Facts About Blood Cholesterol

Table of Contents

Why Blood Cholesterol Matters
The Blood Cholesterol--Heart Disease Connection
Other Risk Factors for Heart Disease
Who Can Benefit From Lowering Blood Cholesterol?
Cholesterol--In Your Blood, In Your Diet
LDL- and HDL-Cholesterol: The Bad and The Good
Things That Affect Blood Cholesterol
Have Your Blood Cholesterol Checked
Guidelines For Heart-Healthy Living
Making The Guidelines Work: Eat the Heart-Healthy Way
Make Physical Activity Part of Your Routine
Lose Weight Sensibly
In Case You Were Wondering. . .

What About Cholesterol Levels in Children?
How High Is a Child's "High" Blood Cholesterol?
Should You Know Your Cholesterol Ratio?
What Are Triglycerides?
Will Lowering My Blood Cholesterol Help Me Live Longer?
Is It Safe To Eat in a Heart-Healthy Way?
How Much Will Your Cholesterol Levels Change?
How To Find Out More

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Home Page   Cholesterol Information for the General Public

Why Blood Cholesterol Matters

Blood cholesterol plays an important part in deciding a person's chance or risk of getting coronary heart disease (CHD). The higher your blood cholesterol level, the greater your risk. That's why high blood cholesterol is called a risk factor for heart disease. Did you know that heart disease is the number one killer of men and of women in the United States? About a half million people die each year from heart attacks caused by CHD. Altogether 1.25 million heart attacks occur each year in the United States.

 Even if your blood cholesterol level is close to the desirable range, you can lower it and reduce your risk of getting heart disease. Eating in a heart-healthy way, being physically active, and losing weight if you are overweight are things everyone can do to help lower their levels. This fact sheet will show you how. But first, a few things you ought to know . . .

The Blood Cholesterol--Heart Disease Connection

When you have too much cholesterol in your blood, the excess builds up on the walls of the arteries that carry blood to the heart. See figure 1. This buildup is called "atherosclerosis" or "hardening of the arteries." It narrows the arteries and can slow down or block blood flow to the heart. With less blood, the heart gets less oxygen. With not enough oxygen to the heart, there may be chest pain ("angina" or "angina pectoris"), heart attack ("myocardial infarction"), or even death. Cholesterol buildup is the most common cause of heart disease, and it happens so slowly that you are not even aware of it. The higher your blood cholesterol, the greater your chance of this buildup.

Other Risk Factors for Heart Disease

A high blood cholesterol level is not the only thing that increases your chance of getting heart disease. Here is a list of known risk factors:
  The more risk factors you have, the greater your chance of heart disease. Fortunately, most of these risk factors are things you can do something about.

Who Can Benefit From Lowering Blood Cholesterol?

Almost everyone can benefit from lowering his or her blood cholesterol. Lowering cholesterol slows the fatty buildup in the arteries, and in some cases can help reduce the buildup already there. And, if you have two or more other risk factors for heart disease or already have heart disease, you have a great deal to gain from lowering your high blood cholesterol. In this case, lowering your level may greatly reduce your risk of any more heart problems.

 Many Americans have had success in lowering their blood cholesterol levels. From 1978 to 1990, the average blood cholesterol level in the U.S. dropped from 213 mg/dL to 205 mg/dL.

Cholesterol--In Your Blood, In Your Diet

Cholesterol is a waxy substance found in all parts of your body. It helps make cell membranes, some hormones, and vitamin D. Cholesterol comes from two sources: your body and the foods you eat. Blood cholesterol is made in your liver. Your liver makes all the cholesterol your body needs. Dietary cholesterol comes from animal foods like meats, whole milk dairy foods, egg yolks, poultry, and fish. Eating too much dietary cholesterol can make your blood cholesterol go up. Foods from plants, like vegetables, fruits, grains, and cereals, do not have any dietary cholesterol.

LDL- and HDL-Cholesterol: The Bad and The Good

Just like oil and water, cholesterol and blood do not mix. So, for cholesterol to travel through your blood, it is coated with a layer of protein to make a "lipoprotein." Two lipoproteins you may have heard about are low density lipoprotein (LDL) and high density lipoprotein (HDL). LDL-cholesterol carries most of the cholesterol in the blood. Remember, when too much LDL-cholesterol is in the blood, it can lead to cholesterol buildup in the arteries. That is why LDL-cholesterol is called the "bad" cholesterol. HDL-cholesterol helps remove cholesterol from the blood and helps prevent the fatty buildup. So HDL-cholesterol is called the "good" cholesterol.

