Does Your Total Cholesterol Number Even Matter?
Total cholesterol is one of the most common blood tests, but what does the resulting number actually tell us?
Updated January 12, 2024.
As one of the most ordered lab tests, total cholesterol can provide a high-level glance at how your body handles lipids or fats. According to the CDC, roughly nine percent of all doctor’s visits include a cholesterol test. 
So, how should you interpret your total cholesterol value? Is the whole greater than the sum of its parts?
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What is total cholesterol?
Total cholesterol is the overall amount of cholesterol in your blood, including both HDL (high-density lipoprotein) or "good" and LDL (low-density lipoprotein) or "bad" cholesterol.
Total cholesterol can be determined in two ways—it can either be directly measured in the blood or, more commonly, be calculated. The calculation takes into account the two main forms of cholesterol–HDL and LDL, as well as a small fraction of triglycerides. Any one of these three components can skew total cholesterol values. Here's a brief definition of each:
- HDL: High-density lipoprotein is a protective form of cholesterol that helps to remove harmful particles from circulation before they can cause damage to blood vessels. This process earned it the nickname "good cholesterol."
- LDL: Low-density lipoprotein is a potentially dangerous type of cholesterol that can become oxidized (a process that makes it unstable and capable of causing damage), which can lead to the hardening of arteries. If LDL builds up, it can lead to blockages – which can cause serious cardiovascular incidents. LDL is, therefore, aptly referred to as the "bad cholesterol."
- Triglycerides: A form of stored fat that circulates in the bloodstream usually from excess weight, calories, alcohol, lack of exercise, liver damage, or genetics.
How to interpret total cholesterol test results
Knowing which biomarker (or combination of the three) is responsible for the skew of your total cholesterol number is more important than the total cholesterol value itself. Three scenarios can account for high total cholesterol:
1. High total cholesterol, high LDL cholesterol, low HDL cholesterol, and high triglycerides
High alert! This is the most dangerous combination of lipid markers. Roughly 32% of Americans have elevated LDL cholesterol, according to the CDC. 
In this ratio, where high LDL is coupled with low HDL, the risk of developing cardiovascular disease is high. It is very important here to bring down LDL cholesterol and increase HDL cholesterol to help combat the “bad” LDL. The ratio of HDL to LDL is very important.
» Learn all about cholesterol tests and what your results mean
2. High total cholesterol, normal LDL, high HDL, normal triglycerides
In this case, the high total cholesterol is less troublesome since it's largely due to elevated HDL (remember, that's the "good" kind). The fact that HDL is high and LDL is normal also makes for a favorable HDL-to-LDL ratio. However, extremely high levels of HDL cholesterol can be due to genetics. Generally, HDL levels shouldn't exceed 116 mg/dL for men and 135 mg/dL for women. 
3. High total cholesterol, normal LDL cholesterol, normal HDL cholesterol, very high triglycerides
Even though triglycerides only contribute a small fraction to the total cholesterol value, very high levels can drastically skew this value and are very dangerous. High levels of triglycerides, especially without high levels of HDL or LDL, may indicate issues in the liver, where triglycerides are made.
Testing your liver enzymes can help you identify whether there is a problem—levels of these enzymes would be high if this were the case. Elevated triglycerides can be damaging to your cardiovascular system but can also lead to acute pancreatitis (inflammation of the pancreas), which requires immediate medical attention. 
Why is my total cholesterol high when my LDL and HDL are normal?
There are a few potential reasons why your total cholesterol could be high when your LDL (bad) and HDL (good) cholesterol levels are normal: - Triglycerides: This is another type of fat in your blood that can contribute to high total cholesterol levels. High triglycerides are often linked to excess weight, unhealthy diet, physical inactivity, and genetics. - Genetics: Some people inherit genes for higher cholesterol synthesis or low clearance of LDL particles.
Does high HDL offset high LDL?
A high HDL cholesterol level does not fully offset a high LDL cholesterol level—although it can help. HDL transports cholesterol from tissues back to the liver for excretion, removing excess cholesterol from the body. So, higher HDL cholesterol can help with LDL cholesterol removal. However, high HDL cholesterol can’t fully offset high LDL cholesterol levels.
What should I do when I have high total cholesterol but a good ratio?
Continue to prioritize lifestyle habits that aim to lower total cholesterol levels. For example, exercise, sleep, and incorporating soluble fiber into your diet can help.
Can you have both high HDL and high LDL?
Yes, you can have both high HDL cholesterol and high LDL cholesterol levels. Certain dietary patterns, like those containing high amounts of animal products, can raise both HDL and LDL cholesterol levels.
What about LDL particle size?
There is a lot of buzz in the health community about LDL particle size. If you recall, LDL is a low-density lipoprotein. Its “low” density is due to its high proportion of fat, which is not a very dense substance (think of salad dressing when it separates–the oil floats to the top). HDL, on the other hand, has a lower fat-to-protein ratio than LDL, making it more dense.
LDL is particularly troublesome due to its capacity to oxidize, which makes it more likely to become implanted in blood vessels and harden. This can eventually cause blockages. This is where the particle size becomes important: smaller LDL particles can become lodged in the arteries more easily. The larger LDL particles appear to be less dangerous.
Unfortunately, LDL particle size is still new science. While it is promising, it should not yet be used to determine and manage someone's risk of cardiovascular disease (CVD). 
Because of this need for further research, InsideTracker doesn’t include LDL particle size in our lipid panels just yet. In the meantime, it appears that there is an association between small LDL particle size and high triglycerides coupled with low HDL. 
» Read more about LDL particle size and heart health
Lower your cholesterol with anti-inflammatory foods
So, how to make the “bad” a little bit better?
As mentioned above, the oxidation and hardening of LDL is largely responsible for the development of heart disease. Accordingly, lowering your LDL value is the first hurdle to tackle when prioritizing your heart health (hint: increase soluble fiber and limit saturated fat intake).
Once you have reached an optimal level, protecting the LDL from oxidation is just as important. Free radicals (yep, the same ones that cause inflammation) are the main stimulant for oxidization.  They're also counteracted by antioxidants, hence the name. Therefore, it follows that in order to reduce the potential for LDL to cause damage in the body, you should eat anti-inflammatory foods.
» Read more about lowering cholesterol without medication
Common antioxidants include vitamins A, C, and E, as well as selenium. These are plentiful in dark leafy greens, bright red, orange, or yellow fruits and vegetables, citrus, berries, broccoli, bell peppers, and nuts and seeds, as well as oatmeal—get a serving of at least one of these foods every day. Dark chocolate and red wine in moderation are also high-antioxidant foods.
Fine tune your health with InsideTracker
Already have your total cholesterol values? Let us help you interpret them by adding them to the InsideTracker platform. Haven’t had your values checked before? Perhaps it's been a while? We can help with that, too. Your lifestyle choices might also be influencing your cholesterol number; if it needs a fine tune, let us build you a personalized plan to improve!