Medical Guidelines And Recommendations
In 2015, the United States Department of Agriculture Dietary Guidelines Advisory Committee recommended that Americans eat as little dietary cholesterol as possible, because most foods that are rich in cholesterol are also high in saturated fat and thereby may increase the risk of cardiovascular disease. For over 2 decades, the Dietary Guidelines for Americans recommended that dietary cholesterol be no more than 300 mg per day. In a 2014 draft, DGAC dropped this recommendation because evidence showed no appreciable relationship between dietary and serum cholesterol. This caught the eye of the Physicians Committee for Responsible Medicine , which sued DGAC due to concerns of conflicts of interest which prompted the final draft to recommend eating “as little dietary cholesterol as possible”. A 2013 report by the American Heart Association and the American College of Cardiology recommended to instead focus on healthy dietary patterns rather than cholesterol limits as they are hard for clinicians and consumers to implement. They recommend the DASH and Mediterranean diet, which are low in cholesterol. A 2017 review by the American Heart Association recommends switching saturated fats for polyunsaturated fats to reduce cardiovascular disease risk.
| > 6.2 | High risk |
Why Age Is A Factor
The recommended ranges for your cholesterol will vary based on age and gender. As people get older, cholesterol levels rise naturally. For example, people who have gone through menopause may have higher LDL and lower HDL cholesterol levels.
The American Academy of Pediatrics recommends that children’s cholesterol levels be checked between ages 9 and 11.
However, children with certain risk factors, such as those whose parents or grandparents have had heart attacks or been diagnosed with blocked arteries at age 55 or earlier in males or 65 or earlier in females, should be tested for cholesterol between ages 2 and 10.
What Is Bad Cholesterol
Cholesterol moves in the body combined with proteins. This combination of cholesterol and proteins is called lipoproteins. The low-density lipoprotein or LDL cholesterol is called bad cholesterol. High levels of this cholesterol increase risk for heart diseases and stroke.
When you have high levels of LDL cholesterol in the body, the LDL cholesterol can accumulate on the walls of the blood vessels forming a plaque. The continuous cholesterol build-up or a plaque narrows the inside of the blood vessels with time. The narrowed blood vessel hampers the blood supply to the concerned organ. Thus, when the plaque is present in the heart, it can cause angina or a heart attack. Plaque build-up in the brain can cause a stroke.
Another type of cholesterol is HDL cholesterol. It is also called good cholesterol as it absorbs cholesterol and carries it back to the liver. The liver then removes the cholesterol from the body. HDL cholesterol, thus, can lower your risk for heart diseases and stroke.
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What Do Your Cholesterol Results Mean
When you have a cholesterol test, it is really important that your healthcare professional explains the results to you to prevent unnecessary worry and confusion.
Its not just your total cholesterol thats important and your results will include different types of cholesterol. If you are only given your total cholesterol, ask for a break-down of the other numbers. Its possible to have a healthy total cholesterol number but an unhealthy balance of the different types of cholesterol.
As a minimum, you should be given your total cholesterol and HDL numbers, then you can work out your ratio of total cholesterol to HDL cholesterol .
You might also have your triglycerides tested, these are another type of blood fat which are linked to heart disease.
Ask for a print out of your results if you are not able to speak to your GP, nurse or pharmacist.
Your results should include:
- Total cholesterol
This is sometimes written as ‘serum cholesterol’ or ‘TC’ and refers to your overall level of cholesterol.
- Non-HDL cholesterol
Your non-HDL cholesterol is your total cholesterol minus your HDL cholesterol. Its all the ‘bad’ cholesterol added together, including your LDL cholesterol. Ideally it should be as low as possible.
- HDL cholesterol
- TC:HDL ratio
You might be given a TC:HDL ratio, which is the ratio of HDL compared to the total cholesterol. If not, you can work it out from your HDL and total cholesterol numbers. This should be as low as possible. Above 6 is considered high.
