High Cholesterol, high HDL, low triglycerides

Dr T Ask Doctor T, Cardiac Risks 36 Comments

I’d like to ask a question about my recent cholesterol test results.  I had it tested for the first time ever recently.  I am a 38-yr-old female, 5’3″ and 115 lbs, no known health issues.  I do cardio exercise 4 -6 days a week for a half hour.  My diet is fairly healthy, as I actively avoid high fat/high sodium foods (though I do not specifically eat ‘diet’ foods, I just limit my intake of the bad stuff, such as saturated/trans fats and sodium).  I consider myself health conscious and fairly healthy.  There is no heart disease or high cholesterol in my very large family that anyone is aware of.So I was very surprised to receive my cholesterol results in the mail and see that it is considered very high.  Total Cholesterol: 250LDL: 162 (normal <130)HDL: 79 (normal >45)Triglycerides: 42 (Normal <150)As you can see, my HDL and triglyceride numbers appear to be very good, but I’m perplexed about the high LDL.  As I said, high cholesterol and heart disease do not run in my family, and I do attempt to exercise and eat a healthy diet, and am far from overweight.  What might account for this high LDL?  Could I be eating too much of something else that I’m not paying enough attention to, such as sugar?  Are there any nutritional deficiencies or other issues that could contribute?  (I do have to keep getting tested for my vitamin D levels, which are continuously very low despite taking prescription doses.) Thyroid disease does run heavily in my family – is this in any way connected to cholesterol levels?

There are 2 kinds of LDL cholesterol, A and B, of which B is associated with heart disease.
Most labs calculate LDL as follows:

LDL = Total Cholesterol – HDL – triglycerides/5.

This doesn’t explain the difference between LDL A (no risk)  or B (at risk for heart disease).

Studies have shown that there is a strong correlation between a low triglyceride/high HDL level and LDL pattern A (good kind).

On the other hand, a high triglyceride/low HDL level is strongly associated with LDL pattern B (heart disease risk). Thus high triglycerides are an independent risk factor for heart disease.

From this you can calculate that in your situation a high LDL is mostly Type A (good), confirmed by a high HDL and low triglyrerides and that therefore there a very low risk of heart disease.

Having high cholesterol may still be healthy if good cholesterol levels, triglycerides, and other markers of cardiovascular health are good. You can calculate this here. People with high good cholesterol levels (60 mg/dL or more) and low levels of triglycerides (less than 100 mg/dL) may actually be at a lower risk for heart disease than people with normal cholesterol levels who have lower levels of good cholesterol and higher levels of bad cholesterol.

Hope this helps,

Dr T

Comments 36

  1. Hi Dr T,
    Thanks for the info here. Would you recommend a CT scan based on the original poster’s results?
    Mine are similar:
    TC: 232 LDL: 150 HDL: 65 Tri: 80 (35yo female, healthy and fit, no diabetes etc, although maternal grandpa had heart issues from a young age)
    I live in Sydney, Australia and cardiologist here recommended I have a CT scan to rule out blockages/plaque, despite good resting and stress test results.
    Would you advise the same?
    Thank you!

  2. Hi
    I am a 57 year old female and just had some preop lab work done. I am 148 1bs and 5″6″

    Should I be concerned with the following results?

    Total Cholesterol 291
    Triglycerides 119
    HDL 103
    LDL 174

    Thank you


  3. These are the results of my most recent lipid panel: Total Cholesterol – 273, Non-HDL – 203, LDL – 175, HDL – 70 and Triglycerides – 139. My doctor stated that because my triglycerides are low, but my LDL is high this indicates genetic high cholesterol rather than related to diet. He immediately wanted to put me on statins. Is a low triglyceride number in combination with a high LDL number indicative of genetic cholesterol problems?

    1. I am not a doctor (am a pharmacist) and have ultra high HDL 109, high total cholesterols 298, ultra low triglycerides 62 and LDL 176 all mmol/l. I have seen numerous published clinical studies which have compared the LDLs calculated using the usual Friedewald formula with the actual measured LDLs and found that the calculated values far exceeded the real values for subjects with very low triglycerides and high HDLs. The studies proposed new formulae to calculate the LDLs which gave results much closer to the actual LDLs. Mine using 2 of the proposed formulae gave lower LDL values than those from the Friedewald formula and within the acceptable range. I’m glad I didn’t go on statins just based on the laboratory results.

