Equating Cholesterol Levels with Risk of Heart Disease

By James M. Rippe

Analysis of a large body of research has informed general cholesterol guidelines that are widely used by physicians and medical research scientists in detecting, evaluating, and treating cholesterol problems.

Here are some general guidelines for interpreting what your cholesterol measurements indicate about your risk of developing heart disease or of experiencing increased complications if you already have it:

  • “Desirable” cholesterol level 200 mg/dL and lower. If you don’t already have existing CHD, a total cholesterol level below 200 mg/dL is considered a desirable blood cholesterol. But please remember that within a broad range of values, lower is better. Thus, a cholesterol level of 170 mg/dL is better than a cholesterol level of 190 mg/dL.

  • Borderline high blood cholesterol 200 mg/dL to 239 mg/dL. If your cholesterol is within this range, your physician will strongly recommend lifestyle modifications and perhaps medication depending on your current practices and risk factors.

  • High blood cholesterol level 240 mg/dL or greater. This classification puts you at high risk. Your physician typically will work closely with you to establish an aggressive treatment program that will likely include lifestyle changes and medication.

In recent years, extensive research, particularly clinical trials, has identified LDL cholesterol as perhaps the lipid of most concern in the development of atherosclerosis. As a result, lowering LDL has also become a primary target for preventing atherosclerosis in the first place and controlling (or even reversing) the process after it results in CHD and other manifestations of heart disease.

In fact, new guidelines from the American Heart Association and American College of Cardiology recommend (in addition to lifestyle therapies) more aggressive treatment with statin medications of certain groups of people:

  • Optimal LDL Cholesterol Level 100 mg/dL and lower. If your LDL cholesterol levels are optimal and you have no other risk factors for heart disease (such as high blood pressure, diabetes, or overweight), most physicians will recommend using lifestyle measures that keep your LDL as low as possible. It’s never too early to pay attention to these bad actors.

  • At Risk LDL Cholesterol Levels 100 mg/dL and above. Although a LDL of 100 to 129 mg/dL has been consider just above optimal, new treatment guidelines urge physicians to begin targeting LDL more aggressively, using lifestyle measures and appropriate statin or other medication. So be sure to talk to your doctor about what is right for you. Certainly, LDL levels above 130 mg/dL need lowering.

  • Low HDL Cholesterol Levels 40 mg/dL and lower. A low HDL cholesterol level also is considered an independent risk factor for heart disease, over and above total cholesterol and LDL levels. Individuals whose HDL is below 40 mg/dL should take steps to raise it, usually to close to 60 mg/dL.

  • Triglycerides. If your triglycerides are below 129 mg/dL, they’re considered to be optimal or near optimal. This recommended classification, may be much lower than you are aware. It takes into account the associations between triglycerides and other lipid and nonlipid risk factors. In addition to increasing your risk of CHD, very high levels of triglycerides may also injure the pancreas, a vital organ that is responsible for producing insulin in the body.