Total cholesterol & HDL ratio guidelines

Updated June 13, 2017

Cholesterol is a naturally-occurring fatty substance that can build up in the arteries of the body and trigger conditions leading to coronary heart disease, heart attack or stroke. However, a certain form of this substance---known as high-density lipoprotein or HDL---works to the body's benefit by eliminating potentially dangerous cholesterol concentrations from the bloodstream. Maintaining low levels of total cholesterol and high levels of HDL is vital to reducing a number of health risks.

Basic Testing Guidelines

If you are over the age of 20, the American Heart Association recommends you undergo complete cholesterol testing at least every 5 years. Children may also be tested if they have known risk factors for the development of future problems. This procedure---called a lipoprotein profile---measures the overall level of cholesterol in your bloodstream, as well as the individual amounts of HDL, LDL (low-density lipoprotein) and another fatty substance called triglyceride. While HDL is commonly known as the "good" cholesterol, LDL and triglyceride are potentially dangerous to your health. In addition to this full cholesterol testing, men over 35 and women over 45 should also get an annual cholesterol check. Typically, this annual test uses measurements of total cholesterol and HDL instead of a full lipoprotein profile.

Benchmark Levels for HDL and Total Cholesterol

In the U.S., cholesterol is measured in milligrams per decilitre of blood, or mg/dl. The optimal amount of total cholesterol in your bloodstream is 200 mg/dl or less. Your total cholesterol is considered borderline high if it is between 200 and 239 mg/dl. It is considered dangerously high if it is 240 mg/dl or higher. An HDL level of 60 mg/dl or greater is believed to provide increased protection against the development of heart disease. Lowered levels of HDL are acknowledged as a major added risk factor for heart disease. If you are a woman, your HDL is considered low if it is below 50 mg/dl. If you are a man, your HDL is low if it is below 40 mg/dL.

Determining the Need for Further Action

When you receive a full lipoprotein profile, your total cholesterol and HDL levels are assessed along with your LDL and triglyceride levels to determine your overall heart disease risk. When only your total cholesterol and HDL levels are checked, these numbers are used to determine whether further testing is needed. If your total cholesterol is above 200 mg/dl, or you have low HDL levels for your gender, your doctor will consider you to be potentially at risk, and will ask you to undergo a full lipoprotein profile. Depending on the results of this profile, you may need to make changes to your diet and lifestyle in order to control or lower your "bad" cholesterol and triglycerides and raise your level of HDL. Consult your doctor for a complete explanation of cholesterol testing procedures and results.

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About the Author

M. Gideon Hoyle is a writer living outside of Houston. Previously, he produced brochures and a wide variety of other materials for a nonprofit educational foundation. He now specializes in topics related to health, exercise and nutrition, publishing for various websites.