Total Cholesterol

Total cholesterol is a sum of the cholesterol in HDL, LDL, and VLDL lipoproteins. Total cholesterol alone cannot provide any useful information. But, total/HDL ratio helps to predict heart attack risk.

Total cholesterol measures cholesterols in all lipoproteins (VLDL, LDL & HDL) by break open.

The total cholesterol number cannot provide everything about heart risk. Total cholesterol number alone is useless. There is an opinion that total cholesterol below 200 mg/dl could lower heart disease risk. But, it is not always correct; to use total cholesterol number, read on for details.

Understand total cholesterol

There are two types of cholesterol. They are HDL-C and LDL-C. Additionally; each lipoprotein has triglyceride loads.

TC = LDL-C + HDL-C + VLDL-C;

Friedewald Formula is useful to calculate VLDL from triglycerides. It calculate LDL from the total, HDL and calculated VLDL.

VLDL-C = Triglycerides/5;

LDL-C = Total cholesterol – (HDL-C + VLDL-C);

Total cholesterol ranges

Total cholesterol level is the sum of all lipids in your blood lipoproteins (VLDL, LDL, and HDL).

TC = LDL-C + HDL-C + VLDL-C

• Optimal: Less than 200 mg/dL (< 5.2 mmol/l)
• Borderline: 200 to 239 mg/dL (5.3 to 6.2 mmol/l)
• High: More than 239 mg/dL (> 6.2 mmol.l)

Total cholesterol alone is useless

For example, Total cholesterol number of 161 considered as a good number. Because it is less than 200 mg/dl (healthy total cholesterol). If the HDL-C number is just 15 points of the total cholesterol. Then, it shows there is high levels of triglyceride, VLDL, and LDL. High triglyceride is a well-defined risk for heart conditions. The total cholesterol is within a healthy range. But, there is higher risk towards heart diseases. The National Cholesterol Education Panel suggested HDL below 35 mg/dl is a heart risk.

Another example, Total cholesterol number of 229 considered as a bad number. Because it is higher than 200 mg/dl. Yet, if the HDL-C number is 68 points of the total cholesterol. Then, it shows there is low levels of triglyceride, VLDL, and LDL. Low triglyceride is well-defined reduced risk towards heart disease. The total cholesterol is higher than healthy range. But, there is lower risk towards heart diseases. The National Cholesterol Education Panel suggested HDL over 60 mg/dl lower heart attacks risk.

Australian Aboriginals, Native Americans, Emigrant Asian Indians and some Russian have low cholesterol levels. But, there has been high heart disease rates. Whereas, the Swiss and the French have higher cholesterol levels. But, there has been low heart disease rates.

A high-cholesterol level did not cause heart disease. But, it acts as a heart-disease marker in younger men.

Total/HDL ratio

TC/HDL-C ratio calculated by dividing the total cholesterol (TC) by the HDL cholesterol (HDL-C). High TC/HDL-C ratio is undesirable and shown to increase heart attack risk. Whereas, a low ratio indicates lower risk. For example, if a person has total cholesterol of 200 mg/dL and an HDL-C of 40 mg/dL, the ratio is 5. Women have higher HDL-C levels; thus, the ratio of women is lower compared to men.

• Optimal: Less than 3.5 (in Men) < 3.0 (in Women)
• Moderate: 3.5 to 5.0 (in Men) 3.0 to 4.4 (in Women)
• High: More than 5.0 (in Men) > 4.4 (in Women)

The TC/HDL-C ratio helps to predict the risk for atherosclerosis.  Scientists diverged on the use of cholesterol ratio for predicting the heart disease risk.

Framingham Heart Study suggest TC/HDL-C ratio of 9.6 (in men) & 7 (in women) doubled average heart disease risk.