What's a Desirable Level of Total Blood Cholesterol in Adults?

How high is too high and how can you lower it?

Atherosclerosis, caused by cholesterol.
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A desirable level of total blood cholesterol in adults is 150 mg/dL or less, according to the American Heart Association. Blood cholesterol levels from 150 to 199 mg/dL are considered borderline high; levels of 200 mg/dL and above indicate high blood cholesterol levels.﻿﻿ Why should you care? The higher your blood cholesterol, the higher your risk of developing heart disease or having a heart attack.

What Is Cholesterol?

Cholesterol is a waxy, fat-like substance in your blood and in all the cells of your body. When it builds in the inner walls of your arteries, it hardens and turns into plaque. That plaque can narrow the artery walls and reduce blood flow, which can cause blocks that can lead to blood clots, heart attacks, or strokes.

Good vs. Bad Cholesterol

Here's the surprise: Your body actually needs cholesterol to stay healthy, and it's entirely capable of making all the cholesterol it needs. What can cause trouble is a diet of less-than-ideal foods and, in some cases, your family health history.

Cholesterol Types

  • Low-density lipoprotein (LDL) cholesterol: When too much LDL ("bad") cholesterol is present in your bloodstream, it can clog your arteries and put you at risk for a heart attack or stroke. It’s produced naturally by the body, but it is also inherited from your parents or even grandparents and can cause you to create too much. Eating a diet high in saturated fat, trans fats, and cholesterol also increases your level of LDL.
  • High-density lipoprotein (HDL) cholesterol: High levels of HDL ("good") cholesterol remove excess plaque from your arteries, slowing its buildup and helping to protect against a heart attack. Low levels, however, can actually increase your risk. The higher your HDL number, the lower your risk of developing heart disease or having a heart attack.﻿﻿
  • Triglycerides: A form of fat made in the body that circulates in the blood. High triglycerides may raise the risk of heart disease and stroke.


Risk Factors

Your risk of developing heart disease or having a heart attack depends on the number of risk factors you have in addition to high blood cholesterol; generally, the higher your LDL level the higher your risk of developing heart disease or having a heart attack. If you already have heart disease, your risk is significantly higher than someone who does not have heart disease. If you have diabetes, your risk is greater as well. Other major risk factors that have an impact on your cholesterol include:

  • Your diet. While saturated fat in your diet is the main source that may cause your blood cholesterol levels to rise, cholesterol in food sources is also important; reducing theses dietary sources of cholesterol can help to lower your blood cholesterol levels.
  • Your weight. If you are overweight, your risk for heart disease and high blood cholesterol is greatly increased. If you lose weight you can lower your LDL and total cholesterol levels and help to increase your HDL and reduce your triglyceride levels.
  • Being physically inactive. Another risk factor for heart disease, as well as a contributing factor in being overweight, is a lack of regular physical activity. Regular physical activity helps to lower LDL and raise HDL cholesterol. The American Heart Association recommends at least 150 minutes per week of moderate-intensity aerobic activity (or 75 minutes per week of vigorous aerobic activity), as well as moderate- to high-intensity muscle-strengthening activity (resistance training or weights) at least two days per week.﻿﻿
  • Your gender: Women are particularly susceptible to the age factor since before menopause total cholesterol levels are lower than men of the same age; however, post-menopausal women often see an increase in LDL levels. You may also be genetically predisposed to high blood cholesterol levels since high cholesterol can run in families.
  • Smoking cigarettes. If you smoke, stop; if you don't smoke, don't start!
  • High blood pressure. If your blood pressure is 130/90 mmHg or higher, or if you are already taking blood pressure medication, you are at increased risk for heart disease or heart attack.
  • Low HDL cholesterol. HDL levels of less than 40 mg/dL increase your risk; while HDL levels of 60 mg/dL or higher do not increase your risk of heart disease or heart attack.
  • Family history. If your family history includes heart disease in your father or brother before age 55 or heart disease in mother or sister before age 65, your risk is increased.
  • Age. The older we get, the higher blood cholesterol levels will rise. Men who are 45 and older and women who are 55 and older face a significant risk of developing heart disease or heart attack if their cholesterol levels are high.﻿﻿

Because factors such as age, gender, and heredity are things you cannot change, controlling your diet, weight, and amount of physical activity are even more important. Your doctor may also recommend cholesterol-lowering drug treatment in addition to these heart-healthy lifestyle modifications.

The TLC Diet

The Therapeutic Lifestyle Changes, also known as the TLC diet, is a special cholesterol-lowering diet plan that includes physical activity and weight management. The TLC diet is a low-saturated-fat, low-cholesterol diet that includes less than 7% of calories from saturated fat and less than 200 mg of dietary cholesterol daily.﻿﻿ The number of calories allowed on the TLC diet is individualized based on the number of calories needed to lose weight or maintain weight while avoiding weight gain.

Sometimes reducing saturated fats and dietary cholesterol is not enough to lower your LDL enough and increasing the amount of soluble fiber may be necessary. Other foods that contain plant stanols or plant sterols such as cholesterol-lowering margarines and salad dressings can be added to the TLC diet to further help boost its effectiveness.

Foods low in saturated fats include:

  • Fat-free or 1% fat dairy products
  • Lean meats
  • Fish
  • Poultry with the skin removed
  • Fruits
  • Vegetables
  • Soft margarine, either liquid or in a tub (read the labels to find the ones that are low in saturated fats, as well as ones that contain little or no trans fat.)

Foods high in cholesterol that should be limited include:

  • Liver and other organ meats
  • Egg yolks
  • Full-fat dairy products

Sources of soluble fiber include:

  • Oats
  • Fruits such as oranges and pears
  • Vegetables such as brussels sprouts and carrots
  • Dried peas and beans

The TLC Diet guide can be accessed for free as a pdf booklet to read online or print out or can be ordered in print form from the National Heart, Lung, and Blood Institute of the National Institutes of Health.﻿﻿

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Article Sources

  1. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the management of blood cholesterol. Circulation. 2018;:CIR0000000000000625. doi:10.1161/CIR.0000000000000625

  2. American Heart Association. Understanding your risks to prevent a heart attack. June 30, 2016.

  3. American Heart Association. American heart association recommendations for physical activity in adults and kids. Updated April 18, 2018.

  4. National Heart, Lung, and Blood Institute; U.S. Department of Health and Human Services. Ischemic heart disease.

  5. U.S. Departement of Health and Human Services. National Institutes of Health National Heart, Lung, and Blood Institute. Your guide to lowering your cholesterol with TLC. Updated 2005.