LDL Cholesterol
Low-density lipoprotein, or "bad"cholesterol
21 of 22 providers
Lipid Panel / Cardiovascular Health
Optimal:<100 mg/dL, Near optimal:100-129 mg/dL, Borderline high:130-159 mg/dL, High:≥160 mg/dL
What is LDL Cholesterol?
LDL Cholesterol (Low-Density Lipoprotein Cholesterol) is often called "bad cholesterol"because elevated levels drive atherosclerosis—the buildup of cholesterol plaques in arteries causing heart attacks and strokes. LDL particles transport cholesterol from the liver to peripheral tissues. When LDL levels are excessive, cholesterol infiltrates artery walls, triggering inflammation and plaque formation.
LDL cholesterol is either directly measured or calculated using the Friedewald equation:LDL=Total Cholesterol - HDL - (Triglycerides/5). This calculation is inaccurate when triglycerides >400 mg/dL, requiring direct LDL measurement. Modern guidelines emphasize that LDL reduction is the primary target of lipid-lowering therapy—each 40 mg/dL reduction in LDL decreases cardiovascular events by ~20%.
While LDL-C (cholesterol content) is widely used, it has limitations. Two people with identical LDL-C can have different numbers of LDL particles. Someone with many small dense LDL particles (Pattern B) has higher cardiovascular risk than someone with fewer large buoyant particles (Pattern A) despite the same LDL-C. This is why advanced testing (ApoB, LDL particle number) provides superior risk assessment, especially when triglycerides are elevated.
Why LDL Is the Primary Target for Cardiovascular Prevention
- Causal role in atherosclerosis:LDL drives plaque formation. Lifelong elevated LDL causes heart disease;lowering LDL prevents it
- Modifiable risk factor:Unlike age or genetics, LDL can be reduced 50-60% with medications, preventing most cardiovascular events
- Dose-response relationship:"Lower is better"—each 40 mg/dL reduction reduces cardiovascular risk 20-25%. No threshold below which benefit stops
- Treatment targets:LDL <100 mg/dL for moderate risk, <70 for high risk, <55 for very high risk (post-MI, stroke)
- Familial hypercholesterolemia:LDL >190 mg/dL suggests genetic disorder requiring lifelong aggressive treatment
- Superior to total cholesterol:LDL more accurately predicts cardiovascular risk than total cholesterol
Optimal vs Standard Ranges
Optimal (Longevity)<70 mg/dL▼
- Associated with lowest cardiovascular risk
- Population studies show LDL <70 mg/dL dramatically reduces atherosclerosis progression
- Infants have LDL 30-70 mg/dL—likely our evolutionary baseline
- Modern guidelines recommend <70 mg/dL for secondary prevention, <55 mg/dL for very high risk
Near Optimal70-100 mg/dL▼
- Acceptable for primary prevention in low-risk individuals
- However, even this range causes gradual plaque accumulation over decades
- Consider targeting <70 mg/dL if family history, diabetes, or other risk factors present
Borderline to Moderately High100-189 mg/dL▼
- 100-129 (Borderline):Lifestyle modification essential
- Consider statin if diabetes or 10-year risk >7.5%
- 130-159 (Moderately High):Statin therapy indicated if diabetes, known heart disease, or multiple risk factors
- 160-189 (High):Statin strongly recommended
- If no contraindication, start moderate to high-intensity statin
Very High (Likely Familial Hypercholesterolemia)≥190 mg/dL▼
- Very high cardiovascular risk
- Strongly suggests familial hypercholesterolemia (FH), especially if <40 years old or family history of early heart disease
- Requires high-intensity statin (atorvastatin 40-80 mg or rosuvastatin 20-40 mg)
- If LDL not <100 mg/dL on maximum statin, add ezetimibe 10 mg
- If still not at goal, add PCSK9 inhibitor
- Untreated FH causes heart attacks by age 50
Scientific Evidence
LDL Causality in Atherosclerosis
Mendelian randomization studies prove LDL is causal in atherosclerosis, not just associated. Genetic variants causing lifelong LDL reduction (PCSK9, NPC1L1, HMGCR loss-of-function) reduce cardiovascular events proportional to LDL lowering. Each 40 mg/dL lower lifelong LDL reduces cardiovascular risk by 50-60%—double the benefit of LDL lowering later in life, proving cumulative LDL exposure drives disease.
