Good cholesterol levels for most adults mean total cholesterol below 200 mg/dL, LDL (“bad”) cholesterol below 100 mg/dL, and HDL (“good”) cholesterol at 60 mg/dL or higher. But these targets shift depending on your age, sex, and heart disease risk, so the number that matters most for you may not be the same as for someone else.
The Numbers That Matter
A standard lipid panel measures four things: total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. Here’s what’s considered healthy for adults age 20 and older:
- Total cholesterol: Below 200 mg/dL
- LDL cholesterol: Below 100 mg/dL
- HDL cholesterol: 60 mg/dL or higher is ideal. Below 40 mg/dL in men or below 50 mg/dL in women is considered low.
- Triglycerides: Below 150 mg/dL
For children and teens (age 19 and younger), the thresholds are tighter: total cholesterol below 170 mg/dL, LDL below 110 mg/dL, HDL above 45 mg/dL, and triglycerides below 90 mg/dL.
Why LDL Targets Depend on Your Risk
LDL is the number doctors pay the most attention to, because it’s the type of cholesterol that builds up inside artery walls and drives heart disease. But the target your doctor sets for you depends on how likely you are to have a heart attack or stroke in the next ten years.
For people at borderline or intermediate risk (a 3% to 10% chance over ten years), current guidelines from the American Heart Association and the American College of Cardiology set the goal at LDL below 100 mg/dL. If your risk is high (10% or greater), the target drops to below 70 mg/dL. And for people who already have heart disease and are at very high risk of another event, the goal is even more aggressive: LDL below 55 mg/dL. Having any amount of calcium buildup visible in the coronary arteries on a scan also supports aiming for LDL below 100, with lower targets as the calcium score rises.
What HDL Actually Does
HDL cholesterol earns its “good” label because of a process called reverse cholesterol transport. HDL particles travel through your bloodstream, pick up excess cholesterol from your tissues and artery walls, and carry it back to the liver. The liver then either recycles it or removes it from your body through bile. This cleanup job is why higher HDL levels are linked to lower heart disease risk.
For men, HDL should stay at or above 40 mg/dL at a minimum, though 60 to 80 is the protective range. For women, the floor is 50 mg/dL. Interestingly, HDL above 80 mg/dL may not offer additional benefit and could signal other issues, so more isn’t always better.
Non-HDL Cholesterol and Ratios
Your non-HDL cholesterol is simply your total cholesterol minus your HDL. It captures all the cholesterol types that contribute to artery buildup, not just LDL, which makes it a useful single number to track. The optimal level for most people is below 130 mg/dL. If you have a history of heart disease, your doctor will likely want it lower.
Another way to gauge your risk is the ratio of total cholesterol to HDL. Most doctors want this ratio below 5:1. A ratio below 3.5:1 is considered very good. So if your total cholesterol is 200 and your HDL is 60, your ratio is about 3.3:1, which is in excellent territory.
Triglycerides: The Often Overlooked Number
Triglycerides aren’t cholesterol, but they show up on the same blood test and play a role in heart disease risk. They’re the most common form of fat in your blood, and levels tend to rise with diets high in sugar, refined carbohydrates, and alcohol. Healthy is below 150 mg/dL. Borderline high is 150 to 199 mg/dL, high is 200 to 499 mg/dL, and very high (above 500 mg/dL) raises the risk of pancreas inflammation on top of cardiovascular problems.
Differences by Age and Sex
Women tend to have higher HDL than men throughout most of life, which is part of why their minimum HDL threshold is set higher (50 vs. 40 mg/dL). After menopause, however, LDL levels often rise as the protective effects of estrogen decline. This is one reason women are recommended to start testing every one to two years at age 55, while men shift to that frequency at 45.
For adults between 20 and their mid-40s (or mid-50s for women), testing every five years is generally sufficient. After age 65, annual testing is recommended for everyone. Children should get their first lipid panel between ages 9 and 11, then every five years. If there’s a family history of high cholesterol, heart attack, or stroke, testing can start as early as age 2.
Do You Need to Fast Before the Test?
For years, a 9- to 12-hour fast was standard before any cholesterol test. That guidance has loosened considerably. Major medical organizations, including the ACC, AHA, and the Canadian Cardiovascular Society, now consider a non-fasting test equally valid for screening purposes. Total cholesterol and HDL barely change after a meal. The main exception is if your triglycerides are known to be significantly elevated, in which case fasting gives a more accurate reading.
Physical Signs of Very High Cholesterol
High cholesterol almost never causes symptoms, which is why blood testing is the only reliable way to know your levels. In rare cases, people with genetic forms of very high cholesterol develop visible signs: waxy, yellowish fatty deposits on the skin called xanthomas, or a pale ring around the iris of the eye known as corneal arcus. These signs point to cholesterol levels that have been severely elevated for a long time and warrant prompt medical evaluation.