Complete Testing & Optimization Guide
Optimal ranges, provider comparison, and strategies to improve your Total Cholesterol levels
Included in 10 of 10 major testing providers
Lipid Panel / Cardiovascular Health
Desirable:<200 mg/dL, Borderline:200-239 mg/dL, High:≥240 mg/dL
Abnormal Total Cholesterol levels can indicate underlying health issues that may go undetected without proper testing. Regular monitoring helps catch problems early when they're most treatable.
Understanding your Total Cholesterol levels enables targeted interventions, tracks treatment effectiveness, and helps optimize your overall health and performance.
Total Cholesterol measures the sum of all cholesterol in your blood, including LDL (low-density lipoprotein), HDL (high-density lipoprotein), and VLDL (very low-density lipoprotein). Cholesterol is a waxy, fat-like substance essential for building cell membranes, producing hormones (testosterone, estrogen, cortisol), synthesizing vitamin D, and creating bile acids for digestion.
While total cholesterol provides a snapshot of lipid status, it is less informative than its components because it combines both "good"HDL and "bad"LDL cholesterol. A person with total cholesterol of 220 mg/dL could have high HDL (protective) or high LDL (harmful)—vastly different cardiovascular risk profiles. This is why modern guidelines emphasize LDL, HDL, and non-HDL cholesterol (total minus HDL) over total cholesterol alone.
Total cholesterol was historically used for cardiovascular risk assessment, with <200 mg/dL considered desirable. However, this arbitrary threshold has been challenged—25% of heart attacks occur in people with "normal"total cholesterol. Advanced lipid testing (ApoB, LDL particle number, Lp(a)) provides superior risk stratification. Total cholesterol remains useful as an initial screening tool and for calculating non-HDL cholesterol (total - HDL), which correlates well with ApoB.
Bottom line: TSH and Free T4 alone miss people with conversion problems. Free T3 is the only way to know if you have enough active thyroid hormone at the tissue level.
| Range Type | Level | Clinical Significance |
|---|---|---|
| Desirable | <200 mg/dL | Associated with lower cardiovascular risk in population studies. However, risk depends on HDL and LDL components. Total cholesterol 180 mg/dL with HDL 80 (excellent) differs dramatically from 180 mg/dL with HDL 30 (poor). Always evaluate with lipid panel components. |
| Borderline High | 200-239 mg/dL | Moderate cardiovascular risk. Check complete lipid panel with LDL, HDL, triglycerides. Calculate non-HDL cholesterol (total - HDL);target <130 mg/dL. Consider lifestyle modifications (diet, exercise, weight loss). If LDL >130 or multiple risk factors, consider statin therapy. |
| High | 240-300 mg/dL | Elevated cardiovascular risk. Requires comprehensive lipid panel, cardiovascular risk assessment (Framingham, ASCVD calculator), and likely pharmacotherapy. If LDL >160 mg/dL, statin therapy indicated. Screen for familial hypercholesterolemia, especially if family history of early heart disease. Aggressive lifestyle modification essential. |
| Very High (Possible Familial Hypercholesterolemia) | >300 mg/dL | Very high cardiovascular risk. Strongly suggests familial hypercholesterolemia (FH), especially if present in young adults (<40 years) or with family history. FH affects 1 in 250 people and increases heart attack risk 20-fold. Requires high-intensity statin (atorvastatin 40-80 mg or rosuvastatin 20-40 mg), possibly combined with ezetimibe or PCSK9 inhibitors. Early intervention critical—untreated FH causes heart disease by age 50-60 in men, 60-70 in women. |
Standard lab range:Desirable:<200 mg/dL, Borderline:200-239 mg/dL, High:≥240 mg/dL
Reduce saturated fat:Limit to <7% of calories. Major sources:red meat, butter, cheese, coconut oil. Each 1% reduction in saturated fat lowers LDL by 2-3 mg/dL
