01 / Reference ranges
What counts as normal
Normal vs optimal
"Normal" on a lab report usually means the ATP III optimal band, under 100 mg/dL. Treatment targets are lower for people who already have cardiovascular disease: the 2018 AHA/ACC guideline uses 70 mg/dL as the very-high-risk threshold, and the 2019 ESC/EAS guideline sets goals of under 55 mg/dL for very-high-risk and under 70 for high-risk patients. Which number applies to you depends on your risk category, not on the lab's reference interval.
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02 / Why it matters
What the number tells you
Two documents govern how LDL-C is read in the US. The NCEP Adult Treatment Panel III (2001) categories are what most lab reports still print: optimal under 100 mg/dL, near optimal 100 to 129, borderline high 130 to 159, high 160 to 189, very high 190 and above. The 2018 AHA/ACC multisociety guideline does not use those bands for decisions; it uses thresholds. An LDL-C of 190 mg/dL or higher means high-intensity statin therapy without a risk calculation. Between 70 and 189 mg/dL, adults 40 to 75 have a risk discussion keyed to their 10-year ASCVD risk. In people at very high risk who are already on a statin, 70 mg/dL is the threshold to consider adding a non-statin.
03 / In practice
Testing and what moves it
When it is tested
- As part of a lipid panel; the USPSTF ties statin decisions to adults 40 to 75 with risk factors, and the 2018 AHA/ACC guideline suggests risk assessment from age 20 with lipids every 4 to 6 years in adults free of disease.
- Fasting is no longer required for a screening lipid panel in most cases; very high triglycerides can distort a calculated LDL-C.
What raises it
- Saturated and trans fat intake, genetics (familial hypercholesterolemia is the classic cause of LDL-C 190 or above), hypothyroidism, nephrotic syndrome, some medications.
What lowers it
- Statins, ezetimibe, PCSK9 inhibitors and other lipid-lowering drugs; dietary change (less saturated fat, more soluble fiber); weight loss has a modest effect.
04 / Related
Read next
Frequently asked questions
Is 130 mg/dL LDL high?
ATP III labels 130 to 159 mg/dL borderline high. Under the 2018 AHA/ACC guideline, whether it needs treatment depends on your 10-year ASCVD risk and risk-enhancing factors, not on the band alone.
Why do some doctors want LDL under 70 or under 55?
Those are treatment thresholds and goals for people at very high cardiovascular risk: 70 mg/dL in the 2018 AHA/ACC guideline, under 55 mg/dL in the 2019 ESC/EAS guideline. They are not the reference range for a healthy adult without disease.
Do I need to fast for an LDL test?
Usually not for screening. If triglycerides are very high, a fasting sample or a direct LDL measurement gives a more reliable LDL-C.
3 documents set the numbers on this page. The oldest was published in 2001, the newest in 2019.
- NCEP Adult Treatment Panel III, Executive Summary (NHLBI, 2001)
- 2018 AHA/ACC Multisociety Guideline on the Management of Blood Cholesterol
- 2019 ESC/EAS Guidelines for the management of dyslipidaemias
We last re-read these sources on . How we verify.