New York Cardiologist Explains the Meaning of Cholesterol Numbers

Posted on: February 11, 2014

Understanding Your Cholesterol Numbers (post 2 of 3)

By Robert Pilchik, MD, Chief of Cardiology at Northern Westchester Hospital

First, a short review of cholesterol basics: The two types of cholesterol in your body – low-density lipoprotein (LDL) and high-density lipoprotein (HDL) – behave totally differently. Over time, excess LDL in your body, largely from fatty foods you eat, builds up in your artery walls as hard plaque, narrowing these vessels and restricting blood flow to your heart and brain. This condition, atherosclerosis, is THE leading cause of heart attack and stroke. By contrast, HDL acts as a vacuum, ridding the arterial walls of cholesterol and flushing it from the body.

Because it’s very common to experience no symptoms while your arteries are already badly blocked, it is a potentially life-saving measure to get regularly tested for cholesterol levels. Over time, your test results give you and your physician clues as to the health of these essential arteries.

Sound familiar? You get blood work done, and are given a number for “total” cholesterol. You’re told that a total over 200 is worrisome. However, the total cholesterol figure commonly given patients is actually a very deceptive number. It can mean different things in different situations. That’s why I’m primarily concerned with your numbers for LDL and HDL cholesterol.

Now you know why you should always ask your physician for the breakdown of test results for your LDL and HDL cholesterol levels.

Your total cholesterol number is actually a formula that includes HDL cholesterol, LDL cholesterol, and a certain fraction of the level of your triglycerides. Taken together, these three numbers form your “lipid (fat) profile.” Triglycerides are part of what remains when your body breaks down the fats you eat. The link between high triglycerides and artery-clogging plaque is much weaker than with cholesterol. However, people with high triglycerides often have low levels of the cholesterol-busting HDL cholesterol. If your triglycerides are high, your HDL is low, and you have fat around the belly, it’s likely you have metabolic syndrome, a condition that starts with insulin resistance and can lead to diabetes. This condition also puts you at increased risk for developing heart disease.

How often should you get tested for cholesterol? Every three years, if you’re between 20 and 30 years old, and have not had cholesterol issues. Yearly, if you’re 40 and over, and haven’t had cholesterol problems. If you’re on medication for high cholesterol, every six to 12 months. There is no evidence that women or men are at greater risk for elevated levels of LDL cholesterol.

OK, you’ve been tested. What are desirable numbers? For HDL cholesterol, if you’re male, your goal is to have greater than 40 (mg/dl or milligrams per deciliter of blood). If you’re female, your goal is greater than 50. For LDL, if you have no history of heart disease, your LDL should be less than 130. If you have a history, you want to be below 70.

Now let’s say you have great numbers. The nurse congratulates you. The doctor congratulates you. Are you totally off the hook? No! You need to maintain those good numbers.

Editor’s Note: Stay tuned… In Part Three, you’ll find simple ways to help bring your cholesterol levels to safe levels, or to maintain them there.