Eliminate trans fats:Avoid partially hydrogenated oils, fried foods, commercial baked goods. Trans fats raise LDL and lower HDL
Increase soluble fiber:5-10g daily (oats, barley, psyllium, beans, apples). Each 1g lowers LDL by ~1 mg/dL
Plant sterols/stanols:2g daily from fortified foods or supplements. Reduce LDL by 6-10%
Mediterranean diet:Emphasize olive oil, fish, nuts, vegetables, whole grains. Lowers total cholesterol 10-15% and reduces cardiovascular events by 30%
Aerobic exercise:150+ minutes/week moderate intensity. Raises HDL 3-5 mg/dL, modestly lowers LDL
Weight loss:Each 10 lbs lost lowers total cholesterol 5-8 mg/dL and improves HDL/LDL ratio
Smoking cessation:Quitting raises HDL by 5-10 mg/dL within weeks and reduces oxidized LDL
Limit alcohol:Moderate intake (1-2 drinks daily) may raise HDL but also increases triglycerides. Avoid if triglycerides elevated
Stress reduction:Chronic stress elevates cortisol, which increases cholesterol synthesis. Meditation, yoga, adequate sleep help
Primary prevention:Statin if LDL >190 mg/dL, diabetes age 40-75, or 10-year ASCVD risk ≥7.5%. Reduces cardiovascular events 25-35%
Moderate-intensity:Atorvastatin 10-20 mg or rosuvastatin 5-10 mg. Lowers LDL 30-40%
High-intensity:Atorvastatin 40-80 mg or rosuvastatin 20-40 mg. Lowers LDL 50%+
Secondary prevention:If established heart disease, stroke, or peripheral artery disease, high-intensity statin regardless of cholesterol level
Monitor:Check lipid panel 4-12 weeks after starting, then every 3-12 months. Check ALT, CK if symptoms. Consider CoQ10 100-200 mg daily for muscle symptoms
Ezetimibe:10 mg daily blocks cholesterol absorption. Lowers LDL additional 15-20%. Add if LDL not at goal with statin
PCSK9 inhibitors:Evolocumab or alirocumab injection every 2-4 weeks. Lower LDL 50-60%. For familial hypercholesterolemia or statin-intolerant patients
Bempedoic acid:180 mg daily. Lowers LDL 15-25%. Alternative for statin-intolerant patients
Bile acid sequestrants:Cholestyramine, colesevelam. Lower LDL 15-30% but GI side effects common
Niacin:No longer recommended—doesn't reduce cardiovascular events despite raising HDL
Non-HDL cholesterol:Calculate as Total - HDL. Target <130 mg/dL. Captures all atherogenic particles
ApoB testing:More accurate than LDL for cardiovascular risk. Each LDL particle has one ApoB. Target <90 mg/dL for primary prevention, <80 for secondary
LDL particle number:If LDL-C normal but triglycerides >150, check LDL-P. May have small dense LDL with high particle count despite "normal"LDL-C
Lp(a):Check once—genetically determined. If >50 mg/dL, increases cardiovascular risk 2-4 fold. Requires aggressive LDL lowering
CAC score:Coronary artery calcium at age 40-75 if uncertain about statin initiation. CAC >100 indicates high risk requiring statin
Note: High cholesterol is a "silent killer"—no symptoms until atherosclerosis causes heart attack, stroke, or peripheral artery disease. This is why screening and early treatment are critical.
Note: Physical signs are more common with familial hypercholesterolemia. Most people with high cholesterol have no visible signs—screening is essential.
Framingham Heart Study and subsequent trials established that total cholesterol >200 mg/dL increases cardiovascular risk. Each 40 mg/dL increase in total cholesterol raises cardiovascular risk by ~30%. However, this relationship is driven primarily by LDL cholesterol—high total cholesterol with high HDL is not harmful. This led to abandonment of total cholesterol alone as a treatment target.
Source:Kannel WB, et al. Serum cholesterol, lipoproteins, and the risk of coronary heart disease. Ann Intern Med. 1971;74(1):1-12.
Meta-analyses of statin trials show each 40 mg/dL reduction in LDL (typically accompanied by 60-80 mg/dL reduction in total cholesterol) reduces cardiovascular events by 20-25% and all-cause mortality by 10%. Benefit is consistent across baseline cholesterol levels—even people with "normal"cholesterol benefit from statins if high cardiovascular risk.
