Does Total Cholesterol Matter in Your Blood Test?

You've probably had your cholesterol checked at some point. Maybe you've even fixated on that "total cholesterol" number you see in your lipid test result. But what does total cholesterol really tell about your heart health?

Heart disease is the leading cause of death for people in the United States. High blood cholesterol is just one of the many risk factors for heart disease. Let's get into what cholesterol is, how to interpret your results, and why focusing on more than just the total number is important.

What is Total Cholesterol?

Cholesterol, at its core, isn't as bad as it's often made out to be. It's a waxy substance your body needs for building healthy cells, producing hormones, and aiding in vitamin D production. 

To check your cholesterol levels, you need to fast for 12 hours and take a lipid panel blood test. The "total cholesterol" number you see on your lipid profile result is a sum of your HDL (high-density lipoprotein), LDL (low-density lipoprotein), and Triglycerides.

• HDL: Often referred to as "good" cholesterol. It helps clean up excess cholesterol in the blood.
• LDL: Known as "bad" cholesterol, it carries cholesterol to your arteries. High levels of LDL lead to plaque buildup in the artery walls, a condition called atherosclerosis. This narrows the arteries and increases your risk of heart attacks and strokes.
• Triglycerides: These are a type of fat your body uses for energy. When its levels are high, combined with high LDL and low HDL, it increases your risk of heart disease.

Here's the formula for calculating total cholesterol:

Total Cholesterol = HDL (high-density lipoprotein) + LDL (low-density lipoprotein) + (Triglycerides/5)

Interpreting Your Total Cholesterol Test Results

A high cholesterol simply means your total cholesterol is 200 mg/dL or higher.

1. High Total Cholesterol, High LDL, Low HDL, and High Triglycerides

This result means you have a very high risk for heart disease. It needs immediate attention to lower your LDL and triglycerides and raise HDL. It is very important to consult with your doctor to create a plan to lower your risk.‍

2. High Total Cholesterol, Normal LDL, High HDL, Normal Triglycerides

A high total cholesterol but good ratio of LDL, HDL, and triglycerides is usually a good sign. However, very high HDL can sometimes be genetic. It's best to have a doctor check it, especially if it's above 116 mg/dL for men or 135 mg/dL for women.‍

3. High Total Cholesterol, Normal LDL Cholesterol, Normal HDL Cholesterol, Very High Triglycerides

High triglycerides, especially when there’s high cholesterol but a good ratio of LDL and HDL, could point to liver problems. Liver enzyme tests can help check this. Also, very high triglycerides can cause pancreatitis. If your triglycerides are very high, talk to your doctor to find out why.

Does LDL Particle Size Also Matter?

You might've heard people talking about LDL particle size, and it's actually pretty interesting. LDL, the "bad" cholesterol, is mostly fat. It causes problems in your arteries, especially when it gets oxidized. And it turns out, the size of those LDL particles matters as well.

Small LDL particles are like tiny pebbles—they get stuck in your arteries more easily. Big LDL particles, on the other hand, are less likely to clog the arteries.

The problem is, the science on LDL particle size is still pretty new. While it's promising, doctors don't rely on it alone to figure out your heart disease risk just yet. That's why not all cholesterol tests even check particle size.

How to Lower Your Cholesterol

Instead of just focusing on your cholesterol numbers, you have to think about the bigger picture. Inflammation is a big player in your cholesterol and heart health. So, how do you do that?

Start by changing your diet. Here are some strategies:

• Load up on fruits, veggies, whole grains, and lean protein.
• Increase omega-3 fatty acids from fish, flaxseed, and walnuts.
• Eat fiber-rich foods to help lower LDL cholesterol.
• Healthy fats like avocados, olive oil, and nuts are excellent sources of good fats.
• Avoid processed foods, refined sugars, and trans fats that add to inflammation and poor cholesterol levels.
• Explore anti-inflammatory foods like garlic, turmeric, and ginger.

Exercise, managing stress, and sleeping well are also important for healthy cholesterol.

Take Control of Your Heart Health

To know your risks of heart attack and stroke, don't just look at total cholesterol. You need to see HDL, LDL, triglycerides, and in some cases, even LDL particle size too.

Remember, a healthy lifestyle is a good start to lowering your chances of getting heart conditions. For a full heart health check, get a blood test at Mito Health. We'll look at your cholesterol, HDL, LDL, and triglycerides, so you can make smart choices for your heart.