  4. Thank you! My blood work shows a similar profile to the letter writer, though I am 20 years older than she! My doctor has not put me on statins, nor even suggested it. In fact, he said he didn’t like my high LDL number, but all other numbers looked good and pointed to my obviously healthy diet! I have been fretting about the high LDL number ever since, but I can stop fretting now.

    I only wish my doctor had understood my numbers the way you’ve explained them.


  5. My child and I seem to be anomalies with low cholesterol and doctors seem to think there’s no problem, but we both struggle with hormonal issues and my child has several diagnosed mental health conditions that are depressive in symptomology. I’m concerned her abnormally low LDL is the cause of these conditions (PMDD and PDD). These numbers are with a high animal fat (250mg cholesterol), 250 mg cholesterol pill supplementation, and moderate carb diet. How can I raise her LDL?

    12 y/o:
    Total cholesterol 90 mg/Dl
    HDL 46 mg/Dl
    LDL 34 mg/Dl
    TG 51 mg/Dl
    non-HDL 44 mg/Dl

    For myself, I’ve struggled to increase TG’s and LDL, plus reduce my HDL. I follow a low carb diet that is very high in animal fat, but the numbers just keep going the opposite way that I need. I currently consume about 500-700mg of cholesterol a day. How can I reduce my HDL and increase my TG’s (animal fat is only reducing it more)? Do I need to eat a higher carb diet?

    40 y/o
    Total cholesterol 173 mg/Dl
    HDL 119 mg/Dl
    LDL 42 mg/Dl
    TG 39 mg/Dl
    non-HDL 44 mg/Dl
    ApoB 45 mg/Dl
    Lipo(a) <10 nmol/L

  6. I am a 66 year old female whose cholesterol report read as follows: Total cholesterol 265; LDL 180; HDL 69 and Triglyceride level was 78. I was told that I should go on Lipitor. How can I avoid this?

  7. Hello Dr. T
    I just turned to 64, female, still full time employee, regularly excise, eat health. BMI 22. Non smoker.
    TC 257
    HDL 96
    TG 83
    LDL 144
    Glucose 89

    My numbers look Ok to you?
    How to distinguish A or B type of LDL?

  8. I have a very high HDL cholesterol of 162, LDL was around 60 I believe, Triglycerides 114, ratio 1.5.

    HDL is the good cholesterol but it is still concerning how high it is and it brings my total cholesterol above 200.

    What can cause this? Is there anything I should be concerned about?

    1. I am 20 years old, 66 inches and 140 pounds. Have two grandparents with heart disease but they both suffered from alcoholism and were smokers.

  9. I’m a 36 year old male, 5’10” 183lbs with a family history of heart disease. My TC is 171. HDL 53. LDL 104(Martin Hopkins calculation). Triglycerides 46. Glucose 96, CRP .4. I work out multiple times a week. Non smoker. Good eating habits. Father had a heart attack at 55. He is also a non smoker and avid workoutaholic however overusage of NSAIDS and other anti inflammatories that were pulled off the market. Should I be concerned about my LDL levels with such low triglycerides? My HDL hasn’t changed a single point in years even with better eating habits and losing 30lbs.

  10. Here are my figures:

    Total cholesterol: 9.96
    HDL : 2.58
    LDL : 6.89
    Triglyceride. : 1.08

    I’m 52 years old male, non smoker, hypertensive with meds, usual bp 110/70. I am an endurance athlete and very lean. I am on a high fiber, low carb diet. I have no family history of cardiac arrests. My ten year risk is 5.8 (acceptable is 5). Should I take medications?

    Thanks in advance.

  11. Hi, I’m a 56ys female and I take an health diet with light-moderate physical activity. Surprisingly I recently found
    Tot Chol 282
    HDL-C 115 (calculated LDL-C 155)
    TG 61
    In this uncommonly high HDL-C condition, cardiovascular risk assessment varies from longevity to high risk.
    Is it possible to understand more? Thanks

  12. Can you please advise where I can locate the studies you referred to regarding high LDL/low trig? I’m an RN and have subscriptions to Elsevier and other pubs if that helps. Thx!

