About Cholesterol and Heart Health

Recently Revised Cholesterol Guidelines Released by U.S. National Institutes of Health

Updated guidelines for the prevention and management of high cholesterol were released in May 2001 by the National Institutes of Health (a division of the U.S. Department of Health & Human Services) as part of the National Cholesterol Education Program (NCEP). Updates are made when warranted by recent advances in science. The new guidelines are the first major update to the program in nearly a decade. The following summary shows the new guidelines used for those people not having been diagnosed with Coronary Heart Disease or considered to be at high Coronary Heart Disease risk due to family history or other contributing risk factors.

Total cholesterol is the measurement of all cholesterol present in your blood, including HDL, LDL, triglycerides, and all other carriers.

Some test results will include a "cholesterol ratio". This number is total cholesterol divided by HDL cholesterol. For example, a total cholesterol level of 200 mg/dL divided by an HDL cholesterol level of 50 mg/dL would result in a ratio of 4:1. While this ratio offers a more complete picture than the total cholesterol number alone, absolute numbers for each of the blood lipids will be most helpful to your physician in determining heart health and an appropriate course of treatment.
A person with a "high" total cholesterol level has more than twice the risk of heart disease compared to someone whose total cholesterol is "desirable".

Total Cholesterol Level Guidelines
Less than 200 mg/dL	Desirable
200 to 239 mg/dL	Borderline-high
240 mg/dL and above	High

High density lipoprotein (HDL) is often termed the "good" cholesterol. It acts like a scavenger in the body, gathering plaque and carrying it to the liver to be eliminated. Its role in preventing plaque deposits creates its reputation as a protector of your heart.

HDL-Cholesterol Level Guidelines
Less than 40 mg/dL	Low
40 to 59 mg/dL	Near Optimal
60 mg/dL and above	Optimal

Low density lipoprotein (LDL) is the culprit in the blood lipid equation. High LDL levels can contribute to plaque formation. The more LDL in your blood, the greater your risk for plaque buildup, which can eventually block the arteries. This is why LDL is commonly referred to as being "bad" cholesterol.

LDL-Cholesterol Level Guidelines
Less than 100 mg/dL	Optimal
100 to 129 mg/dL	Near Optimal
130 to 159 mg/dL	Borderline High
160 to 189 mg/dL	High
190 mg/dL and above	Very High

Triglycerides (TG) are the form in which fat is stored in the body for use as energy. High levels of triglycerides in the blood indicate a risk for heart disease. Excessive triglycerides often accumulate around major organs, including the heart, kidneys and liver. In addition to the impact on the body’s vascular system, accumulated triglyceride deposits can impair the function of the liver. This is often referred to as "fatty liver syndrome". Maintenance of the liver, the body’s waste purification system, is essential for normal cholesterol processing.

Triglyceride Level Guidelines
Less than 150 mg/dL	Normal
150 to 199 mg/dL	Borderline-high
200-499 mg/dL	High
500 mg/dL or above	Very High

  Comparison of Previous and New NCEP Guidelines

  Blood Lipid Level Previous Guidelines New Guidelines

  LDL-cholesterol

    optimal < 130 mg/dL < 100 mg/dL

    above optimal n/a 100-129 mg/dL

    borderline high 130-159 mg/dL 130-159 mg/dL

    high 160 mg/dL 160-189 mg/dL

    very high n/a > 190 mg/dL

  HDL-cholesterol

    minimum > 35 mg/dL > 40 mg/dL

**From the Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Cholesterol Education Program (NCEP)
National Heart, Lung, and Blood Institute (NHLBI)
National Institutes of Health (NIH)

The new guidelines reflect:

more aggressive cholesterol-lowering treatment
better identification of those at high risk for a heart attack
identification of a "metabolic syndrome" of risk factors linked to insulin resistance, which dramatically increase risk
use of a complete lipoprotein profile as the first test for high cholesterol

For more information, see the Related Links page to visit the NCEP website.

Should you be concerned?

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