Your Test Results: A Preview
Your test results will show your cholesterol levels in milligrams per deciliter of blood . Your total cholesterol and HDL cholesterol are among numerous factors your doctor can use to predict your lifetime or 10-year risk for a heart attack or stroke. Your doctor will also consider other risk factors, such as age, family history, smoking status, diabetes and high blood pressure.
Lipid profile or lipid panel is a blood test that will give you results for your HDL cholesterol, LDL cholesterol, triglycerides and total blood cholesterol.
Watch an animation about cholesterol score.
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Low Hdl Cholesterol Levels
HDL cholesterol levels are inversely correlated with the risk of developing atherosclerosis. HDL particles are involved in the process of reverse cholesterol transport, the only means by which cholesterol in peripheral tissues can be transported to the liver for metabolism and excretion from the body. Low HDL cholesterol levels are a risk factor for the development of atherosclerosis. High HDL cholesterol levels have been designated a negative risk factor . It is more difficult to raise HDL cholesterol levels than lower LDL cholesterol levels with nonpharmacological intervention. Common approaches are increased exercise, cessation of smoking, weight loss, and moderate alcohol intake. The magnitude of each intervention varies between individuals.
Neil J. Stone, in, 2009
If Cholesterol Is Necessary Why Do We Have To Worry About How Much We Have
Having enough cholesterol to meet your needs is important. Having too much cholesterol can cause problems. If your cholesterol levels are high, the condition is called hypercholesterolemia. If your cholesterol levels are low, the condition is called hypocholesterolemia. It is not common to have cholesterol levels that are too low, but it can happen.
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What Are Good Levels For The Hdl Cholesterol
A cholesterol test or lipid panel tells the level of HDL cholesterol. What do the numbers mean?
- HDL cholesterol levels greater than 60 milligrams per deciliter are high. That’s good.
- HDL cholesterol levels less than 40 mg/dL are low. That’s not so good.
In general, people with high HDL are at lower risk for heart disease. People with low HDL are at higher risk.
Does Age Make A Difference To Recommended Cholesterol Levels
No, recommended cholesterol levels do not change based on age. It was once thought that high cholesterol becomes less of a problem as one ages. However, there is now good evidence that lowering high cholesterol is of benefit even in the elderly.
Previously, there was also concern that some cholesterol-lowering drugs like statins may interfere with ones cognitive function and that this might be more of an issue in the elderly. This has now been debunked. Nevertheless, it is worth starting with a low dose and gradually increasing to avoid any potential side effects.
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What Causes High Hdl Cholesterol
There are a number of possible causes for high HDL cholesterol, and some of these can be reversed. If you have high HDL cholesterol, your doctor should consider whats causing it to decide on a course of action.
What you eat and drink
Eating a diet high in saturated fats and drinking too much alcohol can contribute to a higher level of HDL. If you and your doctor discuss making lifestyle changes, you will need to keep these going for an agreed time period, such as three months, before checking your HDL cholesterol levels again to see if the changes are working.
Medication
Some medicines could raise your HDL levels, including:
- the oral contraceptive pill
- oestrogen replacement therapy
- anti convulsants.
Your genes
Your doctor should ask you questions about your family to understand if your high HDL could be inherited.
If members of your family, including your parents, grandparents and siblings, have lived for a long time, this is reassuring. If you have a family history of heart disease or strokes, your doctor may want to refer you to a lipid specialist.
Japanese ancestry
Some people with Japanese ancestry have high HDL levels due to a lack of a protein called CETP. This is inherited in the genes.
Menopause
Research has suggested that the changes in hormones that happen during the menopause can affect the way HDL works in the body, and HDL loses some of its protective effects in some women.
Hypothyroidism
Infections and inflammation
Bile Acid Sequestrating Agents
These impede the reabsorption of bile acids from the terminal ileum thereby increasing the hepatic requirement for cholesterol as a precursor for the synthesis of bile acids to replenish the enterohepatic pool . The increased hepatic cholesterol requirement is partially met by increased LDL receptor expression thereby lowering circulating LDL. Even at doses insufficient to lower LDL to the extent that can be achieved by statin therapy, they are poorly tolerated, but they can decrease CVD risk . Unfortunately, they are not available in most European countries.
