Lab result explainedCholesterol and lipidsLast updated November 8, 2026

Total cholesterol: what high and low levels, non-HDL and the cholesterol ratio mean

Total cholesterol (TC) · Lipid panel · reported in mg/dL in the US; mmol/L elsewhere (1 mmol/L = 38.7 mg/dL; 200 mg/dL = 5.2 mmol/L)

Total cholesterol is the sum of all the cholesterol carried in your blood: the cholesterol in LDL, HDL and the triglyceride-rich VLDL particles added together. A total cholesterol under 200 mg/dL (5.2 mmol/L) is desirable, 200 to 239 is borderline high, and 240 mg/dL (6.2 mmol/L) or more is high. These are the US National Cholesterol Education Program categories, and most labs still print them. The average for US adults is about 190 mg/dL.

The two most common reasons total cholesterol is high are a high LDL (the usual meaning, from diet, genetics or both) and, less obviously, a high HDL, which raises the total without raising risk. This is why total cholesterol on its own is a blunt instrument: a woman with a total of 230 made up of HDL 85 and LDL 125 is in a very different position from a man with a total of 230 made up of HDL 35 and LDL 160. The breakdown always matters more than the total, and clinicians have largely stopped making decisions on the total figure alone.

Two derived numbers make total cholesterol more useful. Non-HDL cholesterol (total minus HDL) adds up the cholesterol in every particle that can cause atherosclerosis and is a better predictor than LDL when triglycerides are high; it should be under 130 mg/dL for most people, and about 30 mg/dL above whatever your LDL target is. The total-to-HDL ratio (total divided by HDL) summarises the balance between harmful and protective particles: under 3.5 is ideal, under 5 is acceptable, and higher ratios predict heart disease about as well as any single lipid measure.

TC at a glance

  • What it is: all the cholesterol in your blood, carried in LDL (usually 60 to 70 percent of the total), HDL (20 to 30 percent) and VLDL (about 10 to 15 percent).
  • Categories (mg/dL): under 200 desirable; 200–239 borderline high; 240 or more high. Multiply mmol/L by 38.7 to convert. Labs differ slightly.
  • Non-HDL cholesterol (total minus HDL): under 130 mg/dL is the usual goal; under 100 for people with heart disease. It counts every atherogenic particle.
  • Total-to-HDL ratio: under 3.5 ideal, 3.5 to 5 average, over 5 raised risk. A high total with a high HDL and a low ratio is usually benign.
  • A total cholesterol over 300 mg/dL (7.8 mmol/L), or over 240 with a family history of early heart disease, raises the question of familial hypercholesterolemia.
  • Low total cholesterol (under about 120 to 150) is not harmful in itself; when unexplained it may point to hyperthyroidism, liver disease, malabsorption or serious illness.

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What TC measures

Cholesterol is a waxy lipid every cell needs for its membranes and that the body uses to make steroid hormones, vitamin D and bile acids. Most of it is made in the liver rather than eaten, and it travels in the blood packed inside lipoprotein particles because it does not dissolve in water. The total cholesterol test measures the cholesterol in all of these particles together with an enzymatic reaction (cholesterol esterase and oxidase) that produces a colour change proportional to the amount present. It is one of the most standardised tests in the laboratory, accurate to within about 3 percent.

Because it is a sum, the total tells you nothing about the mix. In a typical adult, LDL cholesterol contributes 60 to 70 percent, HDL 20 to 30 percent and VLDL (estimated as triglycerides divided by 5) 10 to 15 percent. Lipoprotein(a) cholesterol is included in the LDL fraction. The lab uses the total to calculate LDL (total minus HDL minus triglycerides over 5) and non-HDL cholesterol (total minus HDL), which is why a lipid panel always reports the components.

Total cholesterol does not require fasting; it changes by less than 2 percent after a meal. It varies about 6 percent between weeks in the same person, is 2 to 4 percent higher in winter than summer, runs 5 to 10 percent higher when blood is drawn standing rather than seated, and falls by 20 to 40 percent for six to eight weeks after a heart attack, major surgery or a serious infection, so a value drawn in hospital is not representative unless taken within the first 24 hours. In pregnancy it rises 25 to 50 percent by the third trimester. Treatment decisions are based on at least two measurements taken when well.

