Cholesterol and Triglycerides: Values and Interpretation
A blood lipid report has four numbers and most people look at the wrong one. Total cholesterol matters least; what carries the risk is LDL and non-HDL cholesterol, and what reduces it is HDL. On top of that, the same LDL value can be fine for one person and too high for another, because the target depends on overall heart risk and not on the report alone. This article covers the reference values, the targets by risk category, how triglycerides are read and when it is time to see a cardiologist.
Normal cholesterol and triglyceride values
| Test | Desirable | What it is |
|---|---|---|
| Total cholesterol | below 5.0 mmol/L (190 mg/dL) | The sum of all the fractions; on its own a crude indicator. |
| LDL cholesterol | below 3.0 mmol/L (115 mg/dL) at low risk; lower at higher risk, see the table of targets | The “bad” cholesterol that builds up in the wall of the blood vessel. The main number in the report. |
| HDL cholesterol | above 1.0 mmol/L (40 mg/dL) in men; above 1.2 mmol/L (45 mg/dL) in women | The “good” cholesterol that carries the excess from the tissues back to the liver. |
| Triglycerides | below 1.7 mmol/L (150 mg/dL) fasting | Fats from food and the ones the liver makes out of excess sugar and alcohol. |
| Non-HDL cholesterol | the LDL target + 0.8 mmol/L | Total minus HDL: everything that does harm, including what LDL does not capture. Useful when triglycerides are high. |
The LDL target depends on risk, not on the report
| Risk category | Who is in it (examples) | LDL target |
|---|---|---|
| Low | Younger people with no other risk factors | below 3.0 mmol/L |
| Moderate | Middle age with one factor (smoking, blood pressure, obesity) | below 2.6 mmol/L |
| High | Diabetes without complications, markedly high blood pressure or LDL above 4.9, chronic kidney disease | below 1.8 mmol/L |
| Very high | A previous heart attack or stroke, a stent, a bypass, proven plaque in the blood vessels, diabetes with organ damage | below 1.4 mmol/L |
That is why two people with the same LDL of 3.4 get different advice. For a thirty-year-old with no risk factors it is a result that habits can improve; for someone with diabetes and high blood pressure it is a result that calls for treatment. The number in the report is never the only reason for a medicine.
Triglycerides: what raises them and why they are drawn fasting
Triglycerides rise after every meal, so for an accurate result blood is drawn after 10 to 12 hours of fasting, with no alcohol the evening before. Chronically raised triglycerides most often go with extra weight around the waist, insulin resistance, blood sugar, alcohol, sugary drinks and some medicines, and less often with inherited disorders. Values of 1.7 to 5 mmol/L are above all a cardiovascular risk; above 10 mmol/L they carry a risk of inflammation of the pancreas and call for urgent treatment.
The combination of high triglycerides and low HDL with a normal LDL is the classic picture of metabolic syndrome, and it responds best to weight loss, less sugar and alcohol and more movement, often better than to any medicine.
What genuinely lowers LDL
- Replacing saturated fats with unsaturated ones: less fatty meat, processed meat, butter and palm oil; more olive oil, nuts and fish. This is the strongest dietary measure, stronger than cutting out eggs.
- Soluble fiber: oats, pulses, apples, flaxseed. They bind cholesterol in the bowel.
- Weight loss and movement: a smaller effect on LDL than on triglycerides and HDL, but they lower the overall risk.
- Stopping smoking: it does not change LDL, but it raises HDL and halves the risk within a year.
- Medication: when the risk is high or LDL is far from target, a medicine prescribed by a cardiologist or an internist lowers LDL by 30 to 50 percent, and it is the best-proven intervention in the whole of heart medicine. The decision comes from an examination, not from a report.
Habits show up in the report in 6 to 12 weeks, so a recheck before that makes no sense. If the result has not moved after three months of honest work, that is not a failure but information: in some people cholesterol is inherited and habits cannot bring it down far enough.
When to see a cardiologist and what happens at the appointment
You take a lipid report to a cardiologist or an internist when LDL is above 4.9 mmol/L (a possible inherited form), when raised lipids come with high blood pressure, blood sugar, smoking or a heart attack in the family before the age of 55, when triglycerides are above 5 mmol/L, or when you want a risk assessment rather than just an interpretation. The appointment measures blood pressure, records an ECG and, if needed, includes an ultrasound of the heart and a Doppler of the neck vessels, which shows whether plaque is already there; and that is the finding that changes the risk category and the target.
At the Miren Medic clinic cardiology appointments are held by Prof. Dr Radoslav Romanović, Dr Saša Ivanović and Dr Mila Živojinović, without a referral, and the lipid panel, glucose and HbA1c are run in the clinic laboratory. More about the service on the cardiologist Belgrade page.
Prices
| Service | Price |
|---|---|
| Cardiology appointment (Dr Mila Živojinović) | 6.000 RSD |
| Cardiology appointment (Dr Saša Ivanović / Prof. Dr Radoslav Romanović) | 10.000 RSD |
| Cardiology appointment + ultrasound of the heart | 10.000 to 14.000 RSD |
| Ultrasound of the heart | 8.000 RSD |
| Doppler of the neck blood vessels (Dr Oliver Radmili) | 7.000 RSD |
| Internal medicine appointment (Dr Andreja Kovačević) | 6.000 RSD |
Frequently asked questions
What are normal cholesterol values?
Total cholesterol below 5.0 mmol/L, LDL below 3.0 at low risk (lower at higher risk), HDL above 1.0 in men and 1.2 in women, triglycerides below 1.7 mmol/L. The LDL target is set by overall risk, not by the report alone.
What does raised LDL cholesterol mean?
That there are more particles in the blood that build up in the wall of the blood vessel. How dangerous that is depends on blood pressure, smoking, blood sugar, age and family history. An LDL above 4.9 mmol/L points to an inherited form and calls for an appointment whatever else is true.
Is a raised HDL cholesterol bad?
No, in most cases. An HDL above 1.0 in men and 1.2 in women is protective. A markedly high HDL, above 2.5 mmol/L, brings no extra protection and the doctor then looks at the other fractions, but in itself it is not a reason for treatment.
What is non-HDL cholesterol?
Total cholesterol minus HDL, that is, the sum of all the harmful fractions. The target is 0.8 mmol/L above the LDL target. It is especially useful when triglycerides are high, because LDL can then underestimate the risk.
How do I lower my triglycerides?
Less sugar, fewer sweet drinks and less alcohol, weight loss, movement and fish twice a week bring triglycerides down faster than any other fraction, often by 30 percent or more in two months. Values above 5 mmol/L call for an appointment, and above 10 for urgent treatment.
When should you see a cardiologist about raised cholesterol?
When LDL is above 4.9 mmol/L, triglycerides above 5, when the lipids come with high blood pressure, blood sugar, smoking or an early heart attack in the family, or when the result has not moved after three months of changed habits. An appointment with an ECG, an ultrasound of the heart and a neck Doppler gives a risk assessment, not just an interpretation of a number.
Book an appointment
If your LDL or triglycerides are above target, book a cardiology appointment at the Miren Medic clinic. The examination, the ECG, the ultrasound of the heart and the Doppler of the blood vessels come from one place, without a referral, with a clear target and a plan that matches your risk.
