During your annual wellness exam, your doctor may order a series of bloodwork to help gather more insight into your overall health. A lipid panel, or an evaluation of your cholesterol levels, is a routine screening test commonly included in this series of blood work and can help your doctor assess your risk of cardiovascular disease. Based on that risk assessment, your doctor may recommend specific lifestyle changes or medication to reduce your risk.
However, lipid panel results can often be confusing and are easily misunderstood.
So, we sat down with Ashesh Parikh, D.O., a cardiologist and physician on the medical staff at Texas Health Plano and Presbyterian Heart and Vascular Group, a Texas Health Physicians Group practice, to go over what exactly cholesterol is, how it can give a good perspective on cardiovascular health, what the numbers mean and why it’s important to have an open dialogue with your physician.
What is Cholesterol?
Cholesterol is a waxy, fat-like substance that is found in all cells in the body. While it tends to get a bad rap, it is essential for building cells and making hormones, vitamin D, and substances that help digest food. The body makes all the cholesterol it needs, but it can also be found in foods from animal sources, such as egg yolks, meat, and cheese.
However, when blood cholesterol levels become abnormal, your risk for a cardiovascular event or peripheral vascular disease increases. The most common cardiovascular issue stemming from high cholesterol is atherosclerosis, or a hardening of the arteries. It is a chronic, progressive disease in which plaques build up in the walls of the arteries. These plaques can eventually rupture, interrupting blood flow to vital organs such as the heart and brain, causing heart attacks and strokes.
To make sure your cardiovascular risk is as low as possible, you and your doctor will need to work together to optimize your cholesterol levels. Ordering a lipid panel can help give your health care provider the insight they need to help inform your treatment plan.
Understanding the Different Parts of Your Lipid Panel
Below is some common verbiage you may see on your lipid panel. Learn about each test and what low, optimal, and high results signify.
- Total Cholesterol
Optimal: 120-199 mg/dL
Borderline high: 200-239 mg/dL
High: ≥ 240 mg/dL
“Total cholesterol is an equation that measures your healthy cholesterol (HDL), bad cholesterol (LDL), and 20% of triglycerides level,” Parikh explains.
Having the right amount of total cholesterol in your blood usually means it's not causing big problems for your heart health. But we can't just look at total cholesterol alone. We also need to check LDL cholesterol and HDL cholesterol.
Even if your total cholesterol is good, having too much LDL or too little HDL can still mean you have a higher risk of heart problems. And if your total cholesterol is borderline, having a lot of HDL cholesterol can help reduce the risk.
Borderline High or High Results
When your total cholesterol is in the high or borderline high range, it's typically seen as a significant factor that increases your chances of heart problems. If your total cholesterol is on the higher side, your healthcare provider will likely talk to you about improving your diet, getting more exercise, managing your weight, and quitting smoking to lower your overall heart disease risk. Depending on your other cholesterol numbers and any other risk factors you have, your doctor might also suggest medications to lower your cholesterol.
In rare situations, someone's total cholesterol might be high because their HDL cholesterol (the good kind) is so high that it pushes the total cholesterol into the high range. In these cases, having a high total cholesterol usually isn't seen as a risk factor for heart issues.
Optimal: < 150 mg/dL
Borderline high: 150 –199 mg/dL
High:200 –499 mg/dL
Very high: ≥ 500 mg/dL
Parikh notes that in addition to being a type of “bad” cholesterol, triglycerides are one of the most common types of fat in the body due to the fact that it is usually acquired by diet. Any excess calories you consume (whether in the form of fat or carbohydrates) are converted to triglycerides and stored in your fatty tissues. This is why triglyceride levels commonly increase following a meal. This is the main reason why your doctor may require a 12-hour fast before a lipid panel is obtained.
Elevated triglyceride blood levels are associated with an elevated risk of cardiovascular disease.
Triglyceride levels in the optimal or acceptable range do not increase your cardiovascular risk.
There is no well-defined “low range” for triglyceride levels, and most doctors believe the lower the better. On occasion, extremely low triglyceride levels can be seen in people with severe hyperthyroidism or malabsorption (the inability to absorb nutrients from the intestines), but these instances are rare, and the underlying illness is almost always dramatic enough to make the diagnosis fairly obvious.