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How Is An Hdl Cholesterol Test Different From A Low
An HDL cholesterol test and LDL cholesterol test measure different types of cholesterol. The two types of cholesterol are transported in the blood in distinct kinds of particles.
In common descriptions, HDL cholesterol is known as good cholesterol while LDL cholesterol is bad cholesterol. The amount of HDL cholesterol compared to LDL cholesterol can be an important consideration in cardiovascular health.
Measuring HDL cholesterol is more straightforward than measuring LDL cholesterol. For this reason, levels of LDL cholesterol are most often calculated using a formula based on levels of total cholesterol, HDL cholesterol, and triglycerides. In some situations, though, a doctor may prescribe a direct LDL test.
How Do Triglycerides Get Into The Blood
When we eat foods containing triglycerides, such as meat, dairy products, cooking oils and fats, they are absorbed by our intestines and packaged into parcels of fats and protein called chylomicrons . These carry the triglycerides in the blood stream to our tissues to be used for energy straight away, or stored for later.
The body also makes its own supply of triglycerides in the liver. This form is carried in a different type of lipoprotein known as VLDL cholesterol.
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How Can I Lower My Cholesterol
There are two main ways to lower your cholesterol:
- Heart-healthy lifestyle changes, which include:
- Heart-healthy eating. A heart-healthy eating plan limits the amount of saturated and trans fats that you eat. Examples include the Therapeutic Lifestyle Changes diet and the DASH Eating Plan.
- Weight Management. If you are overweight, losing weight can help lower your LDL cholesterol.
- Physical Activity. Everyone should get regular physical activity .
- Managing stress. Research has shown that chronic stress can sometimes raise your LDL cholesterol and lower your HDL cholesterol.
- Quitting smoking.Quitting smoking can raise your HDL cholesterol. Since HDL helps to remove LDL cholesterol from your arteries, having more HDL can help to lower your LDL cholesterol.
- Drug Treatment. If lifestyle changes alone do not lower your cholesterol enough, you may also need to take medicines. There are several types of cholesterol medicines available, including statins. The medicines work in different ways and can have different side effects. Talk to your health care provider about which one is right for you. While you are taking medicines to lower your cholesterol, you should continue with the lifestyle changes.
NIH: National Heart, Lung, and Blood Institute
When Should You Contact Your Healthcare Provider About Your Cholesterol Levels
In truth, your healthcare provider will probably talk to you about your numbers first. As always, contact your provider if you have any new or worsening pain or other uncomfortable feelings. Make sure you know what medications you take and what they are expected to do. Call the provider if you have a reaction to the medicine.
Before you go to the office, and after you have had a cholesterol test, it helps to have a list of questions prepared about your test results and any proposed treatment.
A note from Cleveland Clinic
When considering cholesterol numbers, its important to remember that you really have the ability to make those numbers go in your favor. What you choose to eat, how much you are able to move and how you deal with lifes ups and downs are things that you can influence.
Last reviewed by a Cleveland Clinic medical professional on 07/31/2020.
References
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Testing Your Blood Cholesterol
Your serum cholesterol is measured with a simple blood test. A doctor draws blood from your arm enough to fill one or more little vials. The blood samples are sent to a lab for analysis. Before your blood draw youll need to fast for at least eight hours.
A healthy adult should have a blood test that includes a serum cholesterol check every four to six years. As you get older, your doctor may advise you to have your cholesterol, and other markers of health like your blood pressure, checked every year. This is especially true if you have risk factors for cardiovascular disease. These factors include:
- obesity
- smoking
- family history of heart disease
If you start a new medication or change medications meant to manage your cholesterol, youll probably have more frequent cholesterol checks. Serum cholesterol tests can show whether the medication is working.
