Ideal blood cholesterol and lipid targets for healthy adults
A healthy adult should aim for a total cholesterol below 5 mmol/L (millimoles per litre), and HDL and triglyceride have targets too.
Remember
A healthy adult should aim for a total cholesterol below 5 mmol/L, and you judge risk from the whole lipid profile: a high HDL does not cancel out a raised total cholesterol. Targets are lower after a heart attack or stroke.
Cholesterol is a fatty substance, and the blood carries it inside lipoproteins, which are particles that move fats around in the watery plasma. Total cholesterol is the sum of the cholesterol in all of the lipoproteins.
For healthy adults in the UK, the British Heart Foundation gives a total cholesterol of below 5 mmol/L as the healthy level. The total includes both HDL (high-density lipoprotein, often called good cholesterol, as it carries cholesterol away from the tissues) and LDL (often called bad cholesterol, as it carries cholesterol to the tissues). Doctors also look at the parts of the lipid profile, a blood test that reports several numbers.
Each part is checked against its range. Non-HDL cholesterol, which counts all the cholesterol in particles other than HDL (LDL included), should be 4 mmol/L or below, and LDL cholesterol should be 3 mmol/L or below. HDL is the one that should be high: above 1.0 mmol/L in men, and above 1.2 mmol/L in women. A fasting triglyceride, taken when you have eaten no food for 10 to 14 hours, should be below 1.7 mmol/L.
Judge risk from the whole profile. A high HDL does not make the profile ideal if the total cholesterol is raised, and a good total does not excuse a low HDL.
Targets are lower for people who have had a heart attack or stroke, with a total cholesterol of 4 mmol/L or below as an example. At the other end, a total cholesterol above 7.5 mmol/L in an adult should make you suspect familial hypercholesterolaemia (an inherited condition with a raised LDL). High cholesterol matters because it contributes to atherosclerosis, where fatty plaques build up in the artery walls, leading to heart attacks and strokes.
Key facts
- Total cholesterol
- the healthy target for an adult is below 5 mmol/L.
- Non-HDL cholesterol
- the target is 4 mmol/L or below.
- LDL cholesterol
- the target is 3 mmol/L or below.
- HDL cholesterol
- the healthy level is above 1.0 mmol/L in men and above 1.2 mmol/L in women.
- Fasting triglyceride
- the healthy level is below 1.7 mmol/L.
- After a heart attack or stroke
- targets are lower, such as a total cholesterol of 4 mmol/L or below.
- Suspect familial hypercholesterolaemia
- in an adult whose total cholesterol is above 7.5 mmol/L.
Exam traps
- In healthy adults, 4 mmol/L or below is the guide for non-HDL cholesterol, not for total cholesterol, which should be below 5 mmol/L.
- A high HDL does not make a higher total cholesterol healthy, because the total itself still contributes to the risk of heart attacks and strokes.
- A total cholesterol within the target does not excuse a low HDL, because less cholesterol is then returned to the liver and the profile is not ideal.
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