Things That Affect Blood Cholesterol

Your blood cholesterol level is influenced by many factors. These include:

Have Your Blood Cholesterol Checked

All adults age 20 and over should have their blood cholesterol (also called "total" blood cholesterol) checked at least once every 5 years. If an accurate HDL-cholesterol measurement is available, HDL should be checked at the same time. If you do not know your total and HDL levels, ask your doctor to measure them at your next visit.

 Total and HDL-cholesterol measurements require a blood sample that is taken from your arm or finger. You do not have to fast for this test. If you have had your total and HDL-cholesterol checked, check the chart to see how they measure up.

 Blood cholesterol levels of under 200 mg/dL are called "desirable" and put you at lower risk for heart disease. Any cholesterol level of 200 mg/dL or more increases your risk; over half the adults in the United States have levels of 200 mg/dL or greater. Levels between 200 and 239 mg/dL are "borderline-high." A level of 240 mg/dL or greater is "high" blood cholesterol. A person with this level has more than twice the risk of heart disease compared to someone whose cholesterol is 200 mg/dL. About one out of every five American adults has a high blood cholesterol level of 240 mg/dL or greater.

 Unlike total cholesterol, the lower your HDL, the higher your risk for heart disease. An HDL level less than 35 mg/dL increases your risk for heart disease. The higher your HDL level, the better.

 In certain cases, it may be necessary to have your LDL-cholesterol checked, too, because it is a better predictor of heart disease risk than your total blood cholesterol. You will need to fast. That means you can have nothing to eat or drink but water, coffee, or tea, with no cream or sugar, for 9 to 12 hours before the test.

 If your doctor has checked your LDL level, use the chart below to see how it measures up.
LDL-Cholesterol Categories
Less than 130 mg/dL Desirable
130 to 159 mg/dL Borderline-High Risk
160 mg/dL and above High Risk

Note: These categories apply to adults age 20 and above.

If your LDL-cholesterol level is high or borderline-high and you have other risk factors for heart disease, your doctor will likely plan a treatment program for you. Following an eating plan low in saturated fat and cholesterol and increasing your physical activity is usually the first and main step of treatment. Some people will also need to take medicine. (If you have high blood cholesterol and would like more details on what it means and what you should do about it, contact the NHLBI Information Center.)

Guidelines For Heart-Healthy Living

Whatever your blood cholesterol level, you can make changes to help lower it or keep it low and reduce your risk for heart disease. These are guidelines for heart-healthy living that the whole family (including children ages 2 and above) can follow:

1) Choose foods low in saturated fat.

All foods that contain fat are made up of a mixture of saturated and unsaturated fats. Saturated fat raises your blood cholesterol level more than anything else you eat. The best way to reduce blood cholesterol is to choose foods lower in saturated fat. One way to help your family do this is by choosing foods such as fruits, vegetables, and whole grains--foods naturally low in total fat and high in starch and fiber.

2) Choose foods low in total fat.

Since many foods high in total fat are also high in saturated fat, eating foods low in total fat will help your family eat less saturated fat. When you do eat fat, substitute unsaturated fat--either polyunsaturated or monounsaturated--for saturated fat. Fat is a rich source of calories, so eating foods low in fat will also help you eat fewer calories. Eating fewer calories can help you lose weight--and, if you are overweight, losing weight is an important part of lowering your blood cholesterol. (Consult your family doctor if you have a concern about your child's weight.)

3) Choose foods high in starch and fiber.

Foods high in starch and fiber are excellent substitutes for foods high in saturated fat. These foods--breads, cereals, pasta, grains, fruits, and vegetables--are low in saturated fat and cholesterol. They are also lower in calories than foods that are high in fat. But limit fatty toppings and spreads like butter and sauces made with cream and whole milk dairy products. Foods high in starch and fiber are also good sources of vitamins and minerals.

 When eaten as part of a diet low in saturated fat and cholesterol, foods with soluble fiber--like oat and barley bran and dry peas and beans--may help to lower blood cholesterol.

4) Choose foods low in cholesterol.

Remember, dietary cholesterol can raise blood cholesterol, although usually not as much as saturated fat. So it's important for your family to choose foods low in dietary cholesterol. Dietary cholesterol is found only in foods that come from animals. And even if an animal food is low in saturated fat, it may be high in cholesterol; for instance, organ meats like liver and egg yolks are low in saturated fat but high in cholesterol. Egg whites and foods from plant sources do not have cholesterol.

5) Be more physically active.

Being physically active helps improve blood cholesterol levels: it can raise HDL and lower LDL. Being more active also can help you lose weight, lower your blood pressure, improve the fitness of your heart and blood vessels, and reduce stress. And being active together is great for the entire family.

6) Maintain a healthy weight, and lose weight if you are overweight.

People who are overweight tend to have higher blood cholesterol levels than people of a healthy weight. Overweight adults with an "apple" shape--bigger (pot) belly--tend to have a higher risk for heart disease than those with a "pear" shape--bigger hips and thighs.

