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Biomarker library / Lipids

Total cholesterol (TC)

Also called serum cholesterol, cholesterol blood test

Total cholesterol is the sum of the cholesterol in all lipoprotein particles: LDL, HDL, and the triglyceride carriers. It is the oldest number on the panel and the bluntest, because it adds together a particle family that raises risk (LDL) and one that tracks with lower risk (HDL).

Written by the VitalDecades editorial team Reviewed by the editorial review process Updated

01  /  Reference ranges

What counts as normal

Scale in mg/dL. Cut points from the sources listed below.

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Population Adults 20 and older
Category Healthy level
Range under 200 mg/dL MedlinePlus (NIH) lists under 200 mg/dL as healthy for men and women 20 and older; interpretation runs through LDL, HDL and ApoB.
Source MedlinePlus (NIH National Library of Medicine): Cholesterol Levels

Effective

Population Age 19 and younger
Category Healthy level
Range under 170 mg/dL
Source MedlinePlus (NIH National Library of Medicine): Cholesterol Levels

Effective

Normal vs optimal

Under 200 mg/dL is the healthy listing for adults; under 170 for ages 19 and younger. No guideline sets treatment decisions on the total by itself, so we print no optimal: the actionable numbers live on the LDL, HDL and ApoB pages.

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02  /  Why it matters

What the number tells you

For adults 20 and older, MedlinePlus (NIH) lists a healthy total cholesterol as less than 200 mg/dL. But two people with identical totals can carry very different risk: one with high HDL and low LDL, the other the reverse. Modern guidelines steer by the parts, LDL, non-HDL and increasingly ApoB, plus overall risk, rather than the total alone. Treat the total as a flag that says look closer, not a verdict.

03  /  In practice

Testing and what moves it

When it is tested

  • As part of every standard lipid panel; from age 40 to 75 the panel feeds the USPSTF statin discussion.
  • Fasting is usually unnecessary for a modern panel.
  • A high total is interpreted through its parts, and once, through Lp(a).

What raises it

  • Saturated and trans fat intake, weight gain, hypothyroidism, genetics (familial hypercholesterolemia when LDL is very high), pregnancy.
  • A very high HDL also raises the total, which is why the sum misleads.

What lowers it

  • Statins and other LDL-lowering therapy, dietary change (less saturated fat, more soluble fiber), weight loss.

04  /  Related

Read next

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Metabolic health after 40: the numbers to know

2026-08-19

ApoB vs LDL cholesterol: which number matters more?

2026-08-19

Cholesterol levels by age: chart for men and women

2026-08-27

Frequently asked questions

Is 220 total cholesterol dangerous?

It is a flag, not a verdict. The healthy listing is under 200 mg/dL, but what 220 means depends on the split: a mostly-HDL 220 and a mostly-LDL 220 carry very different risk. The next step is reading the LDL, HDL, triglycerides and ideally ApoB, then overall risk.

Why did guidelines stop using total cholesterol categories?

Because the total mixes opposing signals. Treatment guidelines since 2013 steer by LDL and overall cardiovascular risk, with non-HDL and ApoB as refinements; the total survives mainly as a screening flag and an input to risk calculators.

Do I need to fast for a cholesterol test?

Usually not anymore; non-fasting panels are accepted for most purposes, and triglycerides are the only number that moves much with a recent meal.