Normal range for TC

Reference ranges vary between labs and by age, sex and pregnancy. Use the range printed on your own report.

GroupTypical range (mg/dL in the US; mmol/L elsewhere (1 mmol/L = 38.7 mg/dL; 200 mg/dL = 5.2 mmol/L))Notes
DesirableUnder 200 mg/dL (5.2 mmol/L)NCEP ATP III category. The average US adult value is about 190 mg/dL; roughly 1 in 10 adults is over 240.
Borderline high200–239 mg/dL (5.2–6.1 mmol/L)Interpretation depends on the breakdown: a high HDL may account for it, a high LDL needs attention.
High240 mg/dL (6.2 mmol/L) or higherRoughly double the coronary risk of under 200 in population studies. Check LDL and overall risk.
Possible familial hypercholesterolemiaOver 310 mg/dL (8 mmol/L) in an adult, or over 260 (6.7) in a childDutch Lipid Clinic and UK criteria; combined with family history, tendon xanthomas or a confirmed LDL over 190.
Non-HDL cholesterol, goalUnder 130 mg/dL (3.4 mmol/L); under 100 (2.6) with established heart diseaseTotal cholesterol minus HDL. Goals sit 30 mg/dL above the matching LDL goal. Non-HDL of 220 or more suggests a genetic lipid disorder.
Total-to-HDL ratioUnder 3.5 ideal; 3.5–5 average; over 5 raised riskFramingham data. Average ratios are about 4.5 in women and 5 in men; the ratio predicts risk about as well as apolipoprotein measures.
Children and adolescentsUnder 170 acceptable; 170–199 borderline; 200 or more highNHLBI 2011 cut-offs; universal screening at 9 to 11 and 17 to 21.
LowUnder about 120–150 mg/dL (3.1–3.9 mmol/L)No official lower limit. Expected on statin treatment; if untreated and new, look for hyperthyroidism, liver disease, malabsorption or illness.

High total cholesterol

A high total cholesterol means more cholesterol is circulating in lipoprotein particles than average, and the first question is which particles. If LDL is high, the total is reflecting the main lipid cause of heart attack and stroke, and the discussion is about overall cardiovascular risk, diet and possibly a statin; see the LDL page for the thresholds. If triglycerides are high, the VLDL fraction is inflating the total and the picture is insulin resistance. If HDL is high, say 80 to 100 mg/dL, it can push an otherwise unremarkable profile over 240 without adding risk, and the total-to-HDL ratio will show that.

In the large population studies that established the categories, total cholesterol of 240 or more roughly doubled coronary risk compared with under 200, and a pooled analysis of 61 cohorts found that each 39 mg/dL (1 mmol/L) lower total cholesterol was associated with about a third fewer deaths from heart disease in middle age, with the relationship continuing down to at least 150 mg/dL. The association weakens in people over 80, where frailty and illness lower cholesterol and confound the picture, but trials in older adults still show benefit from LDL lowering.

A total cholesterol over about 310 mg/dL (8 mmol/L), particularly with a parent or sibling who had a heart attack or stroke before 55 (men) or 65 (women), or firm lumps over the Achilles or hand tendons, raises the possibility of familial hypercholesterolemia, an inherited LDL receptor defect affecting about 1 in 250 people. Totals over 240 are also commonly seen with hypothyroidism, nephrotic syndrome, cholestatic liver disease, pregnancy and several medications, and these are checked before any lifelong treatment decision.

Common causes

  1. High LDL cholesterol from diet and common gene variants

    The usual reason. Saturated and trans fats reduce LDL receptor activity, and hundreds of common variants set each person's baseline; the two together explain most totals of 200 to 300. See the LDL cholesterol page for detail.

  2. High HDL cholesterol

    An HDL of 80 to 110 mg/dL, common in active women, moderate drinkers and some families, adds 30 to 50 mg/dL to the total. The total-to-HDL ratio and non-HDL cholesterol strip this out, and no treatment is needed if those are normal.

