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Total Cholesterol

Lipids Biomarker

Sample Needed

Collection Type: Blood

Body System

Related System: Lipids

Overview

Total cholesterol is the sum concentration of all cholesterol carried in the blood (including LDL, HDL and VLDL components). The test measures circulating cholesterol, a lipid essential for cell membranes, steroid hormone and bile acid synthesis. It is used to screen for and monitor risk of atherosclerotic cardiovascular disease (ASCVD) and to detect inherited lipid disorders. Testing is often prompted by risk factors (smoking, obesity, diabetes, hypertension), unexplained xanthomas, or routine health checks. Levels vary with age and sex (tend to rise with age; premenopausal women often have lower levels than men), genetics (familial hypercholesterolemia), diet, pregnancy and certain medications or illnesses.

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Test Preparation

No special preparation is required

Why Do I Need This Test

Included in: Lipid profile (lipids panel).
Symptoms prompting test: chest pain, family history of early heart disease, tendon xanthomas, or routine cardiovascular risk assessment.
Diagnoses/monitoring: cardiovascular risk stratification, response to lipid-lowering therapy, screening for familial hypercholesterolemia.
Reasons for abnormal levels: dietary saturated fat, obesity, diabetes, hypothyroidism, certain drugs, genetic disorders.
Biological meaning: high values indicate increased atherogenic particle load and ASCVD risk; very low values may reflect malnutrition, liver disease or hyperthyroidism.
Lifestyle/family history: sedentary lifestyle, high‑fat diet, alcohol, smoking; family history of early heart attacks suggests testing.

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Understanding Test Results

Desirable: total cholesterol <200 mg/dL (<5.2 mmol/L) lower cardiovascular risk when accompanied by favorable HDL/LDL values.
Borderline high: 200–239 mg/dL (5.2–6.1 mmol/L) modestly increased ASCVD risk; assess other risk factors and lipoprotein fractions.
High: ≥240 mg/dL (≥6.2 mmol/L) elevated risk of atherosclerosis and coronary artery disease; consider lifestyle change and further lipid subfraction testing.
Very high: ≥300 mg/dL (≥7.8 mmol/L) raises concern for familial hypercholesterolemia or severe dyslipidaemia; warrants specialist evaluation.
Low values: total cholesterol well below typical ranges (for example <120 mg/dL) can occur with malnutrition, chronic illness, liver disease or hyperthyroidism and may require investigation if unexplained.
Interpretation must consider LDL, HDL, triglycerides, age, sex, and overall cardiovascular risk to guide management.

Normal Range

<200 mg/dL OR <5.2 mmol/L

FAQs

Q: What is the normal range for total cholesterol?

A: Normal (desirable) total cholesterol for adults is below 200 mg/dL. Levels 200–239 mg/dL are considered borderline high, while 240 mg/dL and above are high and linked to greater cardiovascular risk. Clinicians interpret results alongside HDL, LDL, triglycerides, and individual risk factors to guide treatment or lifestyle changes. Adults should check levels regularly as advised by their healthcare provider.

Q: What happens if total cholesterol is high?

A: High total cholesterol increases risk of atherosclerosis—fatty plaque buildup in arteries—which narrows vessels and reduces blood flow. Over time this raises risk of coronary artery disease, heart attack, stroke, and peripheral artery disease. High cholesterol is often asymptomatic until complications occur. Risk worsens with smoking, high blood pressure, diabetes, and age. Management includes diet, exercise, weight control, and cholesterol-lowering medications when needed.

Q: Should I worry about total cholesterol?

A: Total cholesterol is a useful screening number but not the whole picture. High total cholesterol can signal increased heart disease risk, but LDL, HDL, triglycerides, and personal risk factors (age, blood pressure, smoking, diabetes, family history) matter more. Discuss your full lipid panel and overall cardiovascular risk with your clinician. Lifestyle changes—diet, exercise, quitting smoking—and, if needed, medications can lower risk.

Q: Is total cholesterol both HDL and LDL?

A: Total cholesterol is a single lab number that combines cholesterol carried by different lipoproteins primarily HDL (\

Q: How to reduce total cholesterol?

A: To lower total cholesterol: eat a heart‑healthy diet—limit saturated/trans fats and processed foods, choose lean proteins, oily fish, plenty of fruits, vegetables, whole grains and soluble fiber, and use plant stanols/sterols. Maintain a healthy weight, do at least 150 minutes of moderate exercise weekly, stop smoking and limit alcohol. If lifestyle changes aren’t enough, see your clinician about medication and checks.

Q: What is normal cholesterol by age?

A: For children and teens (0–19): total cholesterol <170 mg/dL is acceptable; 170–199 borderline; ≥200 high. For adults 20+: desirable total <200 mg/dL; 200–239 borderline; ≥240 high. LDL optimal <100 mg/dL. HDL ≥40 mg/dL (men) and ≥50 mg/dL (women) is protective. Triglycerides normal <150 mg/dL. Individual targets may be lower with higher cardiovascular risk.