Lab results explained
High LDL cholesterol: what it means
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Short answer: High LDL cholesterol means more of the cholesterol that builds up in artery walls is circulating in your blood. Under 100 mg/dL (2.6 mmol/L) is optimal, 160 to 189 mg/dL (4.1 to 4.8 mmol/L) is high and 190 mg/dL (4.9 mmol/L) or more is very high. What it means depends on your overall heart risk.
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Typical adult range
Your lab may print a slightly different range. Use the one on your report when there is one.
| Test | Men | Women |
|---|---|---|
| LDL cholesterol ('bad') | Optimal: under 100 mg/dL Near optimal: 100–130 mg/dL Borderline high: 130–160 mg/dL High: 160–190 mg/dL Very high: 190 or more mg/dL | |
| Total cholesterol | Desirable: under 200 mg/dL Borderline high: 200–240 mg/dL High: 240 or more mg/dL | |
| HDL cholesterol ('good') | Low (higher is better): under 40 mg/dL Acceptable: 40–60 mg/dL Good (protective): 60 or more mg/dL | Low (higher is better): under 50 mg/dL Acceptable: 50–60 mg/dL Good (protective): 60 or more mg/dL |
| Non-HDL cholesterol | Desirable: under 130 mg/dL Above desirable: 130–160 mg/dL Borderline high: 160–190 mg/dL High: 190 or more mg/dL | |
What LDL measures
LDL (low-density lipoprotein) carries cholesterol through the blood. It is called 'bad' cholesterol because, over many years, extra LDL builds up in artery walls as plaque, which narrows arteries and raises the risk of heart attack and stroke. A lipid profile also shows total cholesterol, HDL ('good' cholesterol), triglycerides and often non-HDL cholesterol, which is total cholesterol minus HDL. US and Indian labs use mg/dL; the UK and many other countries use mmol/L. Divide mg/dL by 38.7 to convert. High LDL causes no symptoms, which is why testing matters.
Common causes
Diet and weight play a part, but genes have a large effect on LDL. Some people eat well and still have high LDL, while others eat poorly and have normal levels. A very high LDL, 190 mg/dL or more, especially with a family history of early heart disease, can point to familial hypercholesterolaemia, an inherited condition that is worth diagnosing because family members may also be affected.
- Diets high in saturated fat, such as ghee, butter, fatty meat, fried snacks and baked goods
- Inherited high cholesterol (familial hypercholesterolaemia)
- Excess weight and low physical activity
- An underactive thyroid, kidney disease or some medicines
How doctors judge your heart risk
An LDL number is read alongside your whole risk picture. Doctors consider your age, sex, blood pressure, smoking, diabetes, kidney health, family history and HDL. Many use a risk calculator to estimate your chance of a heart attack or stroke in the next 10 years. People of South Asian origin tend to have higher heart risk at the same cholesterol levels, and guidelines count this as a risk-enhancing factor. Someone who has already had a heart attack or stroke, or who has diabetes, will usually have a lower LDL target than someone at low risk.
What usually happens next
Your doctor may repeat the test, check your thyroid, blood sugar and kidney function, and work out your heart risk. Lifestyle steps come first for most people: eating less saturated fat, more fibre from oats, beans, lentils, vegetables and fruit, staying active, keeping a healthy weight and not smoking. These can lower LDL by a modest amount. If your risk is high or your LDL is very high, your doctor may suggest a cholesterol-lowering medicine such as a statin. Lipids are usually rechecked a few months after any change.
When to get help the same day
High LDL on its own does not cause symptoms and is not an emergency. Call your local emergency number straight away for chest pain or pressure, pain spreading to the arm, jaw or back, sudden breathlessness, or signs of stroke such as face drooping, arm weakness or slurred speech.
Questions to ask your doctor
- What is my 10-year risk of heart attack or stroke?
- What LDL level should I aim for, given my health?
- Could I have inherited high cholesterol, and should my family be tested?
- Would lifestyle changes be enough, or do I need medicine?
- When should I repeat my lipid profile?
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Frequently asked questions
Is an LDL of 130 mg/dL high?
An LDL of 130 mg/dL (3.4 mmol/L) is borderline high. For a healthy person at low risk, lifestyle changes are usually the first step. For someone with diabetes, heart disease or several risk factors, a doctor may aim for a lower level and could suggest medicine.
Do I need to fast for a cholesterol test?
Often not. Non-fasting tests are widely accepted for LDL and total cholesterol. If your triglycerides come back high, your doctor may ask for a repeat after fasting for 9 to 12 hours, because a recent meal mainly affects triglycerides and the calculated LDL.
Can thin people have high LDL?
Yes. Genes have a strong effect on LDL, so people of normal weight who eat well can still have high levels. This is one reason adults are advised to have their cholesterol checked even if they feel healthy and are not overweight.
How quickly can LDL come down?
Diet changes can lower LDL within a few weeks, though the drop is usually modest. When doctors prescribe a statin, most of the effect is seen within about 4 to 6 weeks, which is why lipids are often rechecked around 6 to 12 weeks after starting.
Sources
This page explains what results usually mean. It isn't a diagnosis or medical advice; your doctor interprets results with your symptoms, history and medicines. Medical disclaimer
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