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Wait--so maybe my cholesterol isn't that bad?

Let’s talk about your cholesterol. First thing that I tell everyone—high cholesterol doesn’t really mean high cholesterol, and it surely doesn’t meant that you need treatment . Yay, wait, what? So your total cholesterol is a combination of a different types of cholesterol. The two main cholesterols that we look at are your HDL (the good, cardio-protective stuff) and the LDL (the bad stuff, that leads to cholesterol build up and blockage). There are other cholesterol components, and yes they play a part. But in reality, for most people, these are the two we focus on.

Total cholesterol up to 200 is “normal”, anything above that is going to look high. Then we direct our attention to the HDL and LDL numbers. These are those ratios that your doctor might mention when looking at treatment goals.

HLD between 40-60 is normal, anything above 60 is beneficial. Anything below 40, though not going to cause a significant issue, isn’t doing much to help either.

Now let’s look at the LDL, this is where we really put our focus. Most lab ranges for LDL have 129 as the upper limit of normal. If you are healthy, an LDL of up to 160 can still be normal. If that LDL is greater than 190, you doctor SHOULD be starting you on a statin, or at least recommending and conversing about this.

There is a calculator that the American College of Cardiology has created that shows your 10-year risk of an atherosclerotic cardiovascular disease (ASCVD) event. This is how we know if you need treatment. If your risk is greater than 7.5%, your doctor should talk to you about the goals and benefits of medication for treatment.

So, does everyone with high cholesterol need a treatment? No. Recommendations from 10 years ago are not the same they are today. If you have high cholesterol, talk to you doctor. You may not need medication in the way that you used to think!

…until next time

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