Total Cholesterol

What is Total Cholesterol?

Total cholesterol is the sum of all cholesterol types in your blood, including:

• LDL (low-density lipoprotein) — Often called "bad" cholesterol
• HDL (high-density lipoprotein) — Often called "good" cholesterol
• VLDL (very low-density lipoprotein) — Carries triglycerides

While total cholesterol gives a quick snapshot of your lipid status, it's too general on its own. You need to know the breakdown — a high total could mean high protective HDL or high risky LDL.

Normal Ranges

Level	Classification
Below 200 mg/dL	Desirable
200–239 mg/dL	Borderline high
240+ mg/dL	High

These ranges are general guidelines. Individual risk depends on the ratio of HDL to LDL, not just the total.

Why It Matters

Cardiovascular Risk

Cholesterol is a major player in atherosclerosis (arterial plaque buildup). High levels increase risk of heart attack and stroke.

But Context Matters

Total cholesterol alone doesn't tell the whole story. Someone with total cholesterol of 220 might have:

• Scenario A: LDL 160, HDL 40 (concerning)
• Scenario B: LDL 120, HDL 80 (much better)

Both have the same total, but very different cardiovascular risk.

Total Cholesterol vs. LDL vs. HDL

Think of cholesterol as a transport system:

• LDL delivers cholesterol to tissues (including artery walls)
• HDL removes cholesterol from tissues and returns it to the liver

High total cholesterol with high HDL may not be concerning. High total with high LDL is.

What Affects Total Cholesterol

Diet

• Saturated and trans fats raise LDL
• Refined carbohydrates raise triglycerides and lower HDL
• Soluble fiber lowers LDL

Lifestyle

• Regular exercise raises HDL
• Smoking lowers HDL
• Excess weight raises LDL and triglycerides

Genetics

Some people produce more cholesterol regardless of diet (familial hypercholesterolemia).

Medical Conditions

• Hypothyroidism raises cholesterol
• Diabetes affects lipid metabolism
• Kidney and liver disease alter cholesterol

How to Improve Your Cholesterol

• Focus on LDL and HDL individually — Don't just chase a lower total
• Eat more fiber — Oats, beans, vegetables
• Choose healthy fats — Olive oil, nuts, fatty fish
• Exercise regularly — Especially for raising HDL
• Maintain healthy weight
• Don't smoke

How Often to Test

• Adults 20+: Every 4–6 years
• Risk factors present: Every 1–2 years
• Known high cholesterol or on statins: As directed, often annually

Related Biomarkers

• LDL Cholesterol
• HDL Cholesterol
• Triglycerides
• ApoB