  3. High triglycerides (VLDL)

    Every 100 mg/dL of triglyceride adds about 20 mg/dL of VLDL cholesterol to the total, so a triglyceride of 400 inflates the total by about 80. Insulin resistance, sugar, alcohol and some medications are the drivers.

  4. Familial hypercholesterolemia

    Totals of 300 to 500 mg/dL from childhood in the heterozygous form; over 600 in the rare homozygous form. Most cases are undiagnosed, and each first-degree relative has a 50 percent chance of carrying the gene.

  5. Hypothyroidism

    Low thyroid hormone reduces LDL receptor expression and raises total cholesterol by 20 to 50 mg/dL or more; it is the commonest secondary cause and reverses with treatment. TSH is checked with any new high cholesterol.

  6. Kidney disease with protein loss, and cholestatic liver disease

    Nephrotic syndrome drives lipoprotein overproduction, often to totals over 300. Blocked bile flow (primary biliary cholangitis, bile duct obstruction) raises cholesterol through abnormal lipoprotein X and a high HDL.

  7. Pregnancy and menopause

    Total cholesterol rises 25 to 50 percent by the third trimester and is not treated or used for risk assessment. Across the menopause transition it rises about 10 percent as estrogen falls.

  8. Medications

    Thiazides, some beta-blockers, corticosteroids, anabolic steroids, progestins, cyclosporine, isotretinoin, amiodarone, some antipsychotics and HIV protease inhibitors each raise total cholesterol by 5 to 20 percent through LDL, triglycerides or both.

  9. Very-low-carbohydrate (ketogenic) diets and anorexia nervosa

    Both can raise total cholesterol substantially, the first in a subset of lean people through increased LDL production, the second through low thyroid hormone and slowed cholesterol clearance. Both reverse when the diet changes.

  10. Cushing's syndrome and acromegaly

    Excess cortisol or growth hormone raise both LDL and triglycerides; they are rare and come with other features such as central weight gain, a round face, enlarging hands or new diabetes.

Symptoms that can go with it

  • None; high cholesterol produces no symptoms and is found by screening
  • Yellow plaques on the eyelids (xanthelasma), which occur with normal cholesterol too but are more common when it is high
  • Firm, painless lumps over the Achilles tendons or the tendons on the back of the hands (tendon xanthomas), a sign of familial hypercholesterolemia
  • A white or grey ring around the iris before age 45 (corneal arcus)
  • Chest pressure on exertion, calf pain on walking, or a transient episode of weakness or visual loss, the consequences of years of exposure rather than of the number itself

Low total cholesterol

There is no official lower limit for total cholesterol, and a low value in someone who feels well, especially on a statin or a plant-based diet, is good news rather than a concern. Populations with lifelong average totals of 120 to 150 mg/dL have very little coronary disease, people with genetic variants that lower cholesterol from birth are healthy, and trials that pushed total cholesterol below 120 with intensive treatment found no increase in cancer, dementia, depression or violent death, the worries raised by older observational studies.

Those older observations were real but reflected reverse causation: cholesterol falls as a consequence of illness. Cancer, chronic infection, advanced liver disease, inflammatory disease, hyperthyroidism, malabsorption and malnutrition all lower cholesterol, often for months before the diagnosis is made, and in frail older adults a low or falling cholesterol is a marker of poor health. So a total cholesterol under about 120 to 150 that is new, unexplained and not due to treatment is a reason to look for a cause, particularly with weight loss, fatigue, diarrhoea, jaundice or fever.

One specific association survives scrutiny: in large cohorts, total cholesterol under about 160 mg/dL is linked to a slightly higher rate of haemorrhagic (bleeding) stroke, most clearly in people with high blood pressure. The absolute increase is small and is far outweighed by the reduction in ischaemic stroke and heart attack from lowering cholesterol, but it is one reason blood pressure control matters alongside lipid treatment.

Common causes

  1. Statins and other lipid-lowering treatment

    The intended effect. High-intensity statins lower total cholesterol by 30 to 40 percent; with ezetimibe or a PCSK9 inhibitor totals of 80 to 120 mg/dL are common and safe.

