Are My Cholesterol Numbers Concerning? 4 Steps to Know if Your Cholesterol is OK (or Not)
Medically Reviewed by Vincenta Faulkner, RD, CNSC, CCTD
I recently was at the doctors for a different issue and they checked my blood for cholesterol -- the results were not good! I was surprised, maybe not totally shocked, but definitely worried.
So -- I went online to see what I could learn. What I found is that I am not alone. Nearly 200 million Americans will get a cholesterol test this year.
What I ALSO found is there is a lot of information out there, but it is spread out, and instead of making you tediously comb the internet, I decided to just share with you my findings here. Read below for a 4 step guide on how to figure out how bad your cholesterol is. 👇
Should I Care?
Before we really dive in, you may be wondering whether you should care if you have high cholesterol?
Yes, yes you should. Even if it is just a little bit high. High cholesterol levels are a major risk factor for heart attacks and strokes, aka the #1 killer worldwide.
Cardiovascular diseases are the leading cause of death globally, taking an estimated 17.9 million lives each year. That is about one third of all deaths on earth. More than 80% of those cardiovascular deaths are due to heart attacks and strokes.
Step 1: Am I “At Risk” Based On The Table?
Look, you're probably here because you got your cholesterol numbers tested through a blood test called a "Lipid Panel", and you probably were told that one of your numbers is high. Just to review, the four components of your cholesterol test are shown in the graphic below:
The results from the Lipid Panel will tell you your numbers but, how do you know if you are at an increased risk of heart attack or stroke?
The graphic and table below will tell you if you are at an increased risk based on your numbers.
Any number labeled At Risk, is just that... At risk.
Sources: Cholesterol Numbers: What Do They Mean, UpToDate What Numbers to Aim for
A true high or “bad” in the table above will likely have your doctor recommending not only a change in your diet and lifestyle, but your doctor may decide to prescribe medication when taking into consideration your lifetime risk factors (smoking, family history of heart disease, etc.).
Step 2: What is my 10-year risk of heart disease?
But seriously, how bad is bad when combined with MY risk factors?
For those of you above 40 years old, there is an equation to figure out your medium-term risk of heart disease at American College of Cardiology’s Cardiovascular Risk Calculator.
This Risk Calculator estimates your 10 year risk for heart disease. It is used as a talking point for you and your doctor to identify key risk factors (one of them being high LDL cholesterol level) and treatment plans.
This website can categorize you as Low- to High risk of heart disease (potential for heart attack or stroke) in the next 10 years.
Low-risk (<5%)
Borderline risk (5% to 7.4%)
Intermediate risk (7.5% to 19.9%)
High risk (≥20%)
You can then see the recommended treatment for you using the American Heart Association Cholesterol Management Guide for Healthcare Practitioners.
The calculator is only accurate if you are over 40 years old -- I am still in my 30s so I choose 40 as my age to get a result. It’s not totally accurate for me, but can give me a starting point to understanding where I am potentially at.
You can see my results here 👇 (yes, these are my real lipid panel numbers as of 10/28/21). I've also included a graphical user guide as to how to use this website.
My Estimated 10 Year ASCVD risk is 1.3%, which is Low-risk (<5%) of having a heart attack or stroke.
Step 3: How does this compare to others my age?
At this step, I wanted to know where do I rank based on my age? Is my HDL higher than the average, my LDL lower than the average?
And yes, I discovered there is another online gizmo for that too, found at Dutch website Lipid Tools. Make sure that that language is set to “EN” in the top right corner and measurement is set to “mg/dL.” Then enter your lipid panel, gender, and age.
Below is a graphical user guide on how to use the Lipid Tools website.
So, according to Lipid Tools I am about average for a male my age on Total cholesterol, LDL, and TG levels. But I am far below average for my HDL.
Step 4: What is my risk of having Familial Hypercholesterolemia?
Even more interesting, Lipid tools has an algorithm for likelihood of Familial Hypercholesterolemia or FH, which is when you are essentially born with high LDL cholesterol.
What is crazy, is that in the US about 1.3 million people have the genetic mutation, but only about 10% are even aware they have it. Men with FH get coronary heart disease up to 10 to 20 years earlier and left untreated, 50% of those men will have a heart attack or angina before they turn 50 and some as early as their 20s. In women, coronary heart disease appears up to 20 to 30 years earlier and about 30% of untreated women will have a heart attack before they turn 60.
The tool requires you to put in your highest LDL score prior to medication or has another tool to adjust your current LDL if you are on medication. It also asks you several questions about you and your family members, including if they have cholesterol deposits in their tendons or eyes. Not going to lie, it was not easy answering all the questions. So, for some of these factors that I didn’t know, I tried entering both yes and no and saw the different results.
Summarizing the 4 steps
OK to summarize!
- Step 1: Based on the “at risk” guideline, both my LDL and HDL results qualify as At Risk
- Step 2: Based on the CV risk calculator I have Low (1.3%) 10-year risk, but I have a risk factor based on my grandparent’s early death
- Step 3: Compared to others my age my LDL is slightly high in the 52nd percentile, but my HDL is low at only the 24th percentile
- Step 4: Based on my highest LDL score, and what I know about my relatives I could either be a 1 (unlikely FH) or a 3 (possible FH)
Okay, I care, I see my risk. What can I do?
What are my goals here?
One place to start is to target the levels of my HDL and LDL. But what should my target be for each number? What should I be shooting for?
So I asked a preventative cardiologist friend, what are the “Real” target numbers here.
He told me he keeps his own LDL at 35. WHAT?! That is crazy low, like less than one percentile for age and gender. But yeah- makes sense as a cardiologist he is negating his risk.
What advice he did share, echoes a 2018 publication in JAMA Cardiology. This meta-analysis of patients with confirmed atherosclerotic cardiovascular disease showed that lowering your “Bad” LDL cholesterol by 39 points lowers your risk of heart disease by 20%, even below the “optimal” level of 100 mg/dl.
So, if I lowered my LDL from its current level of 131 mg/dL down to 92 mg/dL, I would be below the optimal level (100mg/dL) , and if I continued on my journey, I could not only could reduce my risk by 20%, but possibly by even more, 40%, if I could achieve an ultra-low LDL!
At the same time I was researching my low HDL, and what I found was that low levels of good cholesterol may not be a cardiovascular disease risk factor on its own and raising HDL does not likely reduce a person’s risk, according to a study published in 2016 in the journal of the American College of Cardiology. This caused me to focus on lowering my LDL as the best way of improving my heart health.
One request before you go . . .
I hope this 4 step guide can help you get some context on how "bad" your cholesterol is! If you'd like to contact me please reach out to my email reece@zizi.co!
At Zizi, we are working on creating an online-first program to help people do what we just discussed -- lower their LDL. Join our early-access program here.
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