What your cholesterol numbers mean

You get your cholesterol checked at your annual physical, and a few days later, you get back your results. If you’ve ever looked down the list of acronyms and felt at a loss of how to make sense of what you’re looking at, you’re not alone. Most lab reports list several numbers, and it’s not always obvious which ones matter most.

Simply put, not all cholesterol is bad, and the total number on its own doesn’t tell you the whole story.

Cholesterol numbers are a way to estimate your risk of a heart attack. Of everything on your chart, LDL cholesterol is the most important one to watch. This is considered your “bad cholesterol” because high levels are linked to plaque buildup in your arteries, which increases your risk for heart attack and stroke. For most people, an LDL under 100 is ideal. If you have heart disease or diabetes, your doctor may want it even lower. If your LDL is above 130, that’s when treatment usually becomes part of the conversation.

HDL cholesterol is protective. This is the “good cholesterol” that helps remove LDL from your bloodstream. Higher is better here. For men, you want HDL above 40, and for women, above 50. However, a strong HDL number doesn’t give you a free pass to partake in an all-you-can-eat steak and butter diet. Your HDL score doesn’t tell your whole health story – only a piece of it.

Triglycerides are a separate type of fat in your blood. They’re influenced heavily by what you eat and drink, especially sugar and alcohol. Normal is under 150, while levels above 200 start to become concerning. High triglycerides can increase cardiovascular risk and may also be a clue that your metabolism needs attention. Triglycerides over 500 can cause pancreatitis, a serious and painful condition.

Total cholesterol is the sum of LDL, HDL, and a portion of your triglycerides. This is a broad summary number, and it’s the least useful on its own. For example, you can have a high total cholesterol because your HDL is high, which is actually a good thing. That’s why doctors focus more on the individual components.

When it comes to your cholesterol levels, genetics play a big role. Some people eat well and exercise regularly and still have high cholesterol because their liver produces too much. Others can get away with a less-than-perfect diet and have normal numbers. Diet, weight, physical activity and smoking all matter, but they’re not the whole picture.

If it’s determined your cholesterol needs treatment, your doctor will consider your age, blood pressure, smoking status, diabetes and family history of heart disease, in addition to your cholesterol levels. Two people with the same LDL might get different recommendations based on their overall risk. Lifestyle changes are always the first step – replacing saturated fats (butter, fatty red meat, full fat dairy) with unsaturated fats (olive oil, nuts, seeds, avocado, fish), cutting down on refined carbs and added sugars, exercising more, and losing weight if needed. If that’s not enough, statins and other medications can bring your numbers down and reduce your risk.

If you take away one thing, it’s that LDL and HDL are the numbers that matter most. If your LDL is high or your HDL is low, talk to your doctor about what you can do. Cholesterol is one of the most treatable risk factors for heart disease, but only if you know where you stand.