What do my cholesterol numbers (lipids) mean?

Of all the potential lab work that could be performed as a screening tool for certain ailments, the only one universally recommended for otherwise healthy individuals is cholesterol screening.

The most aggressive recommendation for cholesterol screening comes from National Cholesterol Education Program (NCEP III) guidelines, recommending lipid screening every 5 years for all persons over the age of 20.

According to the United States Preventive Services Task Force (USPSTF) statement in 2001, routine screening for cholesterol should begin at age 35 regardless of health, after age 20 if any risk factors for heart disease exist.

I tend to follow the NCEP III guidelines for a couple reasons: 1) a disturbing percentage of people are overweight and/or relatively inactive, 2) many people are not aware of their family history (e.g. whether or not their parents have high cholesterol), 3) abnormal numbers give me something better to stand on to encourage lifestyle changes, and 4) I want to emphasize the importance of knowing these numbers and doing something about them.

Below is a brief summary of the normal ranges of each component of a typical “lipid profile”, what behaviors tend to make them abnormal, and what you can do to improve them.

Total Cholesterol [normal < 200 mg/dL]

  • not as important as the ratio of total cholesterol/HDL

LDL [ normal < 130 mg/dL for normal-risk individuals]

  • the “bad” cholesterol
  • increased by poor diet, inactivity
  • lowered by dietary changes (esp. eating oatmeal) and physical activity
  • medication: statins

HDL [normal > 39 mg/dL]

  • the “good” cholesterol
  • lowered by inactivity, poor diet
  • elevated by regular physical activity – the more intense, the higher the HDL
  • elevated by alcohol intake (but, only beneficial in moderation; beyond that, it’s other effects negate the benefit of HDL-raising
  • medication: niacin, some effect from statins

Triglycerides [normal < 150 mg/dL]

  • “fatty acids”
  • increased by poor diet
  • lowered by diet, exercise
  • medication: fibrates, statins

TC/HDL ratio [normal < 5.0]

  • increased by a) low HDL or b) high total cholesterol
  • see above under individual components
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