Borderline High, High, or Very High Results
Elevated triglyceride levels are associated with an increase in cardiovascular risk.
Sometimes, certain medical conditions like hypothyroidism, kidney issues, being pregnant, or taking certain medications can make your triglycerides go up.
When triglyceride levels are extremely high, it can be because of genetic factors that affect how your body handles fats. Besides the higher risk of heart issues, very high triglycerides can also lead to a serious type of pancreatitis. In these cases, medicines are usually needed to bring down the triglyceride levels.
- LDL Cholesterol
Optimal: < 100 mg/dL
Above optimal: 100 –129 mg/dL
Borderline high:130 –159 mg/dL
High: 160 –189 mg/dL
Very high: ≥ 190 mg/dL
“This is the bad cholesterol that contributes to plaque buildup in all the arteries,” Parikh explains. “Most labs will still use < 100 mg/dL as the optimal range, but there is no longer a flat baseline for LDL that is considered healthy. According to 2018 guidelines, the range is between 70-190 and every individual patient now gets a more individualized risk-informed range by their doctors.”
Above Optimal and Higher Results
When your LDL cholesterol levels are higher than they should be, it usually means there's a potential risk for heart problems.
If your LDL cholesterol is in the "above optimal" range, your doctor will consider any other factors that might increase your risk of heart issues and suggest changes to your lifestyle to help lower that risk.
When your LDL cholesterol is "borderline high," your doctor will advise you on ways to improve your controllable risk factors. If these changes don't bring down your overall risk, your doctor might recommend medication to lower your cholesterol.
If your LDL cholesterol is "high," along with making significant lifestyle improvements, your doctor will likely prescribe a cholesterol-lowering medication, like a statin.
And if your LDL cholesterol is "very high," your doctor may prescribe a statin even if you don't have other major heart risk factors. If the statin alone isn't enough to lower your LDL cholesterol, you might need additional medications to help.
- HDL Cholesterol
Optimal for Men: ≥ 40 mg/dL
Optimal for Women: ≥ 50 mg/dL
“HDL stands for high-density lipoprotein and is commonly referred to as ‘good’ cholesterol,” Parikh explains. “It moves the excess cholesterol from your bloodstream to the liver where it gets processed and then the body gets rid of it. So higher levels of HDL are considered healthy.”
Parikh adds that most physicians would like to see an HDL level of 40 mg/dL or higher. Lower than 40 can put you at risk for heart disease as lower HDL is not as effective at removing bad cholesterol.
- HDL Risk Ratio
Acceptable: < 5:1
High: ≥ 5:1
The HDL risk ratio is the ratio between the total cholesterol and the HDL cholesterol blood values. This ratio is another tool to assess one’s risk for ASCVD (atherosclerotic vascular disease).
The HDL ratio incorporates the fact that higher HDL cholesterol levels can mitigate at least some of the cardiovascular risk implied by elevated total cholesterol (or LDL cholesterol) levels.
Get a Conversation Started
Even though this helpful guide can help you navigate what your results mean, Parikh says nothing can replace the value that comes from having an open conversation with your physician.
“I believe the best way to answer and explain any questions or concerns regarding your cholesterol results is through a face-to-face or virtual visit,” he explains. “Managing cholesterol is no longer as simple as trying to bring one number down. It is a calculation of a patient’s risk factors and their overall health that drives the decision on what is the right next step.”
This is also a great time to discuss your goals or desires, such as wanting to try lifestyle modifications prior to medication, if possible, or what you can do as a whole to get your levels to where they need to be.
“Some patients want to avoid medication if they can, and I understand that, so I try to honor that. However, there are some patients in which that’s not advisable, at least in the beginning, such as very high-risk patients, diabetics, or those who have already had a stroke or heart attack,” Parikh says. “So that’s worth having an informed discussion to fully understand why I may be prescribing a cholesterol-lowering medication.”
Parikh adds that you should never feel rushed or embarrassed to ask questions, even if you get results back that seem fine.
“It is not uncommon for me to have patients ask me to break down what each number means, if they can reduce their cholesterol without medication first, or if statins are the right route to go, and I’m happy to answer those questions,” he adds. “I think patients should always be able to ask their doctors to explain anything that flags for them or that they’re unsure to help them make sense of it. An informed patient is an empowered patient!”