Normal Cholesterol Levels: LDL, HDL and Triglyceride Ranges by Age

What are normal cholesterol levels for adults?

A cholesterol test, also called a lipid panel, measures several numbers in milligrams per deciliter (mg/dL). Here are the desirable ranges for most adults 20 and older:

• Total cholesterol: below 200 mg/dL. 200 to 239 is borderline high, and 240 or higher is high.
• LDL (the "bad" cholesterol): below 100 mg/dL is optimal. 100 to 129 is near optimal, 130 to 159 is borderline high, 160 to 189 is high, and 190 or higher is very high.
• HDL (the "good" cholesterol): 40 mg/dL or higher for men and 50 or higher for women. 60 or higher is linked with lower heart risk.
• Non-HDL cholesterol (total minus HDL): below 130 mg/dL.
• Triglycerides: below 150 mg/dL. 150 to 199 is borderline high, 200 to 499 is high, and 500 or higher is very high.

Most labs print these ranges next to your results. A number in the normal column is reassuring, but it is only part of your heart risk.

What is non-HDL cholesterol?

Non-HDL cholesterol is everything except HDL. It adds up all the particles that can build up in artery walls, including LDL and the cholesterol carried with triglycerides. It is useful when triglycerides are high, because LDL alone can then underestimate risk.

What are normal cholesterol levels by age?

The adult ranges above apply from about age 20 on. Children and teens have lower targets:

• Ages 19 and younger: total cholesterol below 170, LDL below 110, non-HDL below 120 and HDL above 45 mg/dL.
• Triglycerides in children: below 75 mg/dL up to age 9 and below 90 mg/dL from ages 10 to 19.

Cholesterol tends to rise with age. In men it often climbs through the 40s and 50s. In women LDL usually rises after menopause, when estrogen levels fall. The goal ranges for adults do not loosen with age, but what your doctor does about a number depends heavily on age and other risks.

Why your LDL goal depends on your overall risk

Current cholesterol guidance does not treat one LDL number the same for everyone. The same LDL of 140 means something different for a healthy 35-year-old than for a 62-year-old with diabetes and high blood pressure. Doctors look at your whole picture:

• Age and sex
• Blood pressure and whether it is treated
• Diabetes or prediabetes
• Smoking
• HDL and total cholesterol
• Family history of early heart disease or stroke

For adults 30 to 79 without heart disease, these numbers go into a risk calculator called PREVENT, which estimates your chance of a heart attack or stroke over the next 10 and 30 years. The higher your risk, the lower your LDL goal: for many adults it is below 100 mg/dL, and below 70 for people at high risk. A higher estimate also makes cholesterol-lowering medicine more worth discussing.

Risk enhancers that can change the plan

Some things raise risk beyond what the calculator shows. If your risk is borderline or intermediate, these may tip the decision:

• A parent or sibling with heart disease before 55 (men) or 65 (women)
• LDL that stays between 160 and 189 mg/dL
• Metabolic syndrome, chronic kidney disease, or inflammatory conditions such as rheumatoid arthritis, lupus or psoriasis
• A history of preeclampsia or early menopause
• South Asian ancestry
• Triglycerides that stay at 175 mg/dL or higher
• High lipoprotein(a), apolipoprotein B or hs-CRP on blood tests

When the decision is still unclear, a coronary artery calcium (CAC) scan may help. It is a quick CT scan that shows whether calcium has built up in the heart arteries.

When the calculator does not apply

Some people are treated based on their situation, not a calculator score:

• Anyone who has had a heart attack, stroke, stent or bypass, or has known artery disease
• Adults with an LDL of 190 mg/dL or higher
• Most adults with diabetes, depending on age and other risks

What if your LDL is 190 or higher?

An LDL of 190 mg/dL or higher, especially at a young age, may point to an inherited condition called familial hypercholesterolemia. It runs in families and raises LDL from birth, so heart disease can show up decades earlier than usual. Clues include:

• A parent with very high cholesterol or a heart attack at a young age
• LDL above 160 in a child or teen
• Yellowish bumps on tendons, such as the back of the ankle or knuckles, or around the eyelids

Habits still matter, but they are rarely enough on their own at this level. Medicine is usually discussed, and close family members may be advised to get tested too.

How often should you check your cholesterol?