It usually takes several days or even a few weeks to get your blood test results back. Your lab report will show your serum cholesterol levels in milligrams per deciliter . Your serum cholesterol includes:
- LDL level
- HDL level
- 20 percent of your triglyceride level
The lower the LDL level and the higher the HDL level, the better. LDL is the type of cholesterol that forms waxy plaque on the inside wall of an artery. Too much plaque can limit blood flow through that artery.
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Heres what you should look for in your results:
| healthy serum cholesterol |
Are Home Cholesterol Testing Kits Accurate
The answer is yes if the tests are labeled CDC-certified. This means that the contents have been approved by the Cholesterol Reference Method Laboratory Network, a group that works with test makers, laboratories and the Centers for Disease Control and Prevention to make sure tests are accurate.
For home tests, you will still need to fast for 12 hours and to obtain blood for testing. Some kits come with packages for mailing to a lab for results. Other kits have a monitor so you can get the results at home. The cost of such home kits vary.
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How Is The Total Cholesterol Or Blood Cholesterol Test Done
A blood test is a routine test. A phlebotomist is a person whose job is to draw blood. Blood is usually drawn from the vein in your arm. You will sit down and the phlebotomist will wrap a rubber band around your upper arm so that the vein in your elbow sticks out. Then they will use a needle to puncture the vein and remove blood. The blood is sent to the lab to be examined.
Youve probably been at health fairs where testing is offered. In that case, the person performing the test takes a drop of blood from your finger. The finger-stick test uses a small blade to poke a hole in the tip of your finger to get the blood.
What Can I Do If My Hdl Cholesterol Level Is Low
If your HDL is low, you can take several steps to boost your HDL level and reduce your heart disease risk:
- Exercise. Aerobic exercise for 30 to 60 minutes on most days of the week can help pump up HDL.
- Quit smoking. Tobacco smoke lowers HDL, and quitting can increase HDL levels.
- Keep a healthy weight. Besides improving HDL levels, avoiding obesity reduces risk for heart disease and multiple other health conditions.
In certain cases, your doctor may recommend medication to improve your cholesterol level. Remember that multiple factors besides cholesterol contribute to heart disease. Diabetes, smoking, high blood pressure, obesity, and genetics are all important as well.
Because so many factors contribute to heart disease, cholesterol isn’t everything. People with normal HDL cholesterol can have heart disease. And people with low HDL levels can have healthy hearts. Overall, though, people who have low HDL cholesterol will have greater risk of developing heart disease than people with high HDL levels.
Experts recommend follow-up cholesterol testing every five years for most people. People with abnormal lipid panels, or who have other risk factors, may need more frequent cholesterol tests.
If you have high cholesterol or low HDL levels, take steps to increase HDL cholesterol such as eating right, exercising regularly, and not smoking. Lifestyle changes can make a big difference for most people and may prevent heart disease and stroke.
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What Are Recommended Cholesterol Levels By Age
Lipids are the by-products of common fat we eat. Lipids are classified as triglycerides , diglycerides , and steroids. Cholesterol is a steroid helping in the formation of cell membranes and hormones. Further, this cholesterol is classified as Low-Density Lipoprotein or LDL, and High-Density Lipoprotein or HDL also called good cholesterol. VLDL is another type of cholesterol secreted by the liver into your bloodstream. VLDL stands for Very-Low Density Lipoprotein. Lipoproteins are formed partly by proteins and partly fat. All three types of lipoproteins vary in the proportion that is made of cholesterol, protein, and triglycerides. VLDL has more of triglycerides, LDL more of cholesterol, and HDL more of protein. That is the reason, LDL and VLDL are together known as the bad cholesterol, they both have a significant role in the formation of plaque. Now, plaque is a thick solid sticky mass made of fat, cholesterol, calcium, and other similar substances that get deposited in the arterial lumen interrupting the blood flow.
All in all, both types of bad cholesterol adversely affects your heart health either by getting deposited in the lumen of your arteries or under your skin and in the liver. If the lumen is completely choked, the organ may not get any blood supply. The plaque may burst and move to smaller arteries blocking them completely.
According to the American Heart Association, the following are the age-wise recommended cholesterol levels:
| Triglycerides |