High blood cholesterol presents a major risk factor for artery disease and heart disease. As cholesterol builds up in your blood vessels, they harden and become less flexible, making them susceptible to injury. In addition, cholesterol and other particles clump together forming plaque that makes the passageway for blood narrower. This narrowing increases your chance of having a heart attack or stroke. You can't tell when your cholesterol gets too high. It's critical that you see your health care provider regularly, who can detect elevated cholesterol levels and treat them early.
How Levels are Set
The National Cholesterol Education Program, or NCEP, is a multi-sector initiative partnering the National Institutes of Health with nonprofit health organizations that issues a set of guidelines that spell out a range of blood cholesterol levels as being between optimal and very high. In part, the guidelines are based on results from Framingham Heart Study, which started in 1948 and runs today. In 1961, cholesterol was identified as a factor of cardiovascular disease, and since then, new layers of understanding have been peeled back as to how the nutrient works and causes health issues.
High LDL Cholesterol
The major focus of high blood cholesterol treatment centers on lowering LDL, or "bad" cholesterol. The NCEP says having an LDL reading below 100 mg/dL is optimal. Between 100 and 129 mg/dL is labeled "near optimal/above optimal." A reading between 130 and 159 mg/dL is considered "borderline high." LDL between 160 and 189 mg/dL is "high" and where formal treatment with lifestyle changes and possibly medications may begin. When a reading is higher than 190 mg/dL, it's said to be "very high."
High HDL Cholesterol
In the case of HDL, or "good" cholesterol, high is a good thing. HDL cholesterol protects you from heart disease because it helps to remove LDL cholesterol. For some people with high cholesterol, treatment goals may be to increase HDL in addition to lowering LDL. For HDL, lower than or equal to 40 mg/dL is called "low" and higher than or equal to 60 is called "high."
High Total Cholesterol
A total cholesterol, inclusive of HDL and LDL, below 200 mg/dL is desirable. When your total cholesterol is between 200 and 239 mg/dL, it's borderline high, and greater than 240 is high. The NCEP recommends that every five years all adults who are older than 20 get a comprehensive cholesterol test, which requires them to fast. When you go to your doctor regularly, you may take cholesterol blood tests in which you don't fast. NCEP reports that when that happens, your health care provider will rely on your total cholesterol and HDL cholesterol levels to determine your risk for heart disease. When your total cholesterol is greater than 200 mg/dL and your HDL is lower than 40 mg/dL, your doctor will likely follow up to get the more comprehensive lipoprotein profile, because those readings suggest your LDL and total risk for heart disease may be elevated.
New "Ultra Bad" Cholesterol
In May 2011, British and Canadian researchers reported finding a new form of LDL cholesterol called MGmin-LDL. Publishing in the journal "Diabetes," they said it is a super-sticky substance that is more likely to attach to the walls of arteries, form fatty plaque and increase your risk of heart attack and stroke. The discovery clarified the connection between diabetes and heart complications and could change how heart disease is treated. New guidelines may be set to determine what levels of MGimm-LDL are optimal or high.
References
- National Heart, Lung and Blood Institute; 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); May 2001
- National Cholesterol Education Program: Program Description
- "Diabetes"; Glycation of LDL by Methylglyoxal Increases Arterial Atherogenicity A Possible Contributor to Increased Risk of Cardiovascular Disease in Diabetes; Naila Rabbani et al.; epub May 26, 2011
- Framingham Heart Study: Research Milestones
