Total Cholesterol
Total amount of cholesterol in the blood
21 of 22 providers
Lipid Panel / Cardiovascular Health
Desirable:<200 mg/dL, Borderline:200-239 mg/dL, High:≥240 mg/dL
What is Total Cholesterol?
Total Cholesterol measures the sum of all cholesterol in your blood, including LDL (low-density lipoprotein), HDL (high-density lipoprotein), and VLDL (very low-density lipoprotein). Cholesterol is a waxy, fat-like substance essential for building cell membranes, producing hormones (testosterone, estrogen, cortisol), synthesizing vitamin D, and creating bile acids for digestion.
While total cholesterol provides a snapshot of lipid status, it is less informative than its components because it combines both "good"HDL and "bad"LDL cholesterol. A person with total cholesterol of 220 mg/dL could have high HDL (protective) or high LDL (harmful)—vastly different cardiovascular risk profiles. This is why modern guidelines emphasize LDL, HDL, and non-HDL cholesterol (total minus HDL) over total cholesterol alone.
Total cholesterol was historically used for cardiovascular risk assessment, with <200 mg/dL considered desirable. However, this arbitrary threshold has been challenged—25% of heart attacks occur in people with "normal"total cholesterol. Advanced lipid testing (ApoB, LDL particle number, Lp(a)) provides superior risk stratification. Total cholesterol remains useful as an initial screening tool and for calculating non-HDL cholesterol (total - HDL), which correlates well with ApoB.
Why Total Cholesterol Is A Starting Point, Not the Answer
- Initial screening:Widely available, inexpensive test for identifying lipid abnormalities requiring further evaluation
- Non-HDL calculation:Total cholesterol minus HDL equals non-HDL cholesterol, which captures all atherogenic particles (LDL + VLDL + remnants) and correlates well with cardiovascular risk
- Historical tracking:Decades of epidemiological data link elevated total cholesterol to heart disease risk, though other markers are now preferred
- Familial hypercholesterolemia detection:Very high total cholesterol (>300 mg/dL) in young adults suggests genetic disorder requiring aggressive treatment
- Limited utility alone:Cannot distinguish protective HDL from harmful LDL. Must be interpreted with HDL, LDL, triglycerides
- Medication monitoring:Tracks overall lipid-lowering effect of statins and other therapies
Optimal vs Standard Ranges
Desirable<200 mg/dL▼
- Associated with lower cardiovascular risk in population studies
- However, risk depends on HDL and LDL components
- Total cholesterol 180 mg/dL with HDL 80 (excellent) differs dramatically from 180 mg/dL with HDL 30 (poor)
- Always evaluate with lipid panel components
Borderline High200-239 mg/dL▼
- Moderate cardiovascular risk
- Check complete lipid panel with LDL, HDL, triglycerides
- Calculate non-HDL cholesterol (total - HDL);target <130 mg/dL
- Consider lifestyle modifications (diet, exercise, weight loss)
- If LDL >130 or multiple risk factors, consider statin therapy
High240-300 mg/dL▼
- Elevated cardiovascular risk
- Requires comprehensive lipid panel, cardiovascular risk assessment (Framingham, ASCVD calculator), and likely pharmacotherapy
- If LDL >160 mg/dL, statin therapy indicated
- Screen for familial hypercholesterolemia, especially if family history of early heart disease
- Aggressive lifestyle modification essential
Very High (Possible Familial Hypercholesterolemia)>300 mg/dL▼
- Very high cardiovascular risk
- Strongly suggests familial hypercholesterolemia (FH), especially if present in young adults (<40 years) or with family history
- FH affects 1 in 250 people and increases heart attack risk 20-fold
- Requires high-intensity statin (atorvastatin 40-80 mg or rosuvastatin 20-40 mg), possibly combined with ezetimibe or PCSK9 inhibitors
- Early intervention critical—untreated FH causes heart disease by age 50-60 in men, 60-70 in women
Scientific Evidence
Cholesterol and Cardiovascular Risk
Framingham Heart Study and subsequent trials established that total cholesterol >200 mg/dL increases cardiovascular risk. Each 40 mg/dL increase in total cholesterol raises cardiovascular risk by ~30%. However, this relationship is driven primarily by LDL cholesterol—high total cholesterol with high HDL is not harmful. This led to abandonment of total cholesterol alone as a treatment target.
Statin Benefit Trials
Meta-analyses of statin trials show each 40 mg/dL reduction in LDL (typically accompanied by 60-80 mg/dL reduction in total cholesterol) reduces cardiovascular events by 20-25% and all-cause mortality by 10%. Benefit is consistent across baseline cholesterol levels—even people with "normal"cholesterol benefit from statins if high cardiovascular risk.
Non-HDL Cholesterol
Non-HDL cholesterol (total minus HDL) captures all atherogenic lipoproteins (LDL + VLDL + remnants) and correlates more strongly with cardiovascular risk than LDL alone, especially when triglycerides are elevated. Non-HDL >130 mg/dL indicates increased risk. Target <130 mg/dL for primary prevention, <100 for secondary prevention.
Familial Hypercholesterolemia
Familial hypercholesterolemia affects 1 in 250 people. Untreated FH causes total cholesterol >300 mg/dL (LDL >190 mg/dL) from birth, leading to heart disease 20 years earlier than general population. Early statin treatment (starting in childhood) prevents cardiovascular events. Cascade screening of relatives identifies additional affected family members requiring treatment.
Source:Nordestgaard BG, et al. Familial hypercholesterolaemia is underdiagnosed and undertreated. Nat Rev Cardiol. 2013;10(12):687-696.
Dietary Interventions
Mediterranean diet reduces total cholesterol by 10-15 mg/dL and LDL by 8-10 mg/dL compared to low-fat diet. Plant sterols (2g daily) reduce LDL additional 6-10%. Soluble fiber (10g daily) reduces LDL 5-7%. Combined dietary interventions can achieve 15-25% LDL reduction—comparable to low-dose statin—without medications.
Source:Estruch R, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368(14):1279-1290.
Which Providers Test Total 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 Total Cholesterol?
Total amount of cholesterol in the blood
What is the optimal range for Total Cholesterol?
The standard reference range for Total Cholesterol is Desirable:<200 mg/dL, Borderline:200-239 mg/dL, High:≥240 mg/dL. Optimal ranges may differ based on individual health goals and expert recommendations.
Which blood test providers include Total Cholesterol?
21 out of 22 blood testing providers include Total Cholesterol in their panels. This biomarker is widely available across major providers.
What category does Total Cholesterol fall under?
Total 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