Statin Meta-Analysis - "Lower Is Better"
CTT Collaboration meta-analysis of 170,000 patients shows each 40 mg/dL (1 mmol/L) reduction in LDL reduces major cardiovascular events by 22%, regardless of baseline LDL. Benefit continues down to LDL 30-40 mg/dL with no safety concerns. This established "lower is better"principle—no threshold below which LDL lowering becomes ineffective.
PCSK9 Inhibitor Trials
FOURIER and ODYSSEY OUTCOMES trials demonstrated PCSK9 inhibitors reduce LDL to median 30 mg/dL and reduce cardiovascular events by 15% beyond statin therapy. Patients achieving LDL <20 mg/dL had greatest benefit with no safety concerns. This definitively proved very low LDL (<50 mg/dL) is safe and beneficial.
Familial Hypercholesterolemia
FH affects 1 in 250 people (1 in 300,000 for homozygous FH). Untreated heterozygous FH causes heart attacks 20 years earlier than general population. LDL is markedly elevated from birth (>190 mg/dL). Early statin treatment (starting in childhood for FH) prevents cardiovascular events. Cascade screening identifies affected relatives.
Source:Sturm AC, et al. Clinical genetic testing for familial hypercholesterolemia. J Am Coll Cardiol. 2018;72(6):662-680.
LDL-C vs ApoB Discordance
When triglycerides are elevated (>150 mg/dL), LDL-C underestimates cardiovascular risk. These patients often have high LDL particle number despite "normal"LDL-C. ApoB (which counts particles, not cholesterol content) more accurately predicts risk. LDL-C <100 mg/dL with ApoB >90 mg/dL indicates high particle number and elevated risk requiring treatment.
Source:Sniderman AD, et al. Apolipoprotein B particles and cardiovascular disease:a narrative review. JAMA Cardiol. 2019;4(12):1287-1295.
Which Providers Test LDL Cholesterol?
Full Provider Comparison
| Provider | Includes | Annual Cost | Biomarkers |
|---|---|---|---|
 Superpower | ✓ | $199 | 100+ (150 with ratios) |
 WHOOP Advanced Labs | ✓ | $349 | 65 |
 Labcorp OnDemand | ✓ | $398 | 30+ |
| ✓ | $486 | 40+ | |
| ✓ | $444 | 288 | |
| ✓ | $349 | 100+ | |
| ✓ | $761 | 54 | |
 Function Health | ✓ | $365 | 160+ |
| ✓ | $250 | 65 | |
| ✓ | $495 | 70+ | |
| ✓ | $895 | 100+ | |
| ✓ | $1950 | 150+ | |
| ✓ | $375 | 80+ | |
| — | $Varies | 75+ | |
| ✓ | $190 | 100+ | |
| ✓ | $99 | 50 | |
| ✓ | $124 | 60 | |
| ✓ | $199 | 50 | |
| ✓ | $499 | 120+ | |
| ✓ | $4188 | 70-80+ | |
| ✓ | $375 | 85 | |
| ✓ | $700 | 128 |
Frequently Asked Questions
What is LDL Cholesterol?
Low-density lipoprotein, or "bad"cholesterol
What is the optimal range for LDL Cholesterol?
The standard reference range for LDL Cholesterol is Optimal:<100 mg/dL, Near optimal:100-129 mg/dL, Borderline high:130-159 mg/dL, High:≥160 mg/dL. Optimal ranges may differ based on individual health goals and expert recommendations.
Which blood test providers include LDL Cholesterol?
21 out of 22 blood testing providers include LDL Cholesterol in their panels. This biomarker is widely available across major providers.
What category does LDL Cholesterol fall under?
LDL Cholesterol is categorized under Lipid Panel / Cardiovascular Health. This category includes biomarkers that help assess related aspects of health and wellness.
Medical Disclaimer
This information is for educational purposes only and is not medical advice. Always consult with a qualified healthcare provider about your specific health needs.
Last reviewed:2026-02-20