Paulo Bandeira Pinho, MD, FAAP

Text Box: CHOLEsterol—what it means 
and how to help it

Monitoring for high cholesterol is essential in patients because it is one of the major risk factors for heart disease.  Bad cholesterol builds up on the walls of arteries and contributes to their “hardening” and eventual blocking.  Blocked arteries leads to interrupted blood flow to the heart, brain and other organs.  There are different types of cholesterol that make up one’s total cholesterol:

                 Total cholesterol is ideal when it is below 200

                 HDL (good) cholesterol is ideal when it is above 40, when it is above 60 it is protective

                 Triglycerides ideally should be kept below 150

The most important cholesterol risk factor and the one that doctors use to dictate therapy is the LDL (bad) cholesterol.  It is a calculated number on most lipid panels and comes from the following equation:  LDL=Total-HDL-Triglycerides/5


LDL cholesterol goals vary depending on the presence of other risk factors:


Major Risk Factors That Affect Your LDL Goal

· Cigarette smoking

· High Blood Pressure (140/90 mmHg or higher or on blood pressure medication), Diabetes, History of Heart Disease

· Low HDL cholesterol (less than 40 mg/dL)*

· Family history of early heart disease (heart disease in father or brother before age 55; heart disease in mother or sister before age 65)

· Age (men 45 years or older; women 55 years or older)

If your HDL cholesterol is 60 mg/dL or higher, subtract 1 from your total count.


Based on the above risk factors, we calculate a person’s 10 year risk of heart disease.  You can calculate your risk by clicking on the link to the left.  Remember to pick the appropriate table based on your sex


Based on your ten year risk you can use the following table to determine your LDL goal


Heart disease, diabetes, or risk score more than 20% - Highest Risk (LDL goal <100)

2 or more risk factors and risk score 10-20%  -  Next Highest Risk (LDL goal <130)

2 or more risk factors and risk score less than 10% - Moderate Risk (LDL goal <130)

0 or 1 risk factor    IV. Low-to-Moderate Risk (LDL goal <160)


Initially you can drive your cholesterol management with diet and weight reduction through physical activity and smoking cessation, but after attempts to do so that fail to lower the number to goal, you may need to go on therapy with a cholesterol lowering agent.


The National Heart, Lung and Blood Institute has an excellent webpage that allows you to make modifications to your lifestyle so that it is cholesterol conscious.  Click on the cartoon below to go to that interactive site: