Dr. Prabhat AryaMD · Internal Medicine
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Your lipid profile, number by number.

A lipid profile measures the fats carried in your blood. A few lines flagged high is very common and is rarely urgent, but LDL and your overall heart risk decide whether you need to do something about it.

Reviewed by Dr. Prabhat Arya, MBBS, MD (Internal Medicine)

Reviewed · Next review · Sources: NHS, MedlinePlus, Testing.com

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Read this first.

Go by the range printed on your own report. The ranges below are typical adult ranges, and labs differ a little. Most Indian labs print cholesterol in mg/dL; some print mmol/L.

A lipid profile is not urgent on its own. High cholesterol causes no symptoms. It matters because, over years, it builds up inside the arteries of the heart and brain. So the question is not “is this number high?” but “how high is my overall risk of a heart attack or stroke?” That depends on your age, BP, sugar, smoking, kidneys and family history as well.

The line that matters most is LDL. Then triglycerides and HDL. VLDL, non-HDL and the two ratios are worked out from the other numbers, so they rarely tell you anything new. Most labs calculate LDL rather than measure it, and that calculation goes wrong when triglycerides are very high (above about 400 mg/dL).

You usually do not need to fast for a cholesterol test. Triglycerides go up for some hours after a meal, so if they come back high on a non-fasting sample, a repeat after a 10–12 hour overnight fast is reasonable. Compare with your last report: the trend over a year tells more than one result.

Every value, one by one.

Total cholesterol

All the cholesterol in your blood: LDL, HDL and VLDL added together

Typical adult range Below 200 mg/dL is called desirable; 200–239 borderline; 240 or more high

High usually means
Usually diet, weight, family pattern and age. An underactive thyroid, uncontrolled diabetes, kidney disease that leaks protein, and some medicines (steroids, some water tablets) can push it up too. A high total can also be due to a high HDL, which is good, so look at LDL and HDL before worrying.
Low usually means
Usually just means you are on a cholesterol tablet, or have naturally low levels. Rarely, a low value goes with an overactive thyroid, poor nutrition, or long-standing liver disease.
Usually nothing to worry about when
It is 200–240 with a normal LDL and a good HDL, or the extra is mostly HDL.
See a doctor when
At your next check-up if it is above 240. Within a few weeks if it is above about 300, or if a parent, brother or sister had a heart attack young (men before 55, women before 65): this can be an inherited form that runs in families.

Triglycerides

The main fat that carries energy in the blood; rises after meals

Typical adult range Below 150 mg/dL; 150–199 borderline; 200–499 high; 500 or more very high

High usually means
Usually sugar, sweets, refined flour (maida), white rice in large amounts, alcohol, extra weight around the tummy, fatty liver, or diabetes that is not well controlled. A recent meal raises it. An underactive thyroid, kidney disease and some medicines can also raise it.
Low usually means
Low triglycerides are not a problem. They are usual in people who are slim and active.
Usually nothing to worry about when
It is 150–250 on a sample taken after a meal, especially if fasting values were normal before. Cutting sugar, maida and alcohol often brings it down within a few weeks.
See a doctor when
At your next check-up if it is 200–499. Within a week if it is 500 or more: very high triglycerides can inflame the pancreas. If it is above about 1,000, see a doctor within a day or two, and go to hospital the same day if you have severe tummy pain.

HDL cholesterol

The “good” cholesterol, which carries cholesterol away from artery walls

Typical adult range Above 40 mg/dL in men and above 50 mg/dL in women; 60 or more is best

High usually means
Usually good news, often from family genes or an active life. A high HDL does not cancel out a high LDL, so still look at LDL.
Low usually means
Very common in Indians, often together with high triglycerides and a big waist. Usually due to inactivity, extra weight, smoking, diabetes or prediabetes, and diet heavy in sugar and refined carbohydrate. It adds to heart risk.
Usually nothing to worry about when
It is just below the line and your LDL is low.
See a doctor when
At your next check-up if it is low together with high triglycerides, high sugar or high BP: that combination is worth a proper heart-risk check.

LDL cholesterol

The “bad” cholesterol, which builds up in artery walls. Often marked “calculated” or “direct”

Typical adult range Below 100 mg/dL is optimal for most adults; 100–129 near optimal; 130–159 borderline high; 160–189 high; 190 or more very high

High usually means
Usually diet rich in ghee, butter, fried food and bakery items, extra weight, inactivity and family pattern. An underactive thyroid and kidney disease that leaks protein can raise it. Whether it needs a tablet depends on your overall heart risk, not on this number alone: the same LDL of 130 may be fine for one person and too high for someone with diabetes or a past heart attack.
Low usually means
Low LDL is good. Very low values are usually from a cholesterol tablet and are not harmful.
Usually nothing to worry about when
It is under 130 and you have no diabetes, no heart disease, normal BP, do not smoke, and no early heart disease in the family.
See a doctor when
Within a few weeks if it is 190 or more (this can be inherited, and your family should be tested too), or if it is above your target and you have diabetes, kidney disease, or have had a heart attack, angioplasty or stroke. Otherwise at your next check-up if it is above 130.

VLDL cholesterol

Very-low-density lipoprotein: the particles that carry triglycerides. Most labs calculate it as triglycerides divided by 5

Typical adult range Up to about 30 mg/dL

High usually means
Simply follows triglycerides. If triglycerides are high, VLDL will be high too; it adds no new information.
Low usually means
Not a concern.
Usually nothing to worry about when
It is high only because triglycerides are mildly high: deal with the triglycerides.
See a doctor when
Go by the triglycerides line, not this one.