  2. Hyperthyroidism

    Excess thyroid hormone speeds LDL clearance, lowering total cholesterol by 20 to 30 percent, usually with weight loss, heat intolerance, tremor and a fast pulse. A low TSH confirms it.

  3. Malabsorption and malnutrition

    Celiac disease, pancreatic insufficiency, inflammatory bowel disease, bariatric surgery and eating disorders reduce cholesterol intake and production; albumin and fat-soluble vitamins are often low too.

  4. Advanced liver disease

    The liver makes most of the body's cholesterol, so cirrhosis and acute liver failure lower the total; in known liver disease a falling cholesterol is a marker of worsening synthetic function.

  5. Acute illness, infection, surgery and inflammation

    Total cholesterol falls 20 to 40 percent within a day or two of a heart attack, sepsis or major surgery and recovers over 6 to 8 weeks. Chronic inflammatory diseases such as rheumatoid arthritis and HIV lower it more modestly.

  6. Cancer and blood disorders

    Leukaemia, lymphoma, myeloma and advanced solid tumours lower cholesterol through increased uptake and reduced production; an unexplained fall over a year or two is one of several soft signals that prompt a fuller review.

  7. Inherited low cholesterol

    Familial hypobetalipoproteinemia and PCSK9 loss-of-function variants give lifelong totals of 80 to 140 mg/dL with reduced cardiovascular risk. The rare abetalipoproteinemia causes near-zero levels with fat malabsorption and vitamin E deficiency from infancy.

  8. Very low-fat or plant-based diets

    Strict vegan and very low-fat diets typically lower total cholesterol by 10 to 25 percent; totals of 120 to 160 are common and healthy in long-term adherents.

Symptoms that can go with it

  • None; low cholesterol itself causes no symptoms
  • Unexplained weight loss, fever or night sweats, which point to an illness lowering cholesterol
  • Diarrhoea, greasy stools or bloating if malabsorption is the cause
  • Jaundice, abdominal swelling or easy bruising if liver disease is the cause
  • Tremor, palpitations and heat intolerance if hyperthyroidism is the cause
  • Claims that low cholesterol causes depression or memory problems are not supported by randomised trials of cholesterol lowering

Read it alongside

  • LDL cholesterol — the component that drives risk and treatment decisions; a high total with a normal LDL is usually a high HDL or high triglycerides.
  • HDL cholesterol — explains many high totals; a total of 240 with an HDL of 90 is a different problem (or none) from the same total with an HDL of 35.
  • Triglycerides — inflate the total through VLDL and point to insulin resistance; they also make calculated LDL unreliable above 400.
  • Non-HDL cholesterol — total minus HDL; the sum of all atherogenic particles and a better target than LDL when triglycerides are over 150. Goal under 130, or under 100 with heart disease.
  • Apolipoprotein B — counts atherogenic particles directly and resolves discordance when LDL looks acceptable but the total, triglycerides or non-HDL are high.
  • Lipoprotein(a) — measured once in a lifetime; a high value explains some of the total and adds risk independently.
  • TSH — hypothyroidism is the commonest reversible cause of high cholesterol; hyperthyroidism a cause of low.
  • Fasting glucose, A1C and blood pressure — cholesterol is interpreted within a 10-year cardiovascular risk estimate that uses all three.

What usually happens next

  1. Look past the total: ask for the LDL, HDL, triglycerides and non-HDL figures, and work out the total-to-HDL ratio. The total alone should not decide anything.
  2. If the total is over 200 for the first time, a repeat when well (and fasting if triglycerides were high) is reasonable before any decision; lipids vary 5 to 10 percent between tests.
  3. Expect a check for secondary causes: TSH, fasting glucose or A1C, kidney function and urine protein, liver enzymes, and a review of medications, alcohol and recent diet changes.
  4. Ask for your 10-year cardiovascular risk estimate; the decision about a statin rests on that and on LDL, not on the total. A coronary artery calcium scan can help when risk is borderline.
  5. A total over 310 mg/dL, an LDL over 190, tendon xanthomas or a family history of early heart disease should prompt an assessment for familial hypercholesterolemia and screening of relatives.
  6. For diet and lifestyle, give changes 3 months before rechecking: replacing saturated fat, adding soluble fibre, nuts and plant sterols, and losing weight if needed typically lowers total cholesterol by 10 to 20 percent.

Diet, lifestyle and natural levers with evidence

What can move TC once the cause is known. Nothing here replaces finding the cause.

Replace saturated fat with unsaturated fat

Strong evidence

Pooled analysis of 84 controlled feeding trials shows that swapping 1 percent of daily calories from saturated fat to polyunsaturated fat lowers total cholesterol by about 2.8 mg/dL (0.07 mmol/L) and LDL by about 2 mg/dL, so replacing 5 percent of calories (about 11 g of saturated fat on a 2,000 kcal diet, roughly the butter and fatty meat in a typical day) lowers total cholesterol by about 14 mg/dL. A Cochrane review of 15 trials with 56,675 participants found reducing saturated fat lowered cardiovascular events by 17 percent, with greater benefit the more cholesterol fell. The swap is to olive, rapeseed and other vegetable oils, nuts, seeds, avocado and oily fish, not to refined carbohydrate, which lowers HDL and raises triglycerides instead.

Oats, barley and psyllium (soluble fibre)

Strong evidence

A meta-analysis of 28 trials found that 3 g a day or more of oat beta-glucan (about 70 to 100 g of dry oats, or a large bowl of porridge plus oat bran) lowered total cholesterol by 11.6 mg/dL (0.30 mmol/L) and LDL by 9.6 mg/dL. Psyllium husk at 10 g a day lowers LDL by about 13 mg/dL and total cholesterol by a similar amount in a 28-trial meta-analysis. Soluble fibre binds bile acids in the gut, so the liver draws on blood cholesterol to make more; legumes, barley, apples and flaxseed contribute too. The effect adds to a statin.

Increase fibre gradually and drink water with psyllium; take it 2 hours apart from medications, whose absorption it can delay.

Plant sterols and stanols

Strong evidence

Two grams a day of plant sterols or stanols, from fortified spreads, yoghurt drinks or supplements, lowers LDL by 8 to 10 percent and total cholesterol by about 6 to 8 percent within 2 to 3 weeks, according to a meta-analysis of 124 trials; the effect plateaus above 3 g. They block cholesterol absorption in the gut and work in addition to diet change and statins. No trial has measured heart attacks, so the recommendation rests on the lipid change.

Avoid in sitosterolemia, a rare inherited condition. Lowers blood carotenoid levels by 10 to 20 percent, so keep up vegetable intake. Not studied in pregnancy or young children.

Weight loss and regular exercise

Strong evidence

A meta-analysis of 70 studies found total cholesterol falls by about 1.9 mg/dL for every kilogram lost (LDL 0.8, triglycerides 1.3), so a 10 kg loss lowers total cholesterol by around 19 mg/dL, with HDL rising once weight stabilises. Exercise on its own has a smaller effect on total cholesterol (meta-analyses find 3 to 6 mg/dL falls with regular aerobic training) but larger effects on triglycerides and HDL, and the total-to-HDL ratio improves more than the total suggests. The two together give the best result.

Garlic

Moderate evidence

A meta-analysis of 39 randomised trials found that in people with total cholesterol over 200 mg/dL who took garlic preparations for two months or more, total cholesterol fell by 17 mg/dL (0.44 mmol/L) and LDL by 9 mg/dL, about 8 percent, with a small rise in HDL and no effect on triglycerides. Aged garlic extract and garlic powder tablets (typically 600 to 1,200 mg a day) were the forms studied; raw garlic has less consistent data. Trials are short and the effect is modest, but it is consistent across preparations.

Increases bleeding tendency, particularly with warfarin, antiplatelet drugs and fish oil; stop supplements 7 to 10 days before surgery. Can cause heartburn, body odour and stomach upset, and reduces levels of the HIV drug saquinavir.

