Serum cholesterol, often called total blood cholesterol, gauges the quantity of specific lipids circulating in your bloodstream. This blood test helps clinicians assess your likelihood of developing heart disease over the next decade.
Cholesterol is a kind of fat, also referred to as a lipid. It moves through your circulatory system as tiny particles enclosed by proteins.
Your total blood, or serum, cholesterol reflects three lipid types:
- low-density lipoprotein (LDL), the “bad” cholesterol that can lead to plaque accumulating in your arteries
- high-density lipoprotein (HDL), the “good” cholesterol that helps prevent plaque from building up
- triglycerides
People commonly link cholesterol with heart disease because LDL can deposit in artery walls and reduce or block blood flow. Still, your body requires some cholesterol for healthy digestion, producing vitamin D, and forming certain hormones.
Keep reading to find out what physicians learn from your serum cholesterol values and how they check them.
How cholesterol is tested
A healthcare provider measures serum cholesterol using a blood test called a lipid panel. You’ll need to fast for 8 to 12 hours before the sample is taken.
During the test, a clinician draws blood from a vein in your arm, collecting enough to fill one or more small tubes. The samples are then sent to a laboratory for evaluation.
How often you should have this test depends on your age. The National Heart, Lung, and Blood Institute (NHLBI) suggests screening:
- Children and young adults: Every 5 years
- Women ages 55 to 65: Every other year
- Men ages 45 to 65: Every other year
- Adults 65 and older: Annually
A physician may order lipid panels more frequently if you have particular cardiovascular risk factors, such as:
- overweight or obesity
- tobacco use
- family history of heart disease
- a past heart attack, stroke, or other cardiovascular event
If you begin a new cholesterol medication or change doses, you’ll likely undergo more frequent testing so clinicians can monitor how well the drug is working.
Interpreting your numbers
Laboratory reports present serum cholesterol values in milligrams per deciliter (mg/dL).
A lower LDL and a higher HDL are preferable. LDL is the cholesterol type that forms waxy plaque along artery walls; excess plaque can impede blood flow through that vessel.
HDL assists by transporting LDL particles away from the bloodstream.
Higher HDL levels are linked with improved cardiovascular health. For triglycerides, lower values are better. After eating, your body turns calories you don’t immediately use into triglycerides, which fat cells store. Consuming more calories than you expend can lead to weight gain and often elevated triglyceride levels.
Here’s what to expect in your fasting lipid panel results:
| Total cholesterol | Non-HDL or LDL | HDL | Triglycerides |
|---|---|---|---|
| Optimal: Less than 200 mg/dL | Optimal: below 100 mg/dL | Low: below 40 mg/dL for males | Optimal: below 150 mg/dL |
| Borderline high: 200 to 239 mg/dL | Near optimal: 100 to 129 mg/dL | Low: below 50 mg/dL for females | Mild hypertriglyceridemia: 150 to 499 mg/dL |
| High: 240 mg/dL or higher | Borderline high: 130 to 159 mg/dL | Optimal: 40 mg/dL or greater for males | Moderate hypertriglyceridemia: 500 to 886 mg/dL |
| High: 160 to 189 mg/dL | Optimal: 50 mg/dL or greater for females | Very high or severe hypertriglyceridemia: greater than 886 mg/dL | |
| Very high: 190 mg/dL or greater | High: 60 mg/dL or greater |
Clinicians compute serum cholesterol by adding your HDL and LDL levels plus one-fifth (20%) of your triglyceride value.
For instance, if LDL is 150 mg/dL, HDL is 35 mg/dL, and triglycerides are 180 mg/dL, your total serum cholesterol would be 221 mg/dL. That falls in the borderline high category. Your provider may suggest lifestyle adjustments and treatments to lower these numbers.
If you’ve experienced a heart attack, stroke, or had a stent placed, physicians may recommend medications to reduce future risk, potentially aiming to lower LDL to under 55 mg/dL.
Treatment options
Managing elevated serum cholesterol typically centers on:
- regular physical activity
- dietary changes to reduce cholesterol
- cholesterol-lowering medications when indicated
- stress reduction
- better sleep
Statins are frequently prescribed to lower cholesterol. While individual statins vary in their mechanisms, they all aim to decrease LDL. Some can also raise HDL and lower triglycerides. This has been shown to lower the chances of heart attacks and strokes.
Factors that raise cholesterol risk
A family history of high cholesterol increases your likelihood of elevated levels. In such cases, you might have high cholesterol despite following a heart-healthy diet and exercising.
Cholesterol tends to climb as you age.
Other contributors include smoking and having excess body weight.
Prognosis with high cholesterol
High serum cholesterol is usually manageable with medications and lifestyle modifications like increased exercise and dietary improvements.
Cholesterol deposits can obstruct arteries and elevate the risk of heart attack and stroke.
If your cholesterol is borderline high, a clinician may recommend measures to lower or maintain it within a healthy range.
Takeaway
Serum cholesterol measurements reveal how much of certain lipids are in your blood and can help determine your cardiovascular risk. These results guide treatment and management decisions for elevated cholesterol.
Medications such as statins can reduce high cholesterol and are generally most effective when combined with lifestyle changes.
Without treatment, high cholesterol can raise your likelihood of heart attack and stroke.
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