National Cholesterol Education Program

Why Is Cholesterol Important?

Your blood cholesterol level has a lot to do with

your chances of getting heart disease. High blood

cholesterol is one of the major risk factors for heart

disease. A risk factor is a condition that increases

your chance of getting a disease. In fact, the higher

your blood cholesterol level, the greater your risk

for developing heart disease or having a heart

attack. Heart disease is the number one killer of

women and men in the United States. Each year,

more than a million Americans have heart attacks,

and about a half million people die from heart 

disease.

How Does Cholesterol Cause

Heart Disease?

When there is too much cholesterol (a fat-like substance) in your blood, it builds up in the walls of

your arteries. Over time, this buildup causes “hardening of the arteries” so that arteries become narrowed and blood flow to the heart is slowed down

or blocked. The blood carries oxygen to the heart,

and if enough blood and oxygen cannot reach your

heart, you may suffer chest pain. If the blood supply

to a portion of the heart is completely cut off by a

blockage, the result is a heart attack. 

High blood cholesterol itself does not cause symptoms, so many people are unaware that their cholesterol level is too high. It is important to find out

what your cholesterol numbers are because lowering

cholesterol levels that are too high lessens the risk

for developing heart disease and reduces the chance

of a heart attack or dying of heart disease, even if

you already have it. Cholesterol lowering is important for everyone–younger, middle age, and older

adults; women and men; and people with or without

heart disease.

High Blood Cholesterol

What you need to know

INSIDE:

What Do Your Cholesterol Numbers Mean?

What Affects Cholesterol Levels?

What Is Your Risk of Developing Heart Disease 

or Having a Heart Attack?

Treating High Cholesterol 

Lowering Cholesterol With Therapeutic Lifestyle

Changes (TLC)

NATIONAL INSTITUTES OF HEALTH

NATIONAL HEART, LUNG, AND BLOOD INSTITUTE
What Do Your Cholesterol Numbers Mean?

Everyone age 20 and older should have their cholesterol measured at least once every 5 years. It is best to have 

a blood test called a “lipoprotein profile” to find out your cholesterol numbers. This blood test is done after a

9- to 12-hour fast and gives information about your:

■ Total cholesterol

■ LDL (bad) cholesterol – the main source of cholesterol buildup and blockage in the arteries

■ HDL (good) cholesterol – helps keep cholesterol from building up in the arteries

■ Triglycerides – another form of fat in your blood

If it is not possible to get a lipoprotein profile done, knowing your total cholesterol and HDL cholesterol 

can give you a general idea about your cholesterol levels. If your total cholesterol is 200 mg/dL* 

or more or if your HDL is less than 40 mg/dL, you will need to have a lipoprotein profile done. 

See how your cholesterol numbers compare to the tables below.

*Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood.

HDL (good) cholesterol protects against heart disease, so for HDL, higher numbers are better. 

A level less than 40 mg/dL is low and is considered a major risk factor because it increases your risk 

for developing heart disease. HDL levels of 60 mg/dL or more help to lower your risk for heart disease.

Triglycerides can also raise heart disease risk. Levels that are borderline high (150-199 mg/dL) 

or high (200 mg/dL or more) may need treatment in some people.

What Affects Cholesterol Levels?

A variety of things can affect cholesterol levels. These are things you can do something about:

■ Diet. Saturated fat and cholesterol in the food you eat make your blood cholesterol level go up. 

Saturated fat is the main culprit, but cholesterol in foods also matters. Reducing the amount of 

saturated fat and cholesterol in your diet helps lower your blood cholesterol level.

■ Weight. Being overweight is a risk factor for heart disease. It also tends to increase your cholesterol. 

Losing weight can help lower your LDL and total cholesterol levels, as well as raise your 

HDL and lower your triglyceride levels.

■ Physical Activity. Not being physically active is a risk factor for heart disease. Regular 

physical activity can help lower LDL (bad) cholesterol and raise HDL (good) cholesterol

levels. It also helps you lose weight. You should try to be physically active for 30 minutes 

on most, if not all, days.

Things you cannot do anything about also can affect cholesterol levels. These include:

■ Age and Gender. As women and men get older, their cholesterol levels rise. Before the age 

of menopause, women have lower total cholesterol levels than men of the same age. After the age 

of menopause, women’s LDL levels tend to rise. 

■ Heredity. Your genes partly determine how much cholesterol your body makes. High blood 

cholesterol can run in families. 

Total Cholesterol Level Category

Less than 200 mg/dL Desirable

200-239 mg/dL Borderline high

240 mg/dL and above High

LDL Cholesterol Level LDL Cholesterol Category

Less than 100 mg/dL Optimal

100-129 mg/dL Near optimal/above optimal 

130-159 mg/dL Borderline high

160-189 mg/dL High

190 mg/dL and above Very high
My risk category is ________.

If You Have You Are in Category

Heart disease, diabetes, or risk score more than 20%* I. Highest Risk

2 or more risk factors and risk score 10-20% II. Next Highest Risk

2 or more risk factors and risk score less than 10% III. Moderate Risk

0 or 1 risk factor IV. Low-to-Moderate Risk

Step 1 1

Step 22

Step 33

❍ Cigarette smoking

❍ High Blood Pressure (140/90 mmHg or higher or on blood pressure medication)

❍ 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. 

