Cholesterol travels through the bloodstream attached to carrier molecules, including two important ones called high-density lipoprotein (HDL) and low-density lipoprotein (LDL). A blood test for cholesterol measures the total amount of lipoprotein-bound cholesterol as well as the relative amounts of HDL and LDL.

A relatively high level of HDL, also known as “good” cholesterol, seems to be somewhat protective against heart disease. High levels of LDL, also known as “bad” cholesterol, are associated with an increased risk of heart disease.

July 2004 guidelines issued by the National Cholesterol Education Program establish ranges for cholesterol levels and recommend that regular testing begin at age 20.

Cholesterol ranges from the 2004 guidelines, measured in milligrams per deciliter (mg/dL)
 

Total cholesterol
Less than 200 mg/dL	Desirable
200 – 239 mg/dL	Borderline high
240 mg/dL and above	High

LDL cholesterol
Less than 100 mg/dL	Optimal
100 – 129 mg/dL	Near optimal
130 – 159 mg/dL	Borderline high
160 – 189 mg/dL	High
190 mg/dL or above	Very high

HDL cholesterol (high is better)
Less than 40 mg/dL	Low
More than 60 mg/dL	High

The 2004 treatment guidelines also recommend goals for lowering LDL based on a person’s risk of having a heart attack in the next 10 years, with the lowest level suggested for those at highest risk. Estimates of risk are based on a combination of major risk factors or a score calculated from a risk assessment tool.

If you fall into an increased risk category, you should talk with your doctor about the best way to manage your cholesterol. Management strategies include reduced intake of saturated fats, increased physical activity, weight reduction and certain types of drugs.

The 2004 guidelines establish the following risk categories:

1. The highest risk level includes individuals who have:

   • coronary heart disease or
   • disease in blood vessels in places other than the heart or
   • diabetes or
   • a score on the risk assessment tool indicating a greater than 20 percent likelihood of having a heart attack in the next 10 years.

   The LDL cholesterol target for this group is less than 100.

2. The second-highest risk level includes individuals who have:

   • two or more major risk factors or
   • a score on the 10-year risk assessment that falls between 10 and 20 percent.

   The LDL goal for these individuals is less than 130.

3. The lowest risk category includes individuals with:

   • zero or one major risk factor. Almost everyone in this group has a 10-year risk less than 10 percent.

   The LDL goal for this group is less than 160.

Major risk factors include:

• Cigarette smoking
• High blood pressure, defined as either blood pressure of 140/90 or higher or being on blood pressure medication
• HDL cholesterol less than 40 mg/dL. If your HDL is greater than 60, it counts as a “negative” risk factor, allowing you to subtract one risk factor from your total
• A family history of premature heart disease (a father, brother or male child who had coronary heart disease before age 55 or a mother, sister or female child who had heart disease before age 65)
• Age (45 or older for men; 55 or older for women)
• Diabetes was considered a risk factor in previous versions of the guidelines. The 2004 guidelines move diabetes up to the highest risk category, where it is considered equivalent to having coronary artery disease.

The guidelines recognize that other factors not included in the major risk list also influence cardiovascular health. These other factors include obesity, lack of exercise, high-fat diet, and borderline high blood sugar.

Framingham Point Score Coronary Heart Disease Risk Assessment Tool

This calculator is based on data collected from the Framingham Heart Study, a major investigation of risk factors for heart disease launched in 1948 by the National Heart, Lung, and Blood Institute.

To estimate your 10-year risk for heart disease:

• find your points for each of the five factors below
• total your individual scores
• find your risk percentage on the Point Total/Percent Risk table.

1. Age

2. Total cholesterol

Points by age

3. HDL

4. Cigarette Smoking (any cigarettes smoked in the last month)

Points by age

5. Systolic Blood Pressure (your upper number)
 

Table of 10-year risk of heart disease

Risk of having a heart attack in the next 10 years

Point total	Men	Women
Less than 0	Less than 1%	Less than 1%
0	1 %	Less than 1 %
1	1 %	Less than 1 %
2	1 %	Less than 1 %
3	1 %	Less than 1 %
4	1 %	Less than 1 %
5	2 %	Less than 1 %
6	2 %	Less than 1 %
7	3 %	Less than 1 %
8	4 %	Less than 1 %
9	5 %	1 %
10	6 %	1 %
11	8 %	1 %
12	10 %	1 %
13	12 %	2 %
14	16 %	2 %
15	20 %	3 %
16	25 %	4 %
17	Any total of 17 or above represents a 30 % or greater risk for a man	5 %
18		6 %
19		8 %
20		11 %
21		14 %
22		17 %
23		22 %
24		27 %
25		Any total of 25 or above represents a 30 % or greater risk for a woman

Additional Web resources

• 2004 National Cholesterol Education Program Guidelines

• Online tool for estimating your 10-year risk of having a heart attack
  

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