Source:CTT Collaboration. Efficacy and safety of more intensive lowering of LDL cholesterol:meta-analysis. Lancet. 2010;376(9753):1670-1681.
Non-HDL cholesterol (total minus HDL) captures all atherogenic lipoproteins (LDL + VLDL + remnants) and correlates more strongly with cardiovascular risk than LDL alone, especially when triglycerides are elevated. Non-HDL >130 mg/dL indicates increased risk. Target <130 mg/dL for primary prevention, <100 for secondary prevention.
Source:Boekholdt SM, et al. Association of LDL cholesterol, non-HDL cholesterol, and apolipoprotein B levels with risk of cardiovascular events. JAMA. 2012;307(12):1302-1309.
Familial hypercholesterolemia affects 1 in 250 people. Untreated FH causes total cholesterol >300 mg/dL (LDL >190 mg/dL) from birth, leading to heart disease 20 years earlier than general population. Early statin treatment (starting in childhood) prevents cardiovascular events. Cascade screening of relatives identifies additional affected family members requiring treatment.
Source:Nordestgaard BG, et al. Familial hypercholesterolaemia is underdiagnosed and undertreated. Nat Rev Cardiol. 2013;10(12):687-696.
Mediterranean diet reduces total cholesterol by 10-15 mg/dL and LDL by 8-10 mg/dL compared to low-fat diet. Plant sterols (2g daily) reduce LDL additional 6-10%. Soluble fiber (10g daily) reduces LDL 5-7%. Combined dietary interventions can achieve 15-25% LDL reduction—comparable to low-dose statin—without medications.
Source:Estruch R, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368(14):1279-1290.
| Provider | Includes Test | Annual Cost | Total Biomarkers |
|---|---|---|---|
 Superpower | ✓ | $199 | 100+ |
 WHOOP Advanced Labs | ✓ | $349 | 65 |
 Labcorp OnDemand | ✓ | $398 | 30+ |
| ✓ | $486 | 40+ | |
| ✓ | $468 | 83 | |
| ✓ | $798 | 100+ | |
 InsideTracker | ✓ | $680 | 48 |
 Function Health | ✓ | $499 | 100+ |
| ✓ | $900 | 70+ | |
| ✓ | $1150 | 110 | |
| — | $Varies | 75+ |
Choose from 10 providers that include this biomarker in their panels
Total Cholesterol is a lipid panel / cardiovascular health biomarker that Total amount of cholesterol in the blood The normal reference range is Desirable:<200 mg/dL, Borderline:200-239 mg/dL, High:≥240 mg/dL. Regular testing helps track changes and identify potential health issues early.
10 out of 10 major blood testing providers include Total Cholesterol in their standard panels. These include Superpower, Blueprint, Mito Health and others.
For most people, testing Total Cholesterol 2-4 times per year is recommended to establish baseline levels and track trends. If you have abnormal results or are actively working to optimize this biomarker, more frequent testing (quarterly) may be beneficial. Always consult with your healthcare provider for personalized testing frequency recommendations.
The standard laboratory reference range for Total Cholesterol is Desirable:<200 mg/dL, Borderline:200-239 mg/dL, High:≥240 mg/dL. However, many functional medicine practitioners recommend tighter "optimal" ranges for peak health and performance. Your ideal range may vary based on your age, sex, health goals, and other individual factors. Work with a healthcare provider familiar with optimal ranges to determine your target levels.
Most direct-to-consumer blood testing services that include Total Cholesterol provide the physician order as part of their service. However, some states have restrictions on direct-to-consumer testing. Check with your chosen provider about availability in your state and whether they provide the necessary physician authorization.
High levels increase cardiovascular disease risk. Cholesterol is essential for cell membranes and hormone production but excess contributes to arterial plaque.
This information is for educational purposes only and is not medical advice. Always consult with a qualified healthcare provider about your specific health needs and before making decisions about blood testing.