Even though obesity and physical inactivity are not counted in this list, they are conditions that

need to be corrected.

Check the table below to see how many of the listed risk factors you have;

these are the risk factors that affect your LDL goal.

Major Risk Factors That Affect Your LDL Goal

What Is Your Risk of Developing Heart Disease or 

Having a Heart Attack?

In general, the higher your LDL level and the more risk factors you have (other than LDL), the

greater your chances of developing heart disease or having a heart attack. Some people are at high

risk for a heart attack because they already have heart disease. Other people are at high risk for

developing heart disease because they have diabetes (which is a strong risk factor) or a combination

of risk factors for heart disease. Follow these steps to find out your risk for developing heart disease. 

Use your medical history, number of risk factors, and risk score to find your

risk of developing heart disease or having a heart attack in the table below.

My 10-year risk score is ________%.

How many major risk factors do you have? If you have 2 or more risk

factors in the table above, use the risk scoring tables on the back

page (which include your cholesterol levels) to find your risk score.

Risk score refers to the chance of having a heart attack in the next 

10 years, given as a percentage.

(Use the Framingham Point Scores on the back page.)

*Means that more than 20 of 100 people in this category will have a heart attck

within 10 years.
Treating High Cholesterol

The main goal of cholesterol-lowering treatment is to lower your LDL level enough to reduce your risk 

of developing heart disease or having a heart attack. The higher your risk, the lower your LDL goal will 

be. To find your LDL goal, see the box for your risk category below. There are two main ways to lower

your cholesterol:

Category I, Highest Risk, your LDL goal is less than 100 mg/dL. If your LDL is 100 or above, you will

need to begin the TLC diet. If your LDL is 130 or higher, you will need to start drug treatment at the

same time as the TLC diet. If your LDL is 100 to 129, you may also need to start drug treatment together

with the TLC diet. Even if your LDL is below 100, you should follow the TLC diet on your own to keep

your LDL as low as possible. 

Category II, Next Highest Risk, your LDL goal is less than 130 mg/dL. If your LDL is 130 mg/dL or

above, you will need to begin treatment with the TLC diet. If your LDL is 130 mg/dL or more after 

3 months on the TLC diet, you may need drug treatment along with the TLC diet. If your LDL is less

than 130 mg/dL, you will need to follow the heart-healthy diet for all Americans, which allows a little

more saturated fat and cholesterol than the TLC diet.

Category III, Moderate Risk, your LDL goal is less than 130 mg/dL. If your LDL is 130 mg/dL or above,

you will need to begin the TLC diet. If your LDL is 160 mg/dL or more after you have tried the TLC diet

for 3 months, you may need drug treatment along with the TLC diet. If your LDL is less than 130

mg/dL, you will need to follow the heart-healthy diet for all Americans.

Category IV, Low-to-Moderate Risk, your LDL goal is less than 160 mg/dL. If your LDL is 160 mg/dL or

above, you will need to begin the TLC diet. If your LDL is still 160 mg/dL or more after 3 months on the

TLC diet, you may need drug treatment along with the TLC diet to lower your LDL, especially if 

your LDL is 190 mg/dL or more. If your LDL is less than 160 mg/dL, you will need to follow the 

heart-healthy diet for all Americans.

To reduce your risk for heart disease or keep it low, it is very important to

control any other risk factors you may have such as high blood pressure

and smoking. 

If you are in...

■ Therapeutic Lifestyle Changes (TLC)–includes a cholesterol-lowering 

diet (called the TLC diet), physical activity, and weight management. 

TLC is for anyone whose LDL is above goal.

■ Drug Treatment–if cholesterol-lowering drugs are needed, 

they are used together with TLC treatment to help lower 

your LDL.
Lowering Cholesterol With

Therapeutic Lifestyle Changes (TLC)

TLC is a set of things you can do to help lower your

LDL cholesterol. The main parts of TLC are:

■ The TLC Diet. This is a 

low-saturated-fat, low-cholesterol eating plan that calls for

less than 7% of calories from

saturated fat and less than 200

mg of dietary cholesterol per

day. The TLC diet recommends

only enough calories to maintain

a desirable weight and avoid weight gain. If your LDL is

not lowered enough by reducing saturated fat and cholesterol intakes, the amount of soluble fiber in your diet

can be increased. Certain food products that contain

plant stanols or plant sterols (for example, cholesterollowering margarines and salad dressings) can also be

added to the TLC diet to boost its LDL-lowering power.

■ Weight Management. Losing weight if you are overweight can help lower LDL and is especially important

for those with a cluster of risk factors that includes high

triglyceride and/or low HDL levels and being overweight with a large waist measurement (more than 40

inches for men and more than 35 inches for women).

■ Physical Activity. Regular physical activity (30 minutes

on most, if not all, days) is recommended for everyone. 

