LDL, HDL, triglycerides and what the numbers mean in context — including why there is no single target that applies to everyone.
A lipid profile usually reports four numbers. Understanding what each one does makes the report considerably less opaque.
The four numbers
- LDL cholesterol — the fraction that deposits in artery walls. This is the number that matters most for heart risk, and the one treatment targets.
- HDL cholesterol — carries cholesterol away from the arteries. Higher is generally better, and it rises with regular exercise.
- Triglycerides — a different fat, which rises with excess sugar, refined carbohydrate, alcohol and poorly controlled diabetes.
- Total cholesterol — the least useful of the four on its own, because it combines the harmful and protective fractions into one figure.
- Optimal 50–99 mg/dL
- Near optimal 100–129 mg/dL
- Borderline high 130–159 mg/dL
- High 160 mg/dL and above190 and above is treated as very high.
| Band | Range | Note |
|---|---|---|
| Optimal | 50–99 mg/dL | |
| Near optimal | 100–129 mg/dL | |
| Borderline high | 130–159 mg/dL | |
| High | 160 mg/dL and above | 190 and above is treated as very high. |
- Low 20–39 mg/dLA low HDL is itself a risk factor.
- Acceptable 40–59 mg/dL
- Protective 60 mg/dL and above
| Band | Range | Note |
|---|---|---|
| Low | 20–39 mg/dL | A low HDL is itself a risk factor. |
| Acceptable | 40–59 mg/dL | |
| Protective | 60 mg/dL and above |
- Normal 50–149 mg/dL
- Borderline high 150–199 mg/dL
- High 200–499 mg/dL
- Very high 500 mg/dL and above
| Band | Range | Note |
|---|---|---|
| Normal | 50–149 mg/dL | |
| Borderline high | 150–199 mg/dL | |
| High | 200–499 mg/dL | |
| Very high | 500 mg/dL and above |
Source — NCEP ATP III, National Heart, Lung, and Blood Institute. A lipid report is read alongside your overall risk, not on its own — the same LDL means different things in different people.
Why there is no universal target
People frequently want to know what their LDL should be, and the honest answer is that it depends entirely on everything else about them. The same LDL of 130 warrants very different action in a 32-year-old with no other risk factors than in a 58-year-old with diabetes and a previous stent.
This is because risk factors multiply rather than add. Someone with high cholesterol, high blood pressure and diabetes is at considerably more than three times the risk of someone with one of them. Treatment intensity is set against total risk, which is why the consultation looks at the whole picture rather than the single sheet of paper.
What actually lowers it
Diet and exercise reliably improve triglycerides and HDL, and lower LDL by roughly 10 to 15 per cent with sustained change. Whether that is sufficient depends on how far the number needs to move. For a mildly raised level at low overall risk it may be entirely enough; for established coronary disease it will not be.
The dietary change with the most evidence behind it is replacing saturated fat rather than simply eating less of everything — nuts, whole grains, pulses and vegetables in place of fried food, vanaspati-type fats and processed snacks. For high triglycerides specifically, sugar, refined carbohydrate and alcohol are the levers that move the number.
On statins
Statins are among the most heavily studied medicines in use, across decades and very large populations. Serious side effects are uncommon. Muscle aching is the most frequent complaint, and it is usually manageable by changing the drug, adjusting the dose, or altering how often it is taken.
If you develop aches on a statin, report it rather than quietly stopping. Silently discontinuing is the outcome with the worst consequences, because the risk being weighed on the other side of the scale is a heart attack.