You get your blood test back from your doctor and your cholesterol has dropped! Time to celebrate? Not necessarily. This article answers to two basic questions to evaluate your own cholesterol-related risk of heart disease and heart attack.

1. What’s the real definition of high cholesterol?

Generally, medical risk factors fit into one of three basic categories:

• Risk factors you can’t control
• Risk factors you can control
• Risk factors whose effects you can lessen but not entirely eliminate
  

High cholesterol is an interesting risk factor because it fits into all three of these categories. How come? Your genes determine how much cholesterol your body produces naturally, so high cholesterol may be a risk factor you can’t control. You can take one of several different cholesterol-lowering drugs designed to pull your cholesterol down to safe levels, so high cholesterol may be a risk factor you can control.

You can change your diet, lose weight, and exercise to increase your “good” cholesterol, high-density lipoproteins (HDLs), while lowering your “bad” cholesterol, low-density lipoproteins (LDLs), so high cholesterol (or at least high “bad” cholesterol) may be a risk factor whose effects you can soften. The point? Although high cholesterol is an important risk factor for heart disease - and decreasing your longevity - you have a leading role to play in controlling the risk. What you eat, how you spend your leisure time, and how you work with your doctor have much to do with determining where your rank is on the cholesterol scale.

Before you decide what to do about your cholesterol, you need to know how much cholesterol you actually have. So get up, march over to your doctor’s office, and hold out your arm so your doctor can stick a hollow needle into the vein in the crook of your elbow and draw about 20 milliliters (ml) of bright, red blood. Then when you go home, the little glass tube holding your blood goes off to a medical laboratory where a technician counts the cholesterol particles. The results you get back look like this: 225 mg/dL. Translation: You have 225 milligrams of total cholesterol in every deciliter (1/10 liter) of blood. But these numbers don’t paint the whole picture. The figures for your lowdensity lipoproteins (VLDLs, IDLs, LDLs) and high-density lipoproteins (HDLs) are still missing. Shaky on the details? Lipoproteins are fat-and-protein particles that carry cholesterol into your arteries (LDLs) or out of your body (HDLs), which is why HDLs are “good” and some of the LDLs are “bad.”

The problem with simple finger-stick tests such as those found in cholesterol home-testing kits is that they only measure total cholesterol levels- no HDLs and no LDLs. An incomplete result (total cholesterol alone) can scare you to death if it shows you have high total cholesterol without letting you know that you - lucky girl! lucky boy! - also have high HDLs. The fingerstick test can also provide false reassurance if it shows a low total cholesterol level without letting you know that your LDLs are also very low. Now that you know all this and have an accurate, complete doctor’s report in hand, what do the results say about you? How can you tell if the numbers are high, low, or in-between?

What are normal cholesterol levels? The information you need to grade your cholesterol levels comes from the usual suspects - I mean the usual experts: the National Cholesterol Education Program (NCEP) at the National Heart, Lung, and Blood Institute (NHLBI), an arm of the National Institutes of Health (NIH). In 2001, the NCEP issued a report called ATP III, short for The Third Report of the Expert Panel on the Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. In this report, the NCEP said: A total cholesterol level higher than 240 mg/dL translates into a “high risk” for heart disease. A total cholesterol level between 200 and 239 mg/dL means there’s a “moderate risk” for heart disease. A total cholesterol level below 200 mg/dL is “desirable.” Regardless of total cholesterol levels, the risk of heart attack is highest among men whose HDLs are lower than 37 mg/dL and women whose HDLs are lower than 47 mg/dL. Conversely, the risk of heart attack is lowest among men whose HDLs are higher than 53 mg/dL and women whose HDLs are higher than 60 mg/dL. The table below shows the current descriptions of various levels of total cholesterol, LDL cholesterol, and HDL cholesterol.

But in July 2004, just when everyone thought they had the numbers down pat, the experts at the NCEP added a footnote: People at high risk should push their LDLs down below 100 mg/dL, a task that requires taking one or more of the cholesterol medicines. Are these recommendations final? Probably not. Experience shows that precise numbers for healthful cholesterol levels can change at any moment. What doesn’t change are the basics: Higher HDLs are good. Lower LDLs are good. Sooner or later, like Goldilocks and the Three Bears, someone will figure out exactly how low and how high is just right.

According to the American Heart Association, as you read this chapter an estimated 105,200,000 Americans have total cholesterol levels higher than 200 mg/dL, putting them all into the borderline high category; 36.6 million of those have high total cholesterol levels above 240 mg/dL. Who are all these people? What puts them into these special high-risk categories? Age and gender Among people younger than 50, men are more likely to have high cholesterol. After age 50, women edge into the lead. Either way, a woman’s blood vessels are more elastic than a man’s blood vessels. As a result, women have a little more protection than men throughout their lives against a blood clot that may block their blood vessels and trigger a heart attack.

Pregnancy - strictly a female activity — lowers a woman’s levels of good HDLs, but a study of 1,051 women conducted by researchers at Kaiser Permanente in Oakland, California, showed that nursing the newborn for longer than three months is protective and reduces the decline of HDLs. Counting kids’ cholesterol The cholesterol levels shown above are for grown-ups. (Translation: Adults are people between the ages of 20 and 74.)

Normal Cholesterol Levels For Children

The recommendations for children are a different story. A child’s total cholesterol level rises slowly from age 2 to age 10 and then begins to rise and fall in a gender-related pattern. According to University of Texas (Houston) researcher Darwin R. Labarthe, a girl’s cholesterol level is likely to peak around age 9, a boy’s around age 16. Conversely, a girl’s cholesterol level goes down for a while around age 16; a boy’s cholesterol goes down for a while around age 17. All adults should be tested at least once to establish a baseline cholesterol reading; if the level is higher than it should be, more frequent testing may be required. But as of this writing, the American Academy of Pediatrics (AAP) only recommends cholesterol testing for a relatively small number of children: Kids with a parent or grandparent who had a heart attack, suffered a stroke, or received a diagnosis of coronary artery disease before age 55 Children whose parents have high cholesterol (above 240 mg/dL) The recommendations of the American Heart Association (AHA) are similar to those of the AAP. The AHA suggests only testing children older than the age of 2 who have a family history of coronary artery disease - a parent or a grandparent with high cholesterol or a history of heart disease. Table below shows the AHA-recommended cholesterol levels for children and adolescents between the ages of 2 and 19.

As people turn 70 and sail into their eighth decade, their cholesterol level becomes a less important predictor of death by heart disease. What should you make of this? Perhaps people who die of cholesterol-induced coronary artery disease simply check out earlier in life. After all, cholesterol is often described as a risk factor for an early heart attack. Perhaps, as you age, your cholesterol level becomes less important than your overall health. Perhaps total cholesterol levels aren’t as important as LDL and HDL levels, which aren’t reflected in studies that show the decreasing importance of cholesterol levels as a predictor of death by heart disease as people age. Should you rush out to tell grandma and grandpa to toss out that salad and start gorging on high-fat, high-cholesterol foods? Not yet. But you can send them a postcard with this comment from the American Heart Association: “The issue of normal cholesterol levels in the elderly is still unclear.”