High Cholesterol

Are there different types of cholesterol?

Yes, there are a few different types. If you get a cholesterol test, you might hear your doctor or nurse talk about:

• Total cholesterol
• LDL cholesterol – Some people call this the "bad" cholesterol. That's because having high LDL levels raises your risk of heart attacks, strokes, and other health problems.
• HDL cholesterol – Some people call this the "good" cholesterol. That's because people with high HDL levels tend to have a lower risk of heart attacks, strokes, and other health problems.
• Non-HDL cholesterol – Non-HDL cholesterol is your total cholesterol minus your HDL cholesterol.
• Triglycerides – Triglycerides are not cholesterol. They are another type of fat. But they often get measured when cholesterol is measured. (Having high triglycerides also seems to increase the risk of heart attacks and strokes.)

What should my numbers be?

Ask your doctor or nurse what your numbers should be. Different people need different goals. (If you live outside the United States, see the table (table 1)). In general, people who do not already have heart disease should aim for:

• Total cholesterol below 200
• LDL cholesterol below 130 – or much lower, if they are at risk of heart attacks or strokes
• HDL cholesterol above 60
• Non-HDL cholesterol below 160 – or lower, if they are at risk of heart attacks or strokes
• Triglycerides below 150

Keep in mind, though, that many people who cannot meet these goals still have a low risk of heart attacks and strokes.

What should I do if my doctor tells me I have high cholesterol?

Ask your doctor what your overall risk of heart attacks and strokes is. High cholesterol, by itself, is not always a reason to worry. Having high cholesterol is just one of many things that can increase your risk of heart attacks and strokes. Other factors that increase your risk include:

• Cigarette smoking
• High blood pressure
• Having a parent, sister, or brother who got heart disease at a young age – Young, in this case, means younger than 55 for men and younger than 65 for women.
• A diet that is not heart healthy – A "heart-healthy" diet includes lots of fruits and vegetables, fiber, and healthy fats (like those found in fish and certain oils). It also means limiting sugar and unhealthy fats.
• Older age

If you are at high risk of heart attacks and strokes, having high cholesterol is a problem. On the other hand, if you are at low risk, having high cholesterol might not lead to treatment.

Should I take medicine to lower cholesterol?

Not everyone who has high cholesterol needs medicines. Your doctor or nurse will decide if you need them based on your age, family history, and other health concerns.

You should probably take a cholesterol-lowering medicine called a statin if you:

• Already had a heart attack or stroke
• Have known heart disease
• Have diabetes
• Have a condition called peripheral artery disease, which makes it painful to walk, and happens when the arteries in your legs get clogged with fatty deposits
• Have an abdominal aortic aneurysm, which is a widening of the main artery in the belly

Most people with any of the conditions listed above should take a statin no matter what their cholesterol level is. If your doctor or nurse puts you on a statin, stay on it. The medicine might not make you feel any different. But it can help prevent heart attacks, strokes, and death.

Can I lower my cholesterol without medicines?

Yes, you can lower your cholesterol some by:

• Avoiding red meat, butter, fried foods, cheese, and other foods that have a lot of saturated fat
• Losing weight (if you are overweight)
• Being more active

Even if these steps do little to change your cholesterol, they can improve your health in many ways.

All topics are updated as new evidence becomes available and our peer review process is complete.

Table 1: Cholesterol and triglyceride measurements in the United States and elsewhere

	Measurement used within the United States Milligrams/deciliter (mg/dL)	Measurement used most places outside the United States Millimoles/liter (mmol/Liter)
	Level to aim for	Level to aim for
Total cholesterol	Below 200	Below 5.17
LDL cholesterol	Below 130 – or much lower if at risk of heart attack and stroke	Below 3.36 – or much lower if at risk of heart attack and stroke
HDL cholesterol	Above 60	Above 1.55
Triglycerides	Below 150	Below 1.7

Cholesterol is measured differently in the United States than it is in most other countries. This table shows values used within and outside the United States. It includes the cholesterol and triglyceride levels that most people who do not have heart disease should aim for.