• Children: once between ages 9 and 11, and again between 17 and 21. Earlier if there is a strong family history.
• Adults with normal results and low risk: about every 4 to 6 years.
• Men 45 to 65 and women 55 to 65: every 1 to 2 years is common.
• Adults over 65: every year.
• More often if your numbers are high, you have diabetes or heart disease, or you have just started or changed treatment. A recheck is usually done 4 to 12 weeks after starting a statin.

Many people get their lipid panel as part of a yearly physical with other screening labs.

Read what happens at an annual physical exam and which labs are included

Do you need to fast for a cholesterol test?

Usually not. A non-fasting test is fine for most people. Total, LDL, HDL and non-HDL cholesterol change very little after a meal. Triglycerides can rise after eating, so a fasting test (9 to 12 hours, water only) may be ordered if:

• Your non-fasting triglycerides came back at 400 mg/dL or higher
• An inherited cholesterol problem is suspected
• Your doctor wants a cleaner baseline before starting medicine

Follow the instructions on your lab order. If you are unsure, ask before you go.

What raises cholesterol?

• Foods high in saturated fat, such as fatty red meat, butter, full-fat cheese and many baked goods and fried foods
• Trans fats in some processed and fried foods
• Extra weight, especially around the waist
• Low physical activity
• Smoking, which lowers HDL
• Family history and genetics
• Age and, in women, menopause
• Health conditions such as diabetes, an underactive thyroid, kidney disease and liver disease
• Some medicines, such as steroids and certain diuretics

Because a few of these are medical causes, a high result is a reason to check thyroid, blood sugar, kidney and liver tests as well.

How can you lower cholesterol?

Habits come first

• Cut saturated fat. Swap butter for olive or canola oil and choose fish, chicken, beans and nuts more often than fatty meat.
• Avoid trans fats.
• Eat more soluble fiber: oats, barley, beans, lentils, apples and citrus.
• Fill half your plate with vegetables and fruit, and choose whole grains.
• Move for at least 150 minutes a week, such as a brisk walk most days.
• If you carry extra weight, losing even a modest amount helps.
• Stop smoking, and keep alcohol light.

Give changes about 3 months before you judge them on a lab test.

When medicine is discussed

Statins are the medicines most often used to lower LDL and heart risk. Whether one makes sense depends on your risk level, not just your LDL number. Dr. Munib may discuss a statin if:

• You have heart disease or have had a stroke
• Your LDL is 190 mg/dL or higher
• You are 40 to 75 with diabetes
• Your 10-year risk is intermediate or high, especially with risk enhancers

Statins can cause muscle aches in some people, and many who have trouble with one can take a different statin or a lower dose. Other options, such as ezetimibe, may be added in some patients. Any medicine decision is shared, after talking through benefits, side effects and your preferences.

When should you see a doctor about cholesterol?

• You have never had a lipid panel, or your last one was more than 5 years ago
• Your LDL is 160 or higher, or your triglycerides are 500 or higher
• A parent or sibling had heart disease or a stroke at a young age
• You have diabetes, prediabetes, high blood pressure or kidney disease

High cholesterol does not cause symptoms. Chest pain or pressure, shortness of breath, or sudden weakness, numbness or trouble speaking are emergencies. Call 911.

How Dr. Munib approaches cholesterol

Dr. Munib starts with your actual numbers and your story. She looks at your full lipid panel, blood pressure, blood sugar, weight and family history, and may estimate your 10-year risk. She checks for medical causes such as thyroid or kidney problems and reviews your medicines.

From there, the plan depends on your risk. For many people it is a nutrition and activity plan with a recheck. For others it may include a statin discussion, extra tests such as lipoprotein(a) or a calcium scan, or family testing for inherited high cholesterol. Lipoprotein(a) is mostly inherited, so checking it once in adulthood is now commonly advised.

Learn how Dr. Munib manages high cholesterol, blood pressure and diabetes

Book a preventive checkup with a lipid panel and screening labs

Get your cholesterol checked in Irvine

If you are due for a lipid panel or want help making sense of your results, Dr. Munib can review them with you at our office at 114 Pacifica, Suite 280, Irvine. We are in-network with most PPO plans. Cash-pay visits are $190 for new patients and $150 for returning patients, and labs are billed separately. Call (949) 647-5234 or book online.