It can help raise HDL and lower LDL and is especially important for those with high triglyceride and/or low HDL

levels who are overweight with a large waist measurement.

Drug Treatment

Even if you begin drug treatment to lower your cholesterol, you will need to continue your treatment with

lifestyle changes. This will keep

the dose of medicine as low as

possible, and lower your risk

in other ways as well. There

are several types of drugs available for cholesterol lowering

including statins, bile acid

sequestrants, nicotinic acid,

and fibric acids. Your doctor can help decide which type

of drug is best for you. The statin drugs are very effective in lowering LDL levels and are safe for most people.

Bile acid sequestrants also lower LDL and can be used

alone or in combination with statin drugs. Nicotinic

acid lowers LDL and triglycerides and raises HDL.

Fibric acids lower LDL somewhat but are used mainly

to treat high triglyceride and low HDL levels. 

Once your LDL goal has been reached, your doctor

may prescribe treatment for high triglycerides and/or 

a low HDL level, if present. The treatment includes

losing weight if needed, increasing physical activity,

quitting smoking, and possibly taking a drug. 

Foods low in saturated fat include fat free or 1% dairy products, lean meats, fish, skinless poultry,

whole grain foods, and fruits and vegetables. Look for soft margarines (liquid or tub varieties)

that are low in saturated fat and contain little or no trans fat (another type of dietary fat that can

raise your cholesterol level). Limit foods high in cholesterol such as liver and other organ meats,

egg yolks, and full-fat dairy products.

Good sources of soluble fiber include oats, certain fruits (such as oranges and pears) and vegetables (such as brussels sprouts and carrots), and dried peas and beans.

Resources 

For more information about lowering cholesterol and lowering your risk for heart disease, write to the NHLBI Health Information Center, 

P.O. Box 30105, Bethesda, MD, 20824-0105 or call 301-592-8573, or visit the Web sites listed below:

“Live Healthier, Live Longer”–information on cholesterol lowering (www.nhlbi.nih.gov/chd)

“Aim for a Healthy Weight” (www.nhlbi.nih.gov)

“Your Guide to Lowering High Blood Pressure” (www.nhlbi.nih.gov/hbp)

www.nutrition.gov

www.fitness.gov

www.cdc.gov/tobacco

“Healthfinder”–a free gateway to reliable consumer health and human services information developed by the U.S. DHHS 

(www.healthfinder.gov)

“MedlinePlus”–up-to-date, quality health care information from the National Library of Medicine at the National Institutes of Health 

(www.medlineplus.gov)
Point Total 10-Year Risk %

<0 < 1 

0 1 

1 1 

2 1 

3 1 

4 1 

5 2 

6 2 

7 3 

8 4 

9 5 

10 6 

11 8 

12 10 

13 12

14 16 

15 20 

16 25 

≥17 ≥ 30 

Point Total 10-Year Risk %

< 9 < 1 

9 1 

10 1 

11 1 

12 1 

13 2 

14 2 

15 3 

16 4 

17 5 

18 6 

19 8 

20 11 

21 14 

22 17 

23 22 

24 27 

≥25 ≥ 30 

<160 0 0 0 0 0

160-199 4 3 2 1 0

200-239 7 5 3 1 0

240-279 9 6 4 2 1

>280 11 8 5 3 1

Total

Cholesterol

Age 20-39 Age 40-49 Age 50-59 Age 60-69 Age 70-79

Total

Cholesterol

Age 20-39 Age 40-49 Age 50-59 Age 60-69 Age 70-79

Age 20-39 Age 40-49 Age 50-59 Age 60-69 Age 70-79 Age 20-39 Age 40-49 Age 50-59 Age 60-69 Age 70-79

Points 

Nonsmoker 00 000

Smoker 85 311

Points 

Nonsmoker 00 000

Smoker 97 421

Points 

<160 0 0 0 0 0

160-199 4 3 2 1 1

200-239 8 6 4 2 1

240-279 11 8 5 3 2

>280 13 10 7 4 2

Points 

HDL (mg/dL) Points

≥60 -1

50-59 0

40-49 1

<40 2

HDL (mg/dL) Points

≥60 -1

50-59 0

40-49 1

<40 2

Systolic BP (mmHg) If Untreated If Treated

<120 0 0

120-129 0 1

130-139 1 2

140-159 1 2

>160 2 3

Systolic BP (mmHg) If Untreated If Treated

<120 0 0

120-129 1 3

130-139 2 4

140-159 3 5

>160 4 6

Men Women

Estimate of 10-Year Risk for Men

(Framingham Point Scores)

Age Points

20-34 -9

35-39 -4

40-44 0

45-49 3

50-54 6

55-59 8

60-64 10

65-69 11

70-74 12

75-79 13

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

National Institutes of Health

National Heart, Lung, and Blood Institute

NIH Publication No. 01-3290

May 2001

Estimate of 10-Year Risk for Women

(Framingham Point Scores)

Age Points

20-34 -7

35-39 -3

40-44 0

45-49 3

50-54 6

55-59 8

60-64 10

65-69 12

70-74 14

75-79 16

10-Year risk ______% 10-Year risk ______%