab.
Types of cholesterol
Cholesterol is transported through the bloodstream by different particles. The two main types of cholesterol are low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol.
A lipid profile is a measurement of your total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides.
Cholesterol levels for adults
Low-density lipoprotein (LDL): LDL cholesterol is often called "bad" cholesterol because it can stick to the walls of your arteries and block them, preventing adequate flow of blood to your heart or brain. This blockage, known as atherosclerosis, can cause peripheral artery disease, a heart attack, or a stroke.
|LDL Cholesterol||General Meaning|
|< 70 mg/dL (< 1.8 mmol/L)||This level is recommended if heart disease or diabetes is present|
|< 100 mg/dL (< 2.6 mmol/L)||Desired level if at risk of heart disease|
|100 to 129 mg/dL (2.6 to 3.3 mmol/L)||Considered optimal or high based on your heart disease risk|
|130 to 159 mg/dL (3.4 to 4.1 mmol/L)||Considered borderline high to high based on your heart disease risk|
|160 to 189 mg/dL (4.1 to 4.9 mmol/L)||Considered high to very high based on your heart disease risk|
|190 mg/dL or above (>4.9 mmol/L)||Very high risk; lifestyle changes, exercise and medication use recommended.|
Note: Cholesterol levels are measured in milligrams per deciliter (mg/dL) in the US, and in millimoles per liter (mmol/L) in Canada and many European countries. To convert LDL-C values to mmol/L, multiply by 0.0259.
High-density lipoprotein (HDL): Also referred to as "good" cholesterol. Experts think HDL helps to move extra cholesterol from your cells to your liver so it can be removed from the body. Higher levels of HDL are better for your heart, while low levels may actually increase the risk of heart disease.
|HDL Cholesterol||General Meaning|
||Low levels of HDL may increase risk of heart disease|
|60 mg/dL and higher (>1.3 to 1.5 mmol/L)||Best HDL level; may be protective against heart disease|
Total cholesterol: A total measure of your LDL, HDL, and VLDL (very low density lipoprotein). VLDL carries triglycerides.
|Total Cholesterol||General Meaning|
|< 200 mg/dL (< 5.2 mmol/L)||Desirable|
|200 to 239 mg/dL (5.2 to 6.2 mmol/L)||Borderline high risk|
|240 mg/dL and above (> 6.2 mmol/L)||High risk|
Triglycerides: A common type of fat that stores energy for the body. High triglycerides can elevate the risk for heart disease if your HDL is low and LDL is high and increase your risk for pancreatitis, a serious inflammation of the pancreas.
|<150 mg/dL (< 1.7 mmol/L)||Desirable|
|150 to 199 mg/dL (1.7 to 2.2 mmol/L)||Borderline high|
|200 to 499 mg/dL (2.3 to 5.6 mmol/L)||High|
|500 mg/dL and higher (> 5.6 mmol/L)||Very high|
When should I get a cholesterol test?
The experts differ somewhat in their recommendations for cholesterol testing. Check with your doctor for your specific recommendation.
- The American Heart Association (AHA) recommends testing cholesterol levels in adults 20 years or older every four to six years. After age 40, your doctor may also use an equation to determine your risk for heart attack or stroke.
- The U.S. Preventive Services Task Force (USPSTF) recommends periodic lipid screening in adults 40 to 75 years to determine lipid levels (suggested interval of every 5 years but varies based on risk) and a calculation of 10-year CVD event risk (note: new guidelines are in process).
- The National Cholesterol Education Program (NCEP) recommends that adults 20 years and older have a cholesterol test every five years.
People at high risk or with current heart disease, who have a family history of heart disease, or who are taking medications to lower cholesterol should be checked more often.
Do I need to take medications for high cholesterol?
Simply looking at a chart to determine where your cholesterol levels falls can’t fully answer if you need treatment for high cholesterol. Many other factors that must be considered.
Your doctor can explain your levels to you and make recommendations based not only on your cholesterol test results, but also other risk factors you may have such as:
- a history of coronary heart disease
- if you are overweight or obese
- your age
- if you have diabetes
- your ethnic group
- family history or genetics
- your lifestyle, such as diet and exercise habits
- if you smoke.
Your doctor may also calculate your 10-year risk for heart disease to determine your need for medication. Ask your physician if this number has been calculated and how to interpret the results.
How are cholesterol tests results used?
Your doctor will make a treatment recommendation based on your level of heart disease risk. Guidelines do not use a single cholesterol level to determine treatment options.