  13. Hello doctor,
    TC 269
    HDL 39
    TG 89
    LDL 179

    39 years old male
    1.66 cm
    67 KG
    bmi 24

    Do i need to be on Statin to lower LDL

    Im ex smoker- healthy diet and some exercise.

  14. My total Cholesterol is 296. LdL is 192, hdL is 94 and triglycerides are 50. Dr gv me a statin prescription and SD I’m a heart attack waiting. Last yr my LDL was 108, HDL 121 and triglycerides 42. Dr SD she never saw LDL go up 90 pts in a yr. I didn’t take the statins. Is that wise?

    1. I feel the need to reply because your numbers don’t seem alarming. Check out the work of Dr. Ted Naiman who explains in great detail actual risk factors. Your numbers aren’t similar to the cholesterol numbers of the people ending up in hospitals with heart disease.

  15. Hi,Good morning
    I’m 47 yr’s & suffering from renal problem. Reports r as follows :
    CBC- Hemoglobin-12g/dl, RBC count-3.97m/ul, ESR-28mm/hr, glucose fasting 91mg/dl, cholesterol -191mg/dl, Trig.- 131mg/dl, HDL 31.2mg/dl, vldl-26.2mg/dl , chol/HDL ratio-6.1, SGPT-37iu/l, SGOT-26 u/l, blood urea-29.0mg/dl, CREATININE-2.09mg/dl, uric ACID-8.4mg/dl, IRON-54micro gm/dl, micro Albumin-123.1mg/L, microAlbumin/creatinine ratio 810.4mg/g, T3-86.59ng/dl, T4-8.2, TSH-6.14 ,HBA1c-5.7 & mean plasma glucose -117mg/dl, vitamin D-13.2ng/ml, B12-228pg/ml, BP-130/80 ,glucose fasting-91, feeling well but what should I do for improving these test reports. I’ll be highly oblised you if guide me…..
    Thank you.

    1. Post
  16. Dr. T,

    My husband is 55 year-old. 5’4″ height, 130lbs weight. His lipid panel shows high triglycerides. His Triglycerides was 800 a few year back and he was referred to a specialist who said his liver has not function well. He did CT scan on liver and was seen a benign cyst and luckily it shows no sign of growing. The doctor put him on Fenofibrate and Lovaza. After taking them for two years, his TC, LDL, and Tri have been lowered to bottomline high level. But CT scan showed his liver was a bit larger than normal, which it was considered as fatty liver or infection. So he stopped taking Lovaza to see if the liver would get back to normal size. And Yes, liver size is normal now. He has been taking Fenofibrate for 5 years now. TC and Triglycerides are still in high level as shown below. I am so worried as it seems that his liver is not functioning well. What else can he do to lower his Tri and LDL?

    TC 229
    HDL 51
    LDL 127
    Tri 255
    AST 41 IU/L
    ALT 56

    His diets are considered ok as he eats high protein, low carbs, low sugar. But he doesn’t drink water but fruit juices. Normally he eats what I eat, but my blood results are good as my TC is 225, HDL 125, LDL 129, Tri 53. I always have very high HDL.

  17. Recently, my mom aged 76, had a lipid profile report. Her cholesterol was 128 and HDL was 62. Doctor says, it’s fine and good report. However, when I asked about the High HDL cholesterol, he said, why you want to lower the good Cholesterol? It’s of no worry at this level. Now, I would like to know is HDL at this level, OK? Or should she gain some weight & bring cholesterol levels upto 150 or so? I am confused. Please explain. Thank you.

  18. Hi Dr.T, I really like your blog. I am here to ask you for my husband. He is 39 year old, weighs 150 lb, 5.9″. he got diagnosed with Hyperlipidemia in 2000. he started taking Statin from 2008.he is very against to that medicine,it gave him insomnia , fatigue and increase in his glucose level . He stopped taking it since July 2017. we did a blood work after three month-Nov 1st.
    TC-269 mg/dl
    he watches his diet very strictly but no self motivation with his exercise, on the top he is so against to this statin. Is it ok for him to take Baby aspirin once a day? I don’t know what to do, please help me.Thanks!

