A Guide to Total Cholesterol

Total cholesterol represents the combined amount of "bad" cholesterol (low-density, or LDL), "good" cholesterol (high-density lipoprotein, or HDL) in your blood, and 20% of the triglyceride level. The measurement is then compared to your individual HDL result to gauge your risk for heart disease and stroke.

This comparison is telling because it reveals whether LDL, which is the one that can build up in your arteries and cause blockages, is or is not the predominant cholesterol type in your body.

What Are Lipoproteins?

The HDL and LDL lipoproteins are tiny “packages” in your blood, with fat (lipid) on the inside and proteins on the outside, that carry cholesterol throughout your body. You will often see them called the good cholesterol and the bad cholesterol.

High-Density Lipoprotein (HDL)

HDL is called the good cholesterol because it helps usher cholesterol out of your arteries.

You hear a lot about keeping your cholesterol low. But in the case of the HDL component of total cholesterol, a high (but not too high) level is good.

The problem is, it can be hard to keep your HDL levels high. That’s because it’s often hard to control lifestyle factors that can lower it, including type 2 diabetes, being overweight, not getting enough exercise, and smoking. Genetic factors can also play a role.

Low-Density Lipoprotein (LDL)

This “bad boy” of the cholesterol family needs to be kept at the lowest level you and your healthcare provider can achieve.

Although statin medications can help, your diet matters.

LDL cholesterol goes up if your diet is high in saturated and “trans” fat, also called trans-fatty acid. (This is the manufactured fat used to increase food products’ shelf life and flavor stability.)

Triglycerides

Triglyceride is the most common type of fat in your body. It’s not cholesterol. But it’s measured because elevated triglyceride levels increase your risk of developing atherosclerosis—a buildup of fatty plaques on artery walls—and increased risk of heart disease and stroke.

How Total Cholesterol Is Measured

This is done using a blood test called a lipoprotein panel, which also measures your triglycerides. 

Why You Should Be Tested

Keeping total cholesterol levels within a healthy range is important for people of all ages, whether they have heart disease or not. If like many people, you have high blood cholesterol and don’t know it, the only way you can find out is by having your blood tested.

By itself, high blood cholesterol doesn’t cause symptoms. That’s why, if you’re age 20 years or older, you should have your cholesterol tested at least every five years.

Understanding Results

Test results for total cholesterol are expressed in milligrams per deciliter (mg/dL) of blood and ranked desirable, borderline high, or high.

Your total cholesterol level reflects your risk for heart disease. In general, the higher the level, the higher your risk. Why does the test also measure the lipoproteins in your total cholesterol as well as your triglycerides?

• LDL (“bad”) cholesterol is the main “engine” of cholesterol buildup and blockage in your arteries.
• HDL (“good”) cholesterol helps prevent heart disease by removing cholesterol from your arteries and sending it to your liver for elimination. 
• Triglyceride is another form of fat in your blood that can increase your heart disease risk.

If your total cholesterol is too high, your healthcare provider may recommend lifestyle changes and/or medications to lower it.

Cholesterol Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Download PDF

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