Green tea and green tea extract

Moderate evidence

Meta-analyses of 14 to 31 randomised trials find that green tea or its catechin extracts lower total cholesterol by about 5 to 7 mg/dL and LDL by 2 to 5 mg/dL over 3 to 24 weeks, with no change in HDL or triglycerides, probably by reducing cholesterol absorption. Three to five cups of brewed green tea a day, or extracts providing 300 to 500 mg of catechins, were the typical doses. The effect is small but consistent, and green tea drinking is associated with lower cardiovascular mortality in Japanese cohorts.

Concentrated extracts providing more than about 800 mg of EGCG a day have been linked to liver injury, particularly when taken fasting; brewed tea has not. Caffeine content; reduces absorption of the beta-blocker nadolol and of non-haem iron when taken with meals.

When to see a clinician promptly

  • Chest pressure or pain, breathlessness, or pain spreading to the arm, neck or jaw: possible heart attack, call emergency services.
  • Sudden one-sided weakness or numbness, facial droop, slurred speech, loss of vision or a sudden severe headache: possible stroke, call emergency services.
  • A total cholesterol over 310 mg/dL (8 mmol/L), or over 240 with a parent, sibling or child who had a heart attack or stroke before 55 (men) or 65 (women), or lumps over the Achilles or hand tendons: assessment for familial hypercholesterolemia and family screening.
  • A child or teenager with a total cholesterol over 200 mg/dL, or over 260 at any age: referral to a lipid specialist.
  • A total cholesterol that has fallen substantially without treatment, especially with weight loss, fatigue, diarrhoea, fever, night sweats or jaundice: the cause needs finding.
  • Unexplained muscle pain, weakness or dark urine after starting a statin or red yeast rice: possible muscle injury, needs a creatine kinase test, urgently if severe.

Frequently asked questions

What is a normal total cholesterol level?

Under 200 mg/dL (5.2 mmol/L) is classed as desirable, 200 to 239 borderline high and 240 or more high. The average US adult is at about 190. But the total is only a starting point: the LDL, HDL and triglyceride breakdown, the non-HDL cholesterol (total minus HDL, ideally under 130) and your overall cardiovascular risk decide whether anything needs doing. A total of 210 with a high HDL and low LDL is fine; a total of 195 with an HDL of 30 and triglycerides of 300 is not.

Is a total cholesterol of 220 high?

A total of 220 mg/dL is 'borderline high' (200 to 239). Whether it matters depends on what makes it up. If your HDL is 70 and your LDL 130, your non-HDL is 150 and your ratio is about 3.1, which is a low-risk pattern for most people. If your HDL is 38 and your LDL 155, your non-HDL is 182 and your ratio 5.8, and you would benefit from lifestyle change and a formal risk estimate, which may point to a statin depending on age, blood pressure, smoking and diabetes.

Is a total cholesterol of 240 or 300 dangerous?

A total of 240 mg/dL is the 'high' threshold and in population studies carries roughly twice the coronary risk of under 200 over the long term, assuming the excess is LDL. It is a reason to act, not an emergency. A total over 300, and certainly over 310 (8 mmol/L), is unusual enough that familial hypercholesterolemia should be considered, especially with a family history of early heart disease or tendon xanthomas; statin treatment is recommended for most people at this level regardless of other risk factors, and relatives should be tested.

What is a good total cholesterol to HDL ratio?

Divide your total cholesterol by your HDL. Under 3.5 is ideal, 3.5 to 5 is about average (women average around 4.5, men around 5), and over 5 indicates raised risk; the Framingham study found the ratio predicted coronary disease better than total cholesterol alone. For example, a total of 220 with an HDL of 55 gives 4.0, average; a total of 220 with an HDL of 35 gives 6.3, high. Non-HDL cholesterol and apolipoprotein B do the same job slightly better and are preferred in current guidelines.

What is non-HDL cholesterol and why does it matter?

