Hypercholesterolemia Diagnosis - Wikipedia
Cholesterol is measured as milligrams per deciliter (mg/dL) of blood in the United States and some other countries. In the United Kingdom, most European countries, and Canada, millimoles per liter of blood (mmol/L) is the measure.[22]
For healthy adults, the UK National Health Service recommends total cholesterol of 5 mmol/L or less, and low-density lipoprotein cholesterol (LDL) of 3 mmol/L or less. For people at high risk of cardiovascular disease, the recommendation for total cholesterol is 4 mmol/L or less, and 2 mmol/L or less for LDL.[23]
In the United States, the National Heart, Lung, and Blood Institute within the National Institutes of Health classifies total cholesterol of less than 200 mg/dL as “desirable,” 200 to 239 mg/dL as “borderline high,” and 240 mg/dL or more as “high.”[24]
There is not an absolute cutoff between normal and abnormal cholesterol levels and interpretation of values needs to be made in relation to other health conditions and risk factors.
Higher levels of total cholesterol increase the risk of cardiovascular disease, particularly coronary heart disease. Levels of LDL or non-HDL cholesterol both predict future coronary heart disease, which is the better predictor is disputed.[25] High levels of small dense LDL may be particularly adverse, although measurement of small dense LDL is not advocated for risk prediction.[25] In the past LDL and VLDL levels were rarely measured directly due to cost. Levels of fasting triglycerides were taken as an indicator of VLDL levels (generally about 45% of fasting triglycerides is composed of VLDL), while LDL was usually estimated by the Friedewald formula:
Recent guidelines have therefore advocated the use of direct methods for measurement of LDL wherever possible.[25] It may be useful to measure all lipoprotein subfractions ( VLDL, IDL, LDL, HDL) when assessing hypercholesterolemia and measurement of apolipoproteins and lipoprotein (a) can also be of value.[25] Genetic screening is now advised if a form of familial hypercholesterolemia is suspected.[25]
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See also: High-density lipoprotein#Recommended ranges and Low-density lipoprotein#Normal ranges
| Interpretation of Cholesterol levels | |||
|---|---|---|---|
| cholesterol type | mg/dL | mmol/L | interpretation |
| total cholesterol | under 200 | under 11.1 | desirable[20] |
| 200-239 | 11.1-13.3 | borderline[20] | |
| more than 240 | more than 13.3 | high[20] | |
| LDL cholesterol | under 100 | under 5.55 | most desirable[20] |
| 100-129 | 5.55-7.15 | good[20] | |
| 130-159 | 7.15-8.82 | borderline high[20] | |
| 160-189 | 8.82-10.5 | high and undesirable[20] | |
| over 190 | over 10.5 | very high[20] | |
| HDL cholesterol | under 40 | under 2.21 | undesirable; risk increased[20] |
| 41-59 | 2.21-3.27 | okay, but not optimal[20] | |
| 60 | 3.27 | good; risk lowered[20] | |
| Indications to lower LDL cholesterol | |||
|---|---|---|---|
| Persons whose coronary risk is... | because they have... | should consider lowering LDL if the level is over... | and LDL reduction is indicated if the level is over... |
| high | greater than 20% risk of heart attack in 10 years, or an extreme risk factor such as coronary heart disease, diabetes, peripheral-artery disease, carotid-artery disease, or aortic aneurysm | 70 mg/dL, 3.88 mmol/dL especially if there are risk factors[21] | 100 mg/dL, 5.55 mmol/dL[21] |
| moderately high | a 10-20% risk of heart attack in 10 years and two or more risk factors | 100 mg/dL, 5.55 mmol/dL[21] | 130 mg/dL, 7.21 mmol/dL[21] |
| moderate | less than 10% risk of heart attack in 10 years and two or more risk factors | 130 mg/dL, 7.21 mmol/dL[21] | 160 mg/dL, 8.88 mmol/dL[21] |
| low | No risk factors or only one | 160 mg/dL, 8.88 mmol/dL[21] | 190 mg/dL, 10.5 mmol/dL[21] |
For healthy adults, the UK National Health Service recommends total cholesterol of 5 mmol/L or less, and low-density lipoprotein cholesterol (LDL) of 3 mmol/L or less. For people at high risk of cardiovascular disease, the recommendation for total cholesterol is 4 mmol/L or less, and 2 mmol/L or less for LDL.[23]
In the United States, the National Heart, Lung, and Blood Institute within the National Institutes of Health classifies total cholesterol of less than 200 mg/dL as “desirable,” 200 to 239 mg/dL as “borderline high,” and 240 mg/dL or more as “high.”[24]
There is not an absolute cutoff between normal and abnormal cholesterol levels and interpretation of values needs to be made in relation to other health conditions and risk factors.
Higher levels of total cholesterol increase the risk of cardiovascular disease, particularly coronary heart disease. Levels of LDL or non-HDL cholesterol both predict future coronary heart disease, which is the better predictor is disputed.[25] High levels of small dense LDL may be particularly adverse, although measurement of small dense LDL is not advocated for risk prediction.[25] In the past LDL and VLDL levels were rarely measured directly due to cost. Levels of fasting triglycerides were taken as an indicator of VLDL levels (generally about 45% of fasting triglycerides is composed of VLDL), while LDL was usually estimated by the Friedewald formula:
LDLHowever, this equation is not valid on non-fasting blood samples or if fasting triglycerides are elevated >4.5 mmol/L (> ∼400 mg/dL).total cholesterol - HDL - (0.2 x fasting triglycerides).
Recent guidelines have therefore advocated the use of direct methods for measurement of LDL wherever possible.[25] It may be useful to measure all lipoprotein subfractions ( VLDL, IDL, LDL, HDL) when assessing hypercholesterolemia and measurement of apolipoproteins and lipoprotein (a) can also be of value.[25] Genetic screening is now advised if a form of familial hypercholesterolemia is suspected.[25]
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See also: High-density lipoprotein#Recommended ranges and Low-density lipoprotein#Normal ranges
