The four numbers and what they mean
1. Total Cholesterol — the headline number
Total cholesterol is the sum of all cholesterol types in your blood. Below 200 mg/dL is desirable. But total cholesterol alone is a poor predictor of heart risk — a person with high HDL (protective) may have a high total cholesterol but low actual risk. Always look at the individual components.
2. LDL — the number that matters most
LDL (Low-Density Lipoprotein) is the primary driver of atherosclerosis. It deposits in artery walls. The lower your LDL, the lower your heart attack risk. For healthy adults: below 100 mg/dL is optimal. For people with diabetes, high blood pressure or previous heart attack: aim below 70 mg/dL. Statins primarily work by lowering LDL.
3. HDL — higher is better
HDL (High-Density Lipoprotein) is the only cholesterol you want HIGH. It removes excess cholesterol from artery walls. Men need above 40 mg/dL, women above 50 mg/dL. Above 60 mg/dL is protective against heart disease. Raised by: exercise, weight loss, quitting smoking, moderate alcohol (in those who already drink), and niacin supplements.
4. Triglycerides — the sugar-fat connection
Triglycerides are fats stored from excess calories — especially from sugar, refined carbs and alcohol. Normal is below 150 mg/dL. Above 500 mg/dL is dangerous (pancreatitis risk). The best way to lower triglycerides is to cut sugar and refined carbohydrates — more effective than cutting fat.
The ratio that matters: Total Cholesterol ÷ HDL
| Ratio | Risk Level |
|---|---|
| Below 3.5 | Low risk |
| 3.5 – 5.0 | Moderate risk |
| Above 5.0 | High risk |
How often should you check cholesterol?
- Adults 20–39 with no risk factors: every 4–6 years
- Adults 40+ or with diabetes/hypertension/obesity: every 1–2 years
- People on statins: every 3–6 months until stable, then yearly
- Anyone with a family history of early heart disease: start screening at age 20
Foods that lower LDL cholesterol
- Oats and oat bran — soluble fibre binds cholesterol
- Beans and lentils — soluble fibre + plant protein replaces meat
- Nuts (walnuts, almonds) — unsaturated fats lower LDL
- Fatty fish — omega-3 lowers triglycerides
- Fruits rich in pectin — apples, citrus, strawberries
- Olive oil — replaces saturated fats in cooking