    1. Post

      From the numbers I suspect he has other cardiac risks such as smoking. If not he may have a congenital cholesterol problem and treatment should be considered depending his other risks including the presence of heart disease in his family history.
      Hope this helps,
      Dr T

  19. Good info.

    I’m 32 y/o male and just recently had my health screening done for work which included a finger stick test that measured TC/HDL/LDL/TGs as well as blood glucose. When I took the test, I had just finished a 45 min plyometric workout that morning and was on a 12 hr fast.

    My numbers were
    TG- 87

    I am not as concerned after reading this article, however, I have a couple questions about the results. Can intense exercise in a fasted state raise LDL temporarily? Also, are finger stick lipid tests reliable?

    1. Post
      1. Hi Ben,

        What we’re finding out is that exercise and fasting can raise LDL a lot in lean, healthy people. Whereas these same factors will tend to lower LDL (at least at first) in high-risk individuals. Recently Dave Feldman has shown that the more fat a lean, healthy person eats before a cholesterol test, the lower their LDL will be.
        From this it seems that LDL cholesterol levels in the past have been based on populations of middling fitness, eating conventional diets, and correlations drawn from them may not be accurate at all for anyone outside this demographic, for example the low carb, crossfit generation. TG and HDL, meanwhile, continue to behave much as expected – sugar will increase TG and (eventually) lower HDL in anyone.

  20. Hi
    I am 33 years old female, i have just had a regular check up for lipid profile i asked for
    HDL: 52
    Trig.: 112
    Total Cholesterol 227
    LDL: 152!
    I exercise three times weekly for 30 minutes
    I was 94 kilos lowered that to 76 kg during 10 months by following healthy diet and exercise. so i am shocked why do i have high LDL?
    also i am concerned regarding my platelet count it is 445 is that normal?

  21. I am 57 year old female, 5’2″ 125 lbs. Just retired and am a fitness trainer for the past 6 months. Working out moderate-high each week (as apposed to sitting at my desk prior to retirement for 31 years). I am surprised to see my cholestrol report this year, too.

    Total Cholestrol 230
    LDL 145
    HDL 64
    Triglyerides 107

    I try to eat healthy (stay away from fried foods/fatty foods). High cholestrol runs in my family, but my levels have been under 200 for the past several years.

    Can you please help me understand? I am taking vitamins, also black cohosh for hot flashes, and drinking vinegar water once a day (supposed health benefits).

    Not sure why my increased activity now but my cholestrol level has gone up. My HDL has also gone up from about 40’s to 64 this year, too.

    Thank you!

  22. Hi, so got my first high cholesterol report ever. I’ve always had a really Good reading. I’m a 57 yo very active female. High intensity exercise 4x a week. Also walk my dogs 2 miles a day. Eat very healthy. Lots of fruit & veggies. I’m 5’7” weigh 123 lbs. I’m shocked
    61 triglyceride
    237 cholesterol
    94 HDL
    131 calculated LDL
    chol/HDL ratio 2.5

    1. Post

      The combination of high cholesterol, high HDL is more common in women and does not increase your risks, particularly if combined with a heart healthy lifestyle such as yours!
      Hope this helps,
      Dr T

  23. Hello and thank you for the good information you have shared. I am 64 yo male. 6.2. and 180 lbs. Hiker and I walk ever day. LDL 206, hdl 56 , triglyceride 95 and vldl 19 how high is my risk, I have a family with history of heart disease buy I have not had any symptoms as of yet. Thank you for your time

    1. Post

      Hi Adam,
      Your risk is about 9% to develop heart disease w/i the next 10 years vs. 8% in an “optimal patient”, but it doesn’t take into account your weight (BMI=23=optimal), diet and regular exercise, very important for the prevention of heart disease. If you don’t have diabetes, smoke or have hypertension you are an “optimal patient”!
      You can calculate this here:
      Hope this helps,
      Dr T

      1. Hello Dr T,

        My doctor is pushing me to go on statins and I’m not thinking it’s a wise move, so I’m looking for more information:
        Female age 54
        Blood pressure systolic 110
        Diastolic 68
        Total cholesterol 342
        HDL 70
        LDL 255
        Triglycerides 87
        Blood sugar 86
        No family history of heart issues
        Low carb, avoid sugars & processed, Tran fats
        Statins scare me, looking for safer way!

        Thanks in advance

Leave a Reply

Your email address will not be published. Required fields are marked *