People can calculate their total cholesterol by adding their levels of high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and 20% of their triglycerides.

This information comes from the American Heart Association (AHA).

HDL is a beneficial type of cholesterol, while LDL is not. The former helps remove cholesterol from the arteries, decreasing the risk of a cardiovascular event, such as a heart attack or stroke. Conversely, LDL promotes cholesterol accumulation in the arteries.

A person has a healthy level of total cholesterol if it is less than 200 milligrams/deciliter (mg/dl).

This article discusses how to calculate total cholesterol, the ranges, and what desirable and undesirable cholesterol levels mean. It also examines other cholesterol measurements and suggests questions to ask a doctor.

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Total cholesterol measures how much cholesterol is in a person’s blood overall. This measurement includes all types of cholesterol, including HDL, LDL, and triglycerides, the most common type of fat in the body.

The liver makes cholesterol, a waxy substance that is essential for good health. However, too much cholesterol, particularly harmful types, can increase the risk of cardiovascular disease.

There are two main types of cholesterol in the body. HDL absorbs cholesterol and returns it to the liver, lowering the risk of a cardiovascular event.

In contrast, LDL promotes the buildup of fatty deposits in the arteries. This makes up most of the body’s cholesterol.

People can calculate their total cholesterol by combining the figures from several blood tests. According to the AHA, this involves adding a person’s HDL cholesterol level, LDL cholesterol level, and 20% of their triglyceride level.

An older method involves calculating total cholesterol by adding HDL cholesterol, LDL cholesterol, and very low-density lipoproteins (VLDL). This is the type of lipoprotein carrying the highest quantity of triglycerides.

The below table shows how doctors categorize total cholesterol levels:

Range
desirable cholesterolunder 200 mg/dl
borderline cholesterol200–239 mg/dl
high cholesterol240 mg/dl or higher

High total cholesterol may indicate a person has a higher risk of a cardiovascular event. However, in gauging the likelihood, doctors also consider the other parts of a cholesterol test known as a lipoprotein profile. This includes:

  • HDL: Since HDL is the beneficial type of cholesterol, the higher it is, the more beneficial it is. Levels under 40 mg/dl are ideal.
  • LDL: Since LDL is a harmful type of cholesterol, the lower it is, the less harmful it is. Optimal levels are less than 100 mg/dl.
  • Triglycerides: Levels of less than 150 mg/dl are optimal. People with levels higher than this have a higher risk of cardiovascular disease. Depending on how high the levels are, the person may require treatment.

It is also worth noting that high cholesterol is only one risk factor for cardiovascular disease. Other factors can have a positive or negative influence on the overall risk. When evaluating a person’s risk profile, doctors also consider other factors, such as:

Generally, desirable results mean a person may have a lower risk of cardiovascular disease, but they do not guarantee it. The AHA notes that typical cholesterol levels are less important than a person’s overall risk.

An individual with healthy cholesterol can have an elevated likelihood of a heart attack or stroke if they have several risk factors.

Total cholesterol is just one way of measuring a person’s risk for cardiovascular disease. Other techniques involve looking at the ratios between different types of cholesterol and triglycerides.

For example, older research from 2009 compared the predictive value of various ratios with that of independent measurements, such as HDL, LDL, and total cholesterol. The results indicated that the ratio of total cholesterol to HDL and LDL to HDL predicted heart risk most accurately.

These ratios identified significantly high and low risk groups better than total cholesterol and LDL cholesterol. Additionally, the two ratios are good predictors of the degree that lipid-lowering medications will reduce cardiovascular risk.

Triglyceride levels also help predict cardiovascular risk. Triglycerides are not a type of cholesterol but a type of fat in the blood. They can raise the risk of disease whether a person has high cholesterol or not.

If a person has just received their total cholesterol results, they may want to ask their doctor the following questions:

  • What does my total cholesterol level show?
  • What are the limitations of this test?
  • What other factors are there to consider?
  • What is my overall risk for cardiovascular disease?
  • Do I need any other screenings or tests?
  • What can I do to bring my cholesterol levels into a healthy range?
  • Will I need medical treatment to change my cholesterol levels?

Total cholesterol is the sum of a person’s HDL cholesterol, LDL cholesterol, and 20% of their triglyceride levels. Healthy total cholesterol is less than 200 mg/dL of blood.

However, measurements of cholesterol are merely one risk factor for cardiovascular disease. Various lifestyle factors and other medical conditions can influence the risk.

With this in mind, even if a person’s cholesterol is in the desirable range, it does not guarantee that they do not have an elevated risk. An individual may wish to discuss their cardiovascular risk with a doctor.