Here is what your cholesterol should be at each age

You’ve likely heard that there is “good” cholesterol and “bad” cholesterol, but knowing what ranges are healthy for each might be a little hard to discern—especially because the numbers do change with age. 

Cholesterol is a waxy substance, similar to fat, that is produced by the liver. It’s found in all of the cells in your body. It comes in two forms: blood cholesterol in our body and dietary cholesterol in food. Blood cholesterol is made by your own liver and helps to make hormones and digest fatty foods. Dietary cholesterol is found in animal foods like meat, eggs, seafood, poultry, and dairy products; it contributes only a modest amount to the blood cholesterol level. 

Blood cholesterol accounts for your total cholesterol level, which is measured by a group of blood tests called a lipid panel. You don’t want your total numbers to be too high—but past that, things can be confusing. However, it’s important to try to understand your ideal numbers because high cholesterol levels can lead to heart disease, heart attack, or stroke. 

Read on to learn about the different types of cholesterol and the numbers to shoot for in each stage of your life. The sooner you understand what a healthy level is for you, the sooner you can start doing something about it.

What is a healthy cholesterol level by age?

After you provide blood work for a lipid profile (also known as a lipoprotein panel), your total cholesterol level is determined by a calculation involving three values:

• LDL cholesterol level measures the amount of low-density lipoproteins—the “bad” cholesterol—in your blood. 
• HDL cholesterol level measures the amount of high-density lipoproteins—the “good” cholesterol—in your blood.
• Triglyceride level measures the amount of triglycerides—a type of fat that the body uses for energy—in your blood

“A healthy triglyceride level and a healthy LDL cholesterol level are both less than 100 milligrams per deciliter (mg/dL),” says Roger Blumenthal, MD, director of the Johns Hopkins Ciccarone Preventive Cardiology Center and spokesperson for the American Heart Association. “For men, a healthy HDL cholesterol level is 45 or greater. For women, it’s 50 or greater.” Dr. Blumenthal cited those numbers as a healthy standard for all adults, regardless of age, but, for most people, as they get older, it can get harder and harder to maintain those levels. Meaning, the guidelines for what’s considered optimal change because cholesterol levels naturally increase with age.

“When we’re younger, on average, the LDL cholesterol is maybe 10, 20, or 30 points lower,” Dr. Blumenthal says. As people age, their bodies lose the ability to clear cholesterol from the bloodstream as efficiently as they did when they were younger—which increases the risk of high cholesterol and associated complications. 

“For most people, regardless of what you do, LDL cholesterol tends to go up as you age,” says Samuel Kim, MD, the director of preventive cardiology at New York-Presbyterian Weill Cornell Medical Center and spokesperson for the American College of Cardiology. “Post menopause we can often see a substantial jump, as well. So it’s even more important as we get older to continue leading a healthy lifestyle to maintain those lower levels.”

You will often have a lipid panel as part of a routine checkup, especially when people have one or more risk factors for high cholesterol. “When you get a cholesterol panel, you’re probably going to see four main numbers,” Dr. Kim says. “The first one is your total cholesterol, which is sort of a summary score based on the three components of your cholesterol: your LDL cholesterol, HDL cholesterol, and triglycerides. Those are the other three numbers from the panel.”

RELATED: What are the early signs of high cholesterol?

Total cholesterol

Made up of HDL cholesterol, LDL cholesterol, and triglycerides, and largely determined by your metabolism and genetics and to a lesser extent the dietary cholesterol that you ingest, total cholesterol paints an overall picture of the amount of cholesterol in your bloodstream. 

According to the MedLine Plus and Nemours Kid’s Health, this is where you want your total cholesterol levels to be.

LDL cholesterol

So why is LDL cholesterol so bad? Well, as Dr. Blumenthal notes, “Lousy LDL cholesterol is the type of cholesterol that gets deposited in the arteries throughout the body.”

If you have too much low-density lipoprotein (LDL) cholesterol in your blood, it can join other substances to form plaque, which can build up in your arteries in a condition called atherosclerosis. When this happens in the heart, it’s called coronary artery disease, a type of cardiovascular disease in which the arteries become hardened and narrowed, blocking blood flow to the heart. If a coronary artery becomes completely blocked, it can cause a heart attack. 

“LDL cholesterol is the bad cholesterol because it’s the one that seems to be the most strongly associated with heart disease,” Dr. Kim says.

LDL cholesterol goals can be lower for people with certain risk factors, such as a history of heart attack or stroke, or if someone is already taking cholesterol-lowering medication. In those cases, providers like to see lower numbers.

“When someone is a high-risk person, if they’ve had a heart attack or stroke or bypass surgery, rather than be satisfied with an LDL level of 100, we want to get the LDL number below 70 milligrams per decimeter,” Dr. Blumenthal says.

Triglycerides

Although triglycerides aren’t cholesterol, triglyceride levels are generally included in a cholesterol panel. Triglycerides are a kind of fat, called lipids, that circulate in your bloodstream. They’re the most common type of fat in the body, which stores unused calories as triglycerides in your fat cells. Triglycerides are also found in fatty foods, such as oils and butter, and the body turns extra sugars from food into triglycerides. “Triglycerides are especially affected by one’s intake of sweets and carbohydrates,” Dr. Blumenthal says. 

HDL cholesterol

Made up of a lipid and protein, high-density lipoprotein (HDL) cholesterol carries excess cholesterol from other parts of your body back to your liver, which removes the cholesterol from your blood.

