In 2001, guidelines from the National Cholesterol Education Panel recommended that all lipid tests be performed after fasting and should measure all four cholesterol components: total cholesterol, HDL, LDL, and triglycerides.

The total cholesterol measurement, as with all lipid measurements taken at all laboratories, will be listed as milligrams per deciliter (mg/dL). In most cases, the higher your total cholesterol, the higher your risk for heart disease. A value of less than 200 mg/dL is desirable, placing you at less risk for heart disease. Levels over 240 mg/dL may put you at almost twice the risk of heart disease as someone with a level less than 200 mg/dL.

High LDL cholesterol levels may be the best predictor of risk of heart disease. If you have known heart disease, peripheral vascular disease (blockages in the blood vessels of the extremities), or diabetes, your LDL cholesterol should be below 100 mg/dL. If you have 2 or more heart-disease risk factors (smoking, high blood pressure, low HDL, a family history of heart disease, are a man over 45 or woman over 55), your LDL should be below 130 mg/dL. If you have none or 1 of the risk factors listed, your LDL cholesterol should be below 160.

HDL cholesterol levels more than or equal to 60 mg/dL will take away the increased risk from one risk factor and decrease your risk of heart disease. Levels below 40 mg/dL add a risk factor.

Triglyceride levels are also becoming an important predictor of risk for heart disease. Even if you have low LDL and high HDL cholesterol, high triglyceride levels may put you at risk. Normal triglyceride levels are less than 150 mg/dL and can be incorrectly elevated if a 9-12 hour fast was not completed.

It is important to discuss your results with your doctor to determine the best therapy given your risk factors and lifestyle.

High LDL, low HDL, and or high triglyceride levels may put you at increased risk for heart disease. By depositing in blood vessels, including the coronary arteries, these components may cause blockages (atherosclerosis) leading to a heart attack or cell death in legs or toes, requiring amputation.

Elevated cholesterol levels may be caused by:

• biliary cirrhosis
• familial hyperlipidemias
• high-cholesterol diet
• hypothyroidism
• nephrotic syndrome
• uncontrolled diabetes

Low cholesterol levels may be caused by:

• hyperthyroidism
• liver disease
• malabsorption (inadequate absorption of nutrients from the intestinal tract)
• malnutrition
• pernicious anemia
• sepsis

• arteriosclerosis of the extremities
• familial dysbetalipoproteinemia
• familial hypercholesterolemia
• hypothyroidism; primary
• hypothyroidism; secondary
• Type 1 or Type 2 diabetes
• primary biliary cirrhosis