Cholesterol readings are expressed in milligrams per deciliter of blood (mg/dL), and the numbers are classi?ed by level of health risk. Your reading can change somewhat from day to day, and the classi?cations are based on ranges. Of course, being in a high range doesn’t guarantee that you will develop heart disease, nor does being in a low range assure that you will not. The impact of your cholesterol readings on your over- all risk for heart disease or stroke depends on other factors, including your family history, conditions such as diabetes or high blood pressure, and other health habits such as smoking or physical inactivity.

Total Cholesterol Level

The total cholesterol level is the most common screening measurement. About half the adults in the United States have a reading in the desirable range of 200 mg/dL or less, indicating a lower risk of developing heart disease. Even if you are at this level, it’s still a good idea to eat foods that are relatively low in saturated fats and trans fats, and to exercise regu- larly. Continue to get a full lipoprotein pro?le every 5 years.
The total needs to be interpreted, along with how the cholesterol is packaged in the bloodstream. A total level of 200 to 239 mg/dL is called borderline high and places you at up to two times the risk of heart attack

The total needs to be interpreted, along with how the cholesterol is packaged in the bloodstream. A total level of 200 to 239 mg/dL is called borderline high and places you at up to two times the risk of heart attack as someone with a reading below 200 mg/dL. Your
doctor will discuss this reading and the rest of your pro?le with you, as well as other factors that con- tribute to your risk. Some people, such as menstru- ating women before menopause or young, active men, may have an elevated total cholesterol reading but may not be at high risk for heart disease. The reason is that although the total cholesterol is ele- vated, it is the HDL, or good cholesterol, that is ele- vated, and LDL, the bad cholesterol, is within target range. Talk to your doctor to interpret your results.

If your total cholesterol is above 240 mg/dL, you are more than twice as likely to have a heart attack as someone with a borderline high reading. You are also at a higher risk of stroke. Again, you need to dis- cuss your overall pro?le with your doctor and get started trying to bring your level down to a healthy target.

HDL Level

HDL is the good cholesterol that, at higher levels, appears to reduce your risk of heart disease. People with a low level of HDL are at increased risk for heart disease. In the average man, HDL levels range from 40 to 50 mg/dL. In an average woman, they are higher, 50 to 60 mg/dL, because the female hormone estrogen raises HDL. After menopause, a woman’s HDL levels may fall, increasing her risk of heart disease. For a man or a woman, a reading below 40 mg/dL is considered too low. People who are overweight or physically inactive are more likely to have a low HDL reading.
If your reading is low, your doctor may recommend that you get more exercise, lose weight if you are overweight or obese, and quit smoking if you are a smoker. Although treatment for high
cholesterol usually focuses on lowering LDL

cholesterol, doctors are placing increasing emphasis on the importance of raising HDL as well. A key strategy for raising your HDL choles- terol levels is eating more ?sh and less red meat. Further, consuming omega-3 fish oil reduces triglycerides and raises HDL.
The ratio of total cholesterol to HDL is a more meaningful indicator of risk than is total

HDL Guidelines

HDL Level (mg/dL) Category

Less than 40 Low
40 to 59 Desirable; the higher the better
60 and above High

cholesterol alone. This is especially true because a normal total choles- terol number (less than 200 mg/dL) may pose increased risk if it is asso- ciated with a low HDL level. To calculate that ratio, divide your total cholesterol by your HDL value. A number greater than 5 shows a higher risk level. The lower your ratio is, the lower your risk of heart disease is. Try to keep your ratio lower than 4 to 1.

LDL Levels

LDL is the harmful cholesterol that can slowly build up plaque in the arteries. Of your lipid readings, it is the single most important indicator of your risk of cardiovascular disease. A reading of less than

100 mg/dL is considered optimal, but not everyone needs to be that low if their other risk factors are under control.
You and your doctor will talk about your target LDL reading level in the context of other aspects of your cardiovascular health and other risk factors. Medical conditions that increase your risk include high blood pressure (120/80 mm Hg or higher) or being on med- ication for high blood pressure, other vascular disease, type 2 diabetes (fasting blood glucose of

•126 mg/dL or higher), or having had a heart attack. Other risk factors are:
• Smoking cigarettes or long-term exposure to second-hand smoke
• An HDL reading of less than 40 mg/dL

• A family history of early heart disease (heart disease in your father or brother before age 55 or in your mother or sister before age 65)
• Age (45 years or older if you are a man; 55 years or older or menopausal if you are a woman)
• Menopause, at any age
• A sedentary lifestyle

To lower your LDL reading, a diet low in saturated fat, trans fat, and cholesterol and high in ?ber is your ?rst step (see below and pages
30–32). You also need to lose weight if you are overweight, and get more exercise. If your level of LDL is high, however, drug therapy may be started while you work on lifestyle changes. Lifestyle measures will go a long way to improve your LDL level and condition your heart and blood vessels. But if they do not bring your reading down to your tar- get, your doctor may prescribe medication (see box page 244). A com- bination of cholesterol-lowering drugs and lifestyle changes will bring LDL levels down in most people.

Triglycerides

A high triglyceride level may contribute to your risk of developing heart disease, but it is not clear to what degree high triglycerides alone are a risk factor. Doctors do know, however, that a combination of high LDL level and high triglyceride level raises the risk of a heart attack to a greater extent than either one does on its own. People with high triglycerides are often obese or have low levels of HDL, high blood pressure, or diabetes. Extremely high triglyc-
erides (more than 500 mg/dL) can lead to a life threatening in?ammation of the pancreas called pancreatitis.
If you have an elevated triglyceride reading, you will benefit from staying at a healthful weight, eating a diet low in saturated fat and trans fat, limiting intake of sugar and other car- bohydrates, drinking in moderation if at all (see page 97), and exercising regularly. You should also have a fasting blood sugar test to monitor for early signs of diabetes. Elevated triglycerides can be a sign of meta- bolic syndrome, also called insulin resistance syndrome.