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Cholesterol Testing: What Do Your Results Mean?

Medically reviewed by L. Anderson, PharmD Last updated on Mar 18, 2019.

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 3 deaths in adults in the U.S. Controlling your cholesterol is important to help prevent or treat heart disease (atherosclerosis). 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 any 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

LDL

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.

HDL

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
  • Men: < 40 mg/dL (< 1 mmol/L)
  • Women: < 50 mg/dL ( <1.3 mmol/L)
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

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

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.

Triglycerides General Meaning
<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?

In general, if you are over 40 years old and do not have heart disease or high cholesterol levels, your doctor will probably recommend a test every five years. The experts differ somewhat in their recommendations for testing.

  • The American Heart Association (AHA) recommends testing cholesterol levels in adults 20 years or older every four to six years.
  • The U.S. Preventive Services Task Force (USPSTF) recommends lipid screening in adults 40 to 75 years to determine lipid levels and for a calculation of 10-year CVD event risk.
  • 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.

Overview of Drugs Used to Treat High Cholesterol

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 help in decision-making. This recommendation was included in the 2018 American College of Cardiology (ACC) and American Heart Association (AHA) Guideline on the Management of Blood Cholesterol.

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Cholesterol Guidelines

There are recent expert guidelines on how to prevent and treat heart disease in patients, but each one differs somewhat.

ACC/AHA Guideline on the Management of Blood Cholesterol, 2018

The latest guideline, published in 2018 from the American Heart Association (AHA) and American College of Cardiology (ACC), makes recommendations for both secondary prevention in people who already have heart disease, and for primary prevention in people who have not yet developed heart disease. Patients who have heart disease usually have already experienced an event such as such as chest pain, a heart attack or a stroke.

If you have current heart disease, you will typically be started on cholesterol-lowering medications, such as a statin, right away. These new guidelines promote more aggressive therapy for certain high-risk patients, as well as a patient-centered approach that addresses a more healthy lifestyle. In some high-risk patients, combination treatment with a statin and another lipid-lowering medication, such as ezetimibe (Zetia) or a PCSK-9 inhibitor such as  evolocumab (Repatha) or alirocumab (Praluent) may be suggested. Treatment is always made on a case-by-case basis in conjunction with your doctor.

PCSK-9 Inhibitors: A New Option in Cholesterol Treatment

Recommendations will be based not only from your lipid panel results, but also from risk factors such as presence of coronary heart disease, age, weight, diabetes status, genetics, and if you smoke. The good news is that many of these risk factors can be addressed with diet, exercise and medications.

Based on your risk level for heart disease, your doctor may suggest lifestyle changes for 6 to 12 months to help lower your cholesterol levels in primary prevention. If your levels do not reach the level needed after this time frame, you may need medication in addition to your healthy diet and exercise. Weight loss may be a goal for you, too, and if you smoke, you should quit. Talk to your doctor about proven methods to help you quit smoking.

High- or moderate-intensity statin treatment may be used based on your LDL levels with or without calculating your 10-year risk for heart disease. A coronary artery calcium (CAC) measurement may be used to better define your risk for heart disease.

Calculate your 10-year risk of heart disease for primary prevention (if you do not currently have heart disease). Be sure you discuss these results with your doctor.

USPSTF Statin Guidelines, 2016

The U.S. Preventive Services Task Force (USPSTF) guidelines “Statin Use for the Primary Prevention of Cardiovascular Disease (CVD) in Adults: Preventive Medication” were last published in 2016. These guidelines only address primary prevention.

The USPSTF recommends use of low- to moderate-intensity statins in adults age 40 to 75 years without a history of cardiovascular disease and who have one or more risk factors, such as high lipid levels, diabetes, high blood pressure, or smoking. However, in addition to risk factors, the USPSTF also recommends patients have calculated 10-year CVD risk of 7.5% to 10% or greater. With the lower CVD, clinicians may selectively offer treatment.

In older patients, the evidence is lacking to determine benefit or risks for statin treatment in patients 76 years and over with no history of CVD.

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.

See Also

Sources

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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