For most adults, LDL cholesterol (the “bad” kind) should be below 100 mg/dL. But your ideal number depends heavily on your personal risk for heart disease. Someone with no risk factors can be fine at higher levels, while someone with existing heart disease or diabetes may need to push well below 70 mg/dL. The 2026 ACC/AHA guidelines, the most current available, spell out specific targets based on your estimated 10-year risk of a cardiovascular event.
LDL Targets by Risk Level
Rather than giving everyone the same number, current guidelines match your LDL goal to how likely you are to have a heart attack or stroke in the next decade. Your doctor calculates this using a risk equation that factors in your age, blood pressure, cholesterol, kidney function, and other variables.
- Low risk (under 3% ten-year risk): If your LDL is under 160 mg/dL, lifestyle changes alone are typically enough. No medication is recommended at this level.
- Borderline risk (3% to under 5%): The treatment goal is LDL below 100 mg/dL. If medication is started, a 30% to 49% reduction in LDL is the target.
- Intermediate risk (5% to under 10%): The goal is also LDL below 100 mg/dL, with at least a 30% to 49% reduction. People at the higher end of this range benefit from pushing for a 50% or greater reduction.
- High risk (10% or higher): The goal drops to LDL below 70 mg/dL, with at least a 50% reduction from your starting level.
If you already have heart disease, have had a heart attack or stroke, or have diabetes with additional risk factors, you fall into the highest-risk category. For these individuals, getting LDL below 70 mg/dL is the standard recommendation, and some guidelines push for below 55 mg/dL.
Targets for Children and Teens
For anyone 19 or younger, a healthy LDL level is below 110 mg/dL. Screening is recommended between ages 9 and 11, then every five years. Children as young as 2 may be tested if there’s a family history of high cholesterol, heart attack, or stroke. Medication is generally only considered for children 10 and older whose LDL stays above 190 mg/dL after six months of diet and exercise changes, or above 160 mg/dL if they have additional risk factors for heart disease.
Non-HDL Cholesterol: A Number Worth Knowing
Your lab report likely includes non-HDL cholesterol, which is simply your total cholesterol minus your HDL (“good”) cholesterol. This number captures all the cholesterol-carrying particles that can damage your arteries, not just LDL. For most adults, the optimal non-HDL level is below 130 mg/dL. For high-risk individuals on treatment, the goal is below 100 mg/dL.
Non-HDL is especially useful if you have high triglycerides, because in that situation your LDL reading can underestimate your actual risk. If your doctor seems focused on non-HDL rather than LDL alone, that’s why.
Why Some Doctors Now Test ApoB
A newer measurement called apolipoprotein B (apoB) is gaining traction as a more accurate gauge of cardiovascular risk. Every cholesterol particle that can clog arteries carries exactly one apoB molecule, so measuring apoB tells you the total number of dangerous particles in your blood, not just the amount of cholesterol inside them.
This matters because two people can have the same LDL number but very different numbers of particles. Someone with many small, cholesterol-depleted particles might show a “normal” LDL while actually carrying a high particle count and higher risk. The reverse is also true: large, cholesterol-rich particles can inflate your LDL reading even though your particle count is low.
ApoB targets generally mirror LDL targets. If your LDL goal is below 70 mg/dL, your apoB goal is also below 70 mg/dL. For moderate-risk individuals, below 90 mg/dL is a common target. An apoB level above 130 mg/dL is considered a risk-enhancing factor that may tip the decision toward starting treatment. One practical advantage: apoB testing doesn’t require fasting.
Do You Need to Fast Before Testing?
Many labs still ask you to fast for 9 to 12 hours before a lipid panel, but the evidence supporting this is weaker than most people assume. LDL levels change very little based on fasting time, and research shows that non-fasting LDL predicts long-term outcomes just as well as fasting LDL. Some guidelines have already moved toward accepting non-fasting samples. If your doctor orders a fasting panel, follow those instructions, but don’t worry that a non-fasting result is meaningless.
Lowering LDL Through Diet
Saturated fat raises LDL more than any other dietary component. Keeping it below 7% of your daily calories is the target for people actively trying to lower their cholesterol. On a 2,000-calorie diet, that’s no more than 13 grams per day. For context, a single tablespoon of butter has about 7 grams. The biggest sources in most diets are red meat, full-fat dairy, and fried foods.
Soluble fiber actively pulls cholesterol out of your digestive system before it reaches your bloodstream. Aim for 10 to 25 grams per day from foods like oats, beans, lentils, apples, and barley. Plant stanols and sterols, found naturally in nuts and grains and added to some fortified foods, do the same thing through a different mechanism. About 2 grams per day is the recommended intake. Dietary cholesterol should stay below 200 mg per day if you’re working on lowering your numbers.
Omega-3 fatty acids from fish, walnuts, and flaxseed can also lower LDL and triglycerides. And while limiting salt won’t directly change your cholesterol, staying under 2,300 mg of sodium per day reduces your overall cardiovascular risk by helping control blood pressure.
What Medication Can Achieve
When lifestyle changes aren’t enough, statins are the first-line treatment. A moderate-intensity statin typically lowers LDL by 30% to 49%, while a high-intensity statin can achieve 50% or more. One important detail about statin dosing: doubling the dose only adds about 5% to 6% more LDL reduction. So if you’re not at goal on a moderate dose, your doctor is more likely to switch to a higher-potency option or add a second medication rather than simply doubling up.
Adding a cholesterol-absorption blocker to a statin provides an additional 12% reduction on average, bringing combined reductions into the 50% to 60% range. For people who can’t reach their goals with these options, injectable medications that work differently are available and can push LDL dramatically lower, sometimes by 60% or more on top of what statins achieve.
The key takeaway on treatment: your target isn’t just a specific LDL number. Guidelines also emphasize the percentage reduction from your starting point. Even if you don’t hit an absolute number like 70 or 100 mg/dL, achieving a 50% reduction from where you started provides meaningful protection.