- If you already have coronary heart disease with symptoms such as chest pain (angina) or a previous heart attack, taking medication to reduce your low density lipoprotein cholesterol (LDL) is very beneficial and possibly life-saving.
- If you have been hospitalized due to heart attack or stroke, you will start treatment before you leave the hospital. The latest 2018 cholesterol guidelines recommend using a high-intensity statin (HMG-CoA reductase inhibitors), such as higher doses of rosuvastatin (Crestor) or atorvastatin (Lipitor) to get cholesterol levels below 70 mg/dL. You will be encouraged to follow a heart-healthy diet, exercise, lose weight and stop smoking, if needed.
- If you do not have a diagnosis of heart disease but your cholesterol levels are high, your doctor will look at your other risk factors, and may determine your 10-year risk of cardiac disease. Usually, lifestyle changes like a healthy diet and exercise are implemented for the first 6 to 12 months. Diet and exercise can drop cholesterol levels by roughly 10 percent.
If cholesterols level do not drop to where they need to be, you may need to add a cholesterol-lowering medication to diet and exercise. In some cases, a low-to-moderate intensity statin, such as fluvastatin (Lescol) or simvastatin (Zocor) can be used for treatment. Your LDL cholesterol levels should drop within 4 to 6 weeks after starting medication, and a blood test will be repeated to monitor levels.
If your heart risk remains unclear your doctor may request a coronary artery calcium (CAC) measurement to provide greater insight into your risk and to help you in decision-making about treatment. This recommendation was included in the 2018 American College of Cardiology (ACC) and American Heart Association (AHA) Guideline on the Management of Blood Cholesterol.
Testing Cholesterol at home
Home cholesterol test kits are available at pharmacies or online and may seem like an easier option than going to the lab to get your blood drawn.
With these tests, only a small finger prick with a lancet is needed. A drop of blood is placed on a test strip and may be inserted in to a meter, and the result is available in a matter of minutes. It is quick and convenient. But is this the best way to test your cholesterol?
Are cholesterol test kits reliable?
The FDA does regulate some cholesterol tests, but not all. Reliability of kits can vary, and your results may not always be accurate. However, if you feel at-home cholesterol testing is preferable, ask your doctor to recommend a reliable kit. FDA approved home tests kits meet standards for accuracy.
Many test kits only provide total cholesterol levels, or information about HDL or triglycerides. Your LDL is not directly measured but can be calculated. You can’t use cholesterol home tests to evaluate your overall heart risk yourself, as many risk factors - such as age, weight, gender, family history, and lifestyle -- are used in this determination and should be performed by a doctor.
How much do cholesterol home tests cost?
Costs are variable and reliable tests can run from $50 to over $150 per kit. If you have insurance, it may be better to have your cholesterol test done at a lab. This will allow your doctor to make recommendations based on a full lipid profile, and in most cases, the costs are covered by your insurance.
You can search on a full list of over-the-counter FDA-approved home cholesterol testing kits here.
- High Cholesterol Overview
- High Cholesterol: What Are Your Risk Factors?
- Your Guide on How to Lower Cholesterol
- US Preventive Services Task Force. Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2016;316(19):1997–2007. Accessed May 24, 2021 at doi:10.1001/jama.2016.15450
- American Heart Association. How To Get Your Cholesterol Tested. Accessed May 24, 2021 at https://www.heart.org/en/health-topics/cholesterol/how-to-get-your-cholesterol-tested
- American College of Cardiology (ACC). Blood cholesterol management recommendations. Accessed March 19, 2019 at http://tools.acc.org/ASCVD-Risk-Estimator-Plus/#!/content/patient-split-layout/patient_cholesterol
- Harvard Health. Cholesterol testing at home: It may be faster, but is it better? Accessed May 21, 2021 at https://www.health.harvard.edu/heart-health/cholesterol-testing-at-home-it-may-be-faster-but-is-it-better
- ASCVD Risk Estimator Plus. American College of Cardiology (ACC). Accessed May 21, 2021 at http://tools.acc.org/ASCVD-Risk-Estimator-Plus/#!/calculate/estimate/
- American Heart Association. Coronary calcium test could help clarify heart disease risk – and control cholesterol. November 13, 2018. Accessed May 24, 2021 at https://www.heart.org/en/news/2018/11/13/coronary-calcium-test-could-help-clarify-heart-disease-risk-and-control-cholesterol
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.