What Do Your Cholesterol Test Results Mean?

Nearly 93 million adults in the U.S. have high or borderline-high cholesterol levels. So cholesterol tests, or lipid panels, are recommended for most adults and children. But understanding all of those letters and numbers in the results can be a challenge. Here we’ll break down cholesterol test results and what they might mean for your health.

What is cholesterol?

Cholesterol is fat in the blood. The body needs cholesterol for cells and organs to function. But there are good and bad kinds of cholesterol. Bad cholesterol can block blood vessels over time. That can lead to heart attacks and strokes. So a cholesterol test can help you know if you are at increased risk for cardiovascular disease.

What do the different parts of a cholesterol test mean?

The standard cholesterol test measures three things: HDL, LDL, and triglycerides. You’ll see these numbers reported as mg/dL.

Your results may also show “total cholesterol.” This is the sum of HDL and LDL cholesterol. But this number is less meaningful. The amount and the balance between them is what matters.

LDL cholesterol

LDL (low-density lipoprotein) is the “bad” cholesterol that can form plaques in blood vessels. This is what leads to the blockages that cause heart attacks and strokes. These blockages don’t happen all at once. They build up over time if your LDL is high.

Your healthcare provider will discuss your LDL goal based on your medical conditions and risk factors. But, for most people, here’s how to interpret your LDL cholesterol numbers:

• Good: less than 100 

• Near optimal: 100 to 129 

• Borderline high: 130 to 159 

• High: 160 to 189 

• Very high: 190 or more

HDL cholesterol

HDL (high-density lipoprotein) is your “good” cholesterol because it helps your body get rid of other types of fats that can cause plaques in the blood vessels. So, in the case of HDL, a higher number is better.

The recommended levels for HDL are:

• More than 45 for those 19 or younger

• More than 40 for men 20 and older

• More than 50 for women 20 and older

This is why your total cholesterol count is less important. Someone could have a high total cholesterol because they have a high HDL cholesterol (and normal LDL). So it’s the ratio that is more important.

Triglycerides

Triglycerides aren’t technically a form of cholesterol. They are a type of fat in the blood. Triglycerides increase when someone eats extra calories or has certain health conditions, like diabetes. 

Over time, high triglycerides can also lead to cardiovascular disease. And very high triglycerides can lead to pancreatitis, or a painful, swollen pancreas.

Here’s what your triglycerides numbers mean:

• Normal: Less than 150

• Borderline: 150 to 199

• High: 200 to 499 

• Very high: 500 or more

Does fasting affect your cholesterol test results?

Many times, providers recommend that people not eat for 8 to 12 hours before a cholesterol test. But researchers have looked into this. And it turns out that fasting — or not fasting — has minimal to no impact on your results. 

The one exception is triglycerides, which might be slightly higher if you eat right before your test. So, if your number is high, your provider may recommend that you repeat the test when you are fasting.

What happens if your cholesterol levels are high?

If you have a high cholesterol level, the next step is to talk to your provider about your results. They will help you understand what your numbers mean in terms of risk for cardiovascular disease. They will also talk about what you can do to lower your cholesterol numbers — and lower your risk of heart disease. 

Lifestyle changes

For cholesterol, a healthy lifestyle will lower LDL and triglycerides and raise HDL. These changes also help reduce other risk factors, like blood pressure and diabetes. Here are some helpful tips:

• Eat more fruits, vegetables, whole grains, lean protein, and healthy fats.

• Limit saturated fat, processed foods, and sugar.

• Stay active with exercise that you enjoy.

• Don’t smoke.

• Maintain a healthy weight.

• Get enough sleep.

• Find people and activities that help you manage stress.

• Limit how much alcohol you drink.

Medications

For some people, even those who are doing their best with a healthy lifestyle, it’s hard to meet cholesterol goals. This usually comes from your genes. The best way to manage this is with a combination of a healthy lifestyle and medication. Statins are often prescribed to improve cholesterol levels.

There are also some medications that make it harder to control lipid levels. Talk with your provider to review the medications and supplements you take if managing your cholesterol has been a challenge.

How often do you need a cholesterol test?

Health experts recommend that children get a cholesterol test:

• At least once between the ages of 9 and 11

• Again between ages 17 and 21

• More often if they have excess weight or diabetes

Adults need a cholesterol test:

• Every 4 to 6 years if they are young and healthy

• Every 1 to 2 years after age 45 

• Once a year after age 65

• More often if they have risk factors for cardiovascular disease

• More often if they receive treatment for high lipid levels or cardiovascular disease

Why trust our experts?

Written by:

Anne Jacobson, MD, MPH

Anne Jacobson, MD, MPH has been a board-certified family physician since 1999. She worked as a full-scope family physician (inpatient, outpatient, obstetrics, and office procedures) in the Cook County Ambulatory Health Network for 15 years.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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