Non-HDL cholesterol is your total cholesterol minus your HDL, which leaves the cholesterol in every particle that can cause atherosclerosis: LDL, VLDL, remnants and lipoprotein(a). It needs no fasting and no calculation that breaks down when triglycerides are high, and in a pooled analysis of 68 cohorts it predicted heart disease at least as well as LDL. The usual goal is under 130 mg/dL (3.4 mmol/L), or under 100 for people with heart disease, about 30 mg/dL above the matching LDL goal. A non-HDL of 220 or more suggests a genetic lipid disorder.

Can total cholesterol be high if my HDL is high?

Yes, and it is one of the commonest reasons for an alarming-looking total in a healthy person. An HDL of 85 to 100 mg/dL, typical of some active women and some families, adds 30 to 50 mg/dL to the total, so a total of 230 to 250 can sit alongside a perfectly good LDL of 120. In that situation the non-HDL cholesterol (under 130) and the total-to-HDL ratio (under 3.5) show the real picture, and no treatment is needed. Note that very high HDL does not offset a high LDL, so the components still need checking.

Do I need to fast for a cholesterol test?

Not usually. Total and HDL cholesterol barely change after a meal, LDL changes by less than 10 mg/dL and triglycerides by about 25 mg/dL, so US and European guidelines accept non-fasting lipid panels for screening and risk assessment. Fasting for 9 to 12 hours is still asked for if a non-fasting triglyceride was 400 or more, when very high triglycerides are being monitored, or when the panel is drawn with a fasting glucose. Avoid heavy alcohol for 24 hours beforehand, and do not test within 6 to 8 weeks of a heart attack, surgery or serious infection.

Is low cholesterol dangerous?

Not in itself. People with genetically low cholesterol from birth and populations with lifelong totals of 120 to 150 mg/dL are healthy and have very little heart disease, and trials that lowered cholesterol intensively found no increase in cancer, dementia or depression. The link between low cholesterol and illness in older observational studies reflects illness lowering cholesterol, not the other way round. A total under about 120 to 150 that is new, unexplained and not due to treatment is worth investigating for hyperthyroidism, liver disease, malabsorption or hidden illness, and very low cholesterol is weakly associated with bleeding stroke in people with uncontrolled blood pressure.

References

  1. Cholesterol levels. MedlinePlus, US National Library of Medicine (2024)View source
  2. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA (2001)
  3. Grundy SM, Stone NJ, Bailey AL, et al.. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol. Circulation (2019)
  4. Prospective Studies Collaboration; Lewington S, Whitlock G, Clarke R, et al.. Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet (2007)
  5. Emerging Risk Factors Collaboration; Di Angelantonio E, Sarwar N, Perry P, et al.. Major lipids, apolipoproteins, and risk of vascular disease. JAMA (2009)
  6. Mensink RP. Effects of saturated fatty acids on serum lipids and lipoproteins: a systematic review and regression analysis. World Health Organization (2016)
  7. Hooper L, Martin N, Jimoh OF, Kirk C, Foster E, Abdelhamid AS. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database of Systematic Reviews (2020)
  8. Whitehead A, Beck EJ, Tosh S, Wolever TM. Cholesterol-lowering effects of oat β-glucan: a meta-analysis of randomized controlled trials. American Journal of Clinical Nutrition (2014)
  9. Ras RT, Geleijnse JM, Trautwein EA. LDL-cholesterol-lowering effect of plant sterols and stanols across different dose ranges: a meta-analysis of randomised controlled studies. British Journal of Nutrition (2014)
  10. Dattilo AM, Kris-Etherton PM. Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis. American Journal of Clinical Nutrition (1992)
  11. Ried K, Toben C, Fakler P. Effect of garlic on serum lipids: an updated meta-analysis. Nutrition Reviews (2013)
  12. Zheng XX, Xu YL, Li SH, Liu XX, Hui R, Huang XH. Green tea intake lowers fasting serum total and LDL cholesterol in adults: a meta-analysis of 14 randomized controlled trials. American Journal of Clinical Nutrition (2011)

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This page is educational and is not medical advice or a diagnosis. Lab results have to be interpreted together with your history, symptoms and other results by a clinician who knows you. Do not start or stop a supplement to change a lab value before the cause is known.