Whatever your body shape, when you cut the fat in your diet, you cut down on the richest source of calories. A family eating pattern high in starch and fiber instead of fat is a good way to help control weight. Do not go on crash diets that are very low in calories since they can be harmful to your health. If you are overweight, losing even a little weight can help to lower LDL-cholesterol and raise HDL-cholesterol.

Making The Guidelines Work: Eat the Heart-Healthy Way

Look at how your family eats now and begin to plan. You don't have to cut out all high saturated fat, high cholesterol foods. Just substitute one or two low saturated fat or low cholesterol foods each day, and soon you will reach your goal of heart-healthy eating for you and your family. By making the changes slowly, you are more likely to stick with your new eating plan.

 Choose heart-healthy foods from different food groups--meat, poultry, fish, and shellfish; dairy foods; eggs; fruits and vegetables; breads, cereals, pasta, rice and other grains, and dry peas and beans; fats and oils; and sweets and snacks. Choose the number and size of portions to help you reach and stay at your desirable weight. Eating a variety of foods each day will help your whole family get the nutrients you need. Use these tips to choose foods low in saturated fat and cholesterol:

 Meat, poultry, fish, and shellfish

Buying tips: Preparation tips:

Dairy foods

Buying tips:

Preparation tips:


Buying tips:
  Preparation tips:

Fruits and vegetables

Buying tips:
  Preparation tips:

Breads, cereals, pasta, rice and other grains, and dry peas and beans

Buying tips:
  Preparation tips:

Fats and oils

Buying tips:
  Preparation tips:

Sweets and snacks (have only now and then)

Buying tips:
  Preparation tips:

Read food labels

Reading food labels can help you and your family eat the heart-healthy way. Food labels have two important parts: the nutrition label and the ingredients list. Also, some labels have claims like "low fat" or "light."

 Look on the nutrition label for the amount of saturated fat, total fat, cholesterol, and total calories in a serving of the product. Use this information to compare similar products and find the ones with the smallest amounts.

 If there is no nutrition label, look for the list of ingredients. Here, the ingredient in the greatest amount is shown first and the ingredient in the least amount is shown last. So, to choose foods low in saturated fat or total fat, go easy on products that list fats or oil first--or that list many fat and oil ingredients.

In addition to the nutrition information and ingredients list, some food packages have claims like "low fat," "light," or "fat free." See table 2 for a list of these claims and what they mean. And for more detailed information on reading labels, order Step by Step: Eating To Lower Your High Blood Cholesterol.

Eat out the heart-healthy way

Whether your family is eating on the run or sitting down together to a full course meal, you can make choices that are low in saturated fat and cholesterol. These tips will help:

Make Physical Activity Part of Your Routine

Regular physical activity improves cholesterol levels: It helps to lower LDL and raise HDL. It can also help you lose weight, if you are overweight. But you don't have to train like a long distance runner to benefit: Even doing any physical activity for just a few minutes each day is better than none at all. Try to build physical activity into your daily routine in ways like these:
  Try to be active as a family: Take trips that include hiking, swimming, or skiing. Use your back yard or the park for games like badminton, basketball, football, or volleyball.

 Vigorous activities like brisk walking, running, swimming, or jumping rope are called "aerobic." They are especially good for the health of your heart and can burn off extra calories. Aerobic activities can condition your heart if you do them for at least 30 minutes, three to four times a week. But even if you don't have 30 minutes, three to four times a week, try to find two 15-minute periods or even three 10-minute periods.

 Most people do not need to see a doctor before they start being active, especially if they start off slowly and work up gradually to a sensible plan. But you should get advice from your doctor beforehand if any of these conditions apply to you: if you have a medical condition; if you have pains or pressure in the chest or shoulder area; if you tend to feel dizzy or faint; if you get very breathless after a mild workout; and if you are middle-aged or older, have not been physically active, and plan a fairly strenuous exercise program.

Lose Weight Sensibly

If you are overweight, losing even 5 to 10 pounds can improve your blood cholesterol levels. But don't go on a crash diet: The healthiest and longest-lasting weight loss happens when you take it slowly, losing 1/2 to 1 pound a week. If you cut 500 calories a day by eating less and being more active, you should lose 1 pound (which amounts to about 3,500 calories) in a week. (Overweight children and adolescents should not be put on strict weight loss diets; consult your family doctor if this is a concern.)

 A heart-healthy eating plan can help you lose weight because cutting down on fat is a good way to cut down on calories. And, if you are overweight, you should take care to eat foods high in starch and fiber (like vegetables, fruits, and breads and cereals) instead of high fat foods. Choose low fat and low calorie items from each food group; table 1 will help. Finally, you'll need to limit the amount--or serving sizes--as well.