Non-HDL cholesterol

Total cholesterol minus HDL: all the cholesterol that can build up in arteries

Typical adult range Below 130 mg/dL for most adults

High usually means
The same causes as a high LDL or high triglycerides. It is a useful number when triglycerides are high, because then the calculated LDL is less reliable, and it does not need a fasting sample.
Low usually means
Good. Usually seen on cholesterol tablets.
Usually nothing to worry about when
It is just above 130 with no other heart risks.
See a doctor when
At your next check-up if it is above 160, or sooner if you have diabetes or heart disease and it is above the target set for you.

TC/HDL ratio (cholesterol ratio)

Total cholesterol divided by HDL

Typical adult range Lower is better; many labs flag above about 5

High usually means
Means HDL is low compared with the total, often with high triglycerides. It points the same way as the other lines.
Low usually means
Good.
Usually nothing to worry about when
It is mildly high and your LDL is fine. Doctors use LDL, non-HDL and your overall risk to decide treatment, not this ratio alone.
See a doctor when
Go by LDL and your overall heart risk.

LDL/HDL ratio

LDL divided by HDL

Typical adult range Lower is better; many labs flag above about 3.5

High usually means
Either LDL is high, HDL is low, or both. It repeats what those two lines already show.
Low usually means
Good.
Usually nothing to worry about when
It is mildly high and both LDL and HDL are close to their ranges.
See a doctor when
Go by LDL and your overall heart risk.

Results that go together.

PatternsTypical, not certain
When you seeIt usually means
High triglycerides, low HDL, borderline LDLThe commonest pattern in Indians. It usually goes with a big waist, fatty liver and prediabetes or diabetes. Check your sugar and HbA1c and your liver tests. Less sugar, maida and alcohol, more walking and weight loss improve all three.
High LDL with high TSHAn underactive thyroid raises cholesterol. Treating the thyroid often brings LDL down. See the thyroid guide.
LDL 190 or more at a young ageOften an inherited form (familial hypercholesterolaemia). It needs treatment early, and parents, brothers, sisters and children should be tested.
High total cholesterol with a high HDLOften fine. A high HDL pushes the total up. Look at LDL and non-HDL instead.
Very high triglycerides (above 400) and an LDL that looks oddly low or is not givenThe calculated LDL is not reliable at this level. Ask the lab for a direct LDL, or go by non-HDL.
High cholesterol with protein in the urine and swollen feetKidneys leaking protein can push cholesterol up. This needs a doctor within a week; see protein in urine.

Get help today if

  • Chest pain, pressure or tightness lasting more than a few minutes, with sweating or breathlessness, or spreading to the arm, jaw or back: call 112. Do not drive yourself.
  • Triglycerides above 1,000 mg/dL with severe pain in the upper tummy going through to the back, and vomiting: go to hospital today. This can be an inflamed pancreas.
  • Sudden weakness of the face, arm or leg on one side, slurred speech or sudden loss of vision: call 112 and note the time it started.
  • Muscle pain or weakness after starting a cholesterol tablet, with dark, cola-coloured urine: stop the tablet and see a doctor today.

Call 112 or go to the nearest emergency department. Ambulance: 108 (102 in some states).

Read more.

Questions people ask.

  1. Do I need to fast for a lipid profile?

    Usually not. Total cholesterol, LDL, HDL and non-HDL change very little after a meal. Triglycerides do rise for a few hours after eating, so if they come back high on a non-fasting test, a repeat after a 10–12 hour overnight fast (water is fine) is reasonable.

  2. My LDL is 140. Do I need a cholesterol tablet?

    Not automatically. It depends on your overall risk of heart attack and stroke: age, BP, sugar, smoking, kidneys and family history. For someone young and healthy, food, activity and weight usually come first. For someone with diabetes, kidney disease or a past heart attack, an LDL of 140 is too high and a tablet is usually advised. Dr. Arya can work out your risk and target from your reports.

  3. Is high triglycerides dangerous?

    Mildly high triglycerides (150–500 mg/dL) add to heart risk over the years but are not an emergency. They respond well to cutting sugar, maida, sweet drinks and alcohol, and to losing weight. Very high levels, above 500 and especially above 1,000, can inflame the pancreas and need a doctor within a week, sooner if there is tummy pain.

  4. Can I be thin and still have high cholesterol?

    Yes. Genes play a large part. Many slim Indians have high LDL or low HDL, and some have an inherited form. That is why a first lipid profile in your twenties or thirties is worthwhile, whatever your weight.

  5. What should my cholesterol numbers be?

    For most healthy adults: LDL below 100–130 mg/dL, HDL above 40 (men) or 50 (women), triglycerides below 150 and non-HDL below 130. People with diabetes, kidney disease or heart disease need lower LDL targets. Go by the range on your report, and ask for your own target.

Where this can be checked

These are trusted general sources. The advice on this page is Dr. Arya’s, written for patients in India. Ranges differ between labs: go by the range printed on your own report.

Your whole report, read by your doctor.

Send every page, old reports too. He reads them himself and tells you what changed and what to do.

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Dr. Prabhat Arya · MBBS, MD (Internal Medicine)