“HDL cholesterol is the good cholesterol,” says Dr. Kim. “It helps to counter some of the bad effects from the LDL cholesterol.”

Dr. Blumenthal explains that you want HDL cholesterol as high as possible because of its role. “HDL cholesterol is involved with removing some of the plaque—the fatty cholesterol and what we call hardened fibrous tissue—from the arteries and taking it back to the liver,” says Dr. Blumenthal.

How often should you get tested?

The National Heart, Lung, and Blood Institute recommends getting children their first lipid panel between the ages of 9 and 11. After that, they should be tested again every five years. In some cases, the first lipid panel may be done on children as young as 2 if the child has a family history of heart attack, stroke, or high blood cholesterol at a young age.

Young adults should have their cholesterol levels checked every five years. Men should start getting checked every one to two years at age 45. Women should start getting yearly or biennial lipid panels at age 55.

“Most doctors will check at least every couple of years,” Dr. Blumenthal says. “If the patient has other risk factors for heart disease, like high blood pressure, high blood sugar, or a family history of high cholesterol, it might be at least yearly.”

Dr. Kim agrees that how often you are tested will depend on your underlying risk factors. “If you’re on any medications, especially cholesterol medications, or if you have a history of heart disease, stroke, or peripheral arterial disease, then you should probably get checked more frequently.”

Be sure to speak with your cardiologist or healthcare provider about your risks and recommendations.

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Factors that affect cholesterol levels 

According to the Centers for Disease Control and Prevention (CDC), in the U.S. in 2020, about 86 million people aged 20 and older had total cholesterol levels above 200 mg/dL, the upper limit of what doctors consider healthy. This puts them in the borderline category. Nearly 25 million people had levels above 240 mg/dL, or what is medically considered to be high cholesterol. Factors that can put you at higher risk of high cholesterol include the following. 

• Unhealthy diet: The number one controllable cause of high cholesterol, according to the NIH, is an unhealthy lifestyle, a major component of which is a diet high in saturated fats, trans fats, sugar, and processed foods. “Cholesterol is related to dietary habits,” says Dr. Blumenthal. “If you have a couple days of a lot of sweets, a lot of blood sugar, or if you have a higher-fat diet and gain some weight, that can cause significant changes in cholesterol levels over just a few days.”
• Lack of physical activity: A sedentary lifestyle, getting little or no regular exercise, can make you more likely to gain weight, which can make your cholesterol levels higher and increase your risk of heart complications. 
• Family medical history: If other members of your family have high cholesterol, it can make you more likely to have it, as well. You should discuss your family history with a healthcare provider to see if you should have lipid panels done more frequently. “Some people are genetically predisposed to having very high LDL cholesterol, like 160 and above,” Dr. Blumenthal says. “Most people don’t have that genetic tendency, but if you do, you have to work extra hard with lifestyle choices and medication to get it down.”
• Underlying health conditions: Type 2 diabetes and obesity both raise your risk of higher LDL cholesterol levels and lower HDL cholesterol levels, increasing the risk of heart disease, heart attack, and stroke. Familial hypercholesterolemia—an inherited genetic condition that can cause very high levels of LDL cholesterol—can cause very high LDL cholesterol levels.  
• Smoking: Cigarette smoke damages the blood vessels, making them more likely to collect plaque buildup. It can also lower HDL cholesterol levels.

How to lower your cholesterol

For most people who aren’t genetically predisposed toward high cholesterol, the simplest, best way to lower your cholesterol and improve your heart health is through positive lifestyle changes. “It always starts with lifestyle,” Dr. Kim says. “That’s the emphasis.” You can make the following changes: 

• Eat a healthy diet. One of the most important steps to lower your cholesterol is to start eating a healthy diet consisting of more fruits and vegetables and less saturated fats. “As a whole, if you follow more of a Mediterranean-style diet, your numbers will improve over time,” Dr. Kim says. Mediterranean diets typically include monounsaturated fats—so-called “healthy fats”—found in fish and olive oil, whole grains, fruits, vegetables, nuts, legumes, and moderate alcohol consumption (heavy drinking can lead to increased levels of LDL cholesterol and triglycerides). Foods to avoid include red meats, fried foods, processed foods, coconut oil, palm oil, butter, cream, whole milk, and egg yolks. 
• Exercise regularly. Since high cholesterol is frequently linked to being overweight, weight loss and regular exercise are also great ways to lower cholesterol levels. “Exercise has a modest effect on cholesterol levels, so we want to encourage patients to increase modest, vigorous activity,” says Dr. Kim. “We recommend trying to get four days a week of 40 minutes or more of some brisk activity for the average person,” says Dr. Blumenthal. On top of that, quit smoking and reduce your stress.
• Take cholesterol medication. If lifestyle changes alone are not enough to lower cholesterol levels, your provider may prescribe cholesterol-lowering medications. “If diet and exercise don’t work, or if there are strong risk factors, or if you have a history of heart disease, then we start thinking about adding some medications to bring the levels down,” Dr. Kim says. “There are now several classes of medications that we can use.”

According to Dr. Kim, most people who need cholesterol-lowering medications start with statin therapy, which is a once-daily medication that lowers cholesterol by causing the liver to produce less cholesterol. Commonly prescribed statins include Lipitor (atorvastatin), Crestor (rosuvastatin), and Zocor (simvastatin).

Other medications that are less commonly prescribed to help lower cholesterol include cholesterol-absorption inhibitors, like Zetia (ezetimibe), PCSK9-inhibitors, bile acid sequestrants, fibrates, niacin, and omega-3 fatty acid supplements.