aApproximately 25 million adults in the United States have high cholesterol levels, which puts them at higher risk of having a heart attack or stroke over the next 10 years. However, a much larger portion has what is called borderline high cholesterol, an intermediate state that is not very high but not within the normal range.

Here’s what you need to know about borderline cholesterol.

What is borderline cholesterol?

High cholesterol is defined as a total cholesterol level of 240 mg/dL or higher. On the other hand, people with total cholesterol in the 200 to 239 range have borderline cholesterol.

“We create these thresholds to classify people so that we can understand whether further analysis or evaluation is needed to understand their risk of cardiovascular disease, and this is clearly “It’s somewhat artificial,” said Dr. Donald Lloyd-Jones, former president of the American Football Club. He is a member of the Heart Association and a professor of cardiology and professor of preventive medicine at Northwestern University Feinberg School of Medicine. He has some flexibility. Some people have a total cholesterol level of 235 and are perfectly healthy, while others have a total cholesterol level of 205 and are at risk. It depends on the person’s other risk factors. But broadly speaking, these thresholds help doctors make decisions about patient care.

People with total cholesterol levels below 200 tend to have a low risk of developing heart disease, while those with total cholesterol levels above 240 are at increased risk. According to Lloyd-Jones, those who reach 200 to 239 are somewhere in between.

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Dr. Daron Gersh, a family physician at CentraCare Hospital in Long Prairie, Minn., says cholesterol levels in this intermediate category don’t automatically make you dangerous, but they do increase your risk of developing high cholesterol. . In borderline categories, the effects can be cumulative. A study published in 2015 found that people who had borderline high cholesterol levels for 11 to 20 years were twice as likely to develop heart disease as those who had high cholesterol levels for 10 years. It was said to be expensive. Circulation.

“My example is that throughout our lives we bathe our arteries in cholesterol particles,” says Lloyd-Jones. “The more you marinate, the more likely plaques will form. People with very high levels over a short period of time are at risk of forming plaques, but even those with moderate levels over a long period of time will develop plaques.” Over time, these plaques can build up and become inflamed, leading to heart attacks and strokes.

The type of cholesterol is important

Total cholesterol levels alone do not tell the whole story. Of greatest concern are levels of low-density lipoprotein, or LDL, cholesterol, also known as “bad” cholesterol, said Anne-Marie Navar, associate professor of cardiology at the University of Texas Southwestern Medical School and co-author of the paper. says the doctor. Circulation study. That’s because LDL is a type of cholesterol that builds up in your arteries. A healthy LDL level is less than 100.

High-density lipoprotein, or HDL, cholesterol, on the other hand, is sometimes referred to as “good” cholesterol because it removes fat from the blood, Gersh says. A healthy HDL level for him is over 60.

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“If you have elevated total cholesterol levels due to HDL, you may not be at increased risk and may actually be somewhat protected,” Gersh says. It is broken down into good cholesterol and bad cholesterol. ”

That’s why it may be more accurate to look only at borderline high LDL cholesterol, Navar says. According to the American College of Family Physicians, an LDL cholesterol level of 160 or higher is considered high, while an LDL cholesterol level of 130 to 159 is borderline.

This is a rough classification and does not guarantee that heart disease will occur in the future. “The risk of LDL-related cholesterol is a continuum. There is no magic number above which you are at risk and below which you are not at risk,” Navarre says. “The higher your LDL is, and the longer your LDL is elevated, the more risk it accumulates over time.”

How to lower borderline high cholesterol

After reviewing blood test results in conjunction with your medical history, your doctor will recommend the best course of action to bring your cholesterol levels within a healthy range.

If you have borderline high cholesterol levels but are otherwise healthy and under age 60, your doctor may recommend lifestyle modifications to help lower your overall risk of developing heart disease. there is. These include achieving and maintaining a healthy weight, eating a balanced diet (reducing intake of starches, alcohol, and high-fat foods), smoking cessation, and exercising regularly.

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But if you have borderline high cholesterol and two or more other risk factors for heart disease, your doctor will likely recommend cholesterol-lowering drugs to keep your heart safe for as long as possible, Dr. Gersh says. . These risk factors include high blood pressure, diabetes, exposure to smoking or second-hand smoke, being over 60 years old, having a family history of heart disease, being sedentary, or having excess weight.

When should you get a cholesterol test?

If any of these risk factors sound familiar to you, it’s a good idea to start getting your cholesterol tested around age 20. Men without risk factors for heart disease can usually wait until age 35, and women without these risk factors can wait until age 45 to start regular cholesterol tests, Gersh says.

If your test results show your cholesterol is within a healthy range, you should be retested every four to six years. However, if your blood test levels fall into the borderline or high category, or if you have other heart disease risk factors, you can expect to have your blood tested more regularly, preferably once a year. Masu.

Having borderline high cholesterol levels may mean it’s time to start taking some preventive measures, but it doesn’t mean a heart attack or stroke is inevitable. Also, your overall health and future risk factors for heart disease are more important than specific numbers on your cholesterol panel.

‘Is there really a difference between 199 and 201? No, there isn’t,’ says Lloyd-Jones. Rather, it is a generalized population-wide relationship between cholesterol and heart disease risk, and at the individual level it is just one piece of the puzzle. “These are kind of arbitrary barriers, but they help you decide initially how aggressive and focused you want to be.”