 But there's more to losing weight than just eating less. The most successful weight-loss programs are those that combine diet and increased physical activity. A low fat, low calorie way of eating combined with increased physical activity can help you lose more weight and keep it off longer than either way can achieve alone. See the box for some ideas for physical activities.

In Case You Were Wondering . . .

. . . What About Cholesterol Levels in Children?

Most children do not need to have their blood cholesterol checked. But, all children should be encouraged to eat in a heart-healthy way, along with the rest of the family. Children who should be tested at age 2 or older include those who have any of these conditions:
  Also, if the parent's medical history is not known, the doctor may want to check the child's blood cholesterol level, especially in children with other risk factors like obesity.

. . . How High Is a Child's "High" Blood Cholesterol?

If your child does need to have a cholesterol test, it can be part of a regular doctor's visit. Your doctor will likely measure your child's total cholesterol level first. However, if your family has a history of early heart disease, the doctor may measure the LDL-cholesterol level right from the start. Otherwise, your child's LDL-cholesterol level should be measured if his or her total cholesterol level was checked and found to be 170 mg/dL or greater. The blood cholesterol categories for children from families with high blood cholesterol or early heart disease are shown in the box below.
Total and LDL-Cholesterol Levels in Children and Teenagers From Families With High Blood Cholesterol or Early Heart Disease
Total Cholesterol LDL-Cholesterol
Less than 170 mg/dL
170 to 199 mg/dL
200 mg/dL or greater
Less than 110 mg/dL
110-129 mg/dL
130 mg/dL or greater
Note: These blood cholesterol levels apply to children 2 to 19 years old.

. . . Should You Know Your Cholesterol Ratio?

When you have your cholesterol checked, some laboratories may give you a number called a cholesterol ratio. This number is your total cholesterol or LDL level divided by your HDL level. The idea is that combining the levels into one number gives you an overall view of your risk for heart disease. But the ratio is too general: It is more important to know the value for each level separately because LDL- and HDL-cholesterol both predict your risk of heart disease.

. . . What Are Triglycerides?

Triglycerides are the form in which fat is carried through your blood to the tissues. The bulk of your body's fat tissue is in the form of triglycerides. Your triglycerides are measured whenever your LDL-cholesterol is checked. Triglyceride levels less than 200 mg/dL are considered normal.

 It is not clear whether high triglycerides alone increase your risk of heart disease. But many people with high triglycerides also have high LDL or low HDL levels, which do increase the risk of heart disease.

. . . Will Lowering My Blood Cholesterol Help Me Live Longer?

Many studies show that lowering cholesterol levels reduces the risk of illness or death from heart disease, which kills more men and women each year than any other illness. If you have heart disease, lowering your cholesterol level will probably help you to live longer. If you don't have heart disease, the studies so far do not show that you will live longer, but you will definitely reduce your risk of illness and death from heart attack.

. . . Is It Safe To Eat in a Heart-Healthy Way?

Eating in a way that is lower in saturated fat and cholesterol is safe and can be more nutritious than an eating plan higher in saturated fat and cholesterol. It will even meet the higher needs that women, children, and teenagers have for nutrients like calcium, iron, and zinc, and an eating pattern lower in total fat will reduce the risk for other chronic diseases, such as cancer. And an eating pattern lower in saturated fat, total fat, and cholesterol can still provide enough calories for the proper growth and development of children ages 2 and above. Children younger than 2 years have special nutrient needs for fat.

. . . How Much Will Your Cholesterol Levels Change?

Generally your blood cholesterol level should begin to drop a few weeks after you start eating the heart-healthy way. How much it drops depends on the amount of saturated fat you used to eat, how high your high blood cholesterol is, how much weight you lose if you are overweight, and how your body responds to the changes you make. Over time, you may reduce your cholesterol level by 5 to 35 mg/dL or even more.

How To Find Out More

The National Cholesterol Education Program (NCEP) has other booklets for the public and health professionals on lowering blood cholesterol. The NCEP has booklets for adults with high blood cholesterol, age-specific booklets for children and adolescents with high blood cholesterol and their parents, and a pamphlet on physical activity and how to get started. To order publications on cholesterol, weight and physical activity or request a catalog, write to the address below:
NHLBI Information Center
P.O. Box 30105
Bethesda, MD 20824-0105



Public Health Service
National Institutes of Health
National Heart, Lung, and Blood Institute

 NIH Publication No. 94-2696
Originally Printed 1985
Previously Revised 1994
Reprinted August 1996

 National Cholesterol Education Program
NHLBI Obesity Education Initiative
Coordinated by the National Heart, Lung, and Blood Institute