Total Cholesterol
The total amount of cholesterol in your blood, counting HDL, LDL and VLDL together. It is one piece of the lipid panel.
AI-verified against cited sources. Awaiting expert reviewAlso called TC, CHOL, TCholLOINC 2093-3
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What it is
Cholesterol is a waxy, fat-like substance. Your body needs it to build cells and to make hormones, vitamin D and bile. Your liver makes most of it, and some comes from food. This test adds up the cholesterol carried in all the particles that move it through your blood, mainly LDL, HDL and VLDL. Because it lumps "good" and "bad" cholesterol together, it is usually read alongside the rest of your lipid panel.
Why it matters
Cholesterol carried on LDL and similar particles can build up in artery walls over many years. That raises the chance of a heart attack or stroke. Total cholesterol is a quick first look, and it is one of the numbers clinicians put into heart risk calculators. On its own it can mislead. A higher total can come partly from protective HDL, and a normal total can hide high LDL with low HDL. That is why clinicians also look at HDL, LDL or non-HDL cholesterol, and triglycerides.
If it’s low
A low total cholesterol is usually considered good for heart health, and it is expected if you take cholesterol-lowering treatment. Occasionally a very low level goes along with another health issue, such as an overactive thyroid, liver disease, poor nutrition, or poor absorption of fat. It is worth mentioning to your clinician if it is very low and you are not being treated.
Common causes
- Cholesterol-lowering treatment or a very low-fat diet
- Acute illness, infection or inflammation, which can lower cholesterol for a while
- An overactive thyroid (hyperthyroidism)
- Severe liver disease
- Malnutrition, or conditions that stop the gut from absorbing fat well (malabsorption)
- Some cancers
- Rare inherited conditions that lower cholesterol
What can help
- If you are not on cholesterol-lowering treatment and your level is very low, talk with your clinician, especially if you also have unplanned weight loss or other symptoms
- Ask whether a recheck, or thyroid and liver tests, would help explain it
If it’s high
A higher total cholesterol means more cholesterol is traveling in your blood, often on LDL. Higher levels are linked to a greater chance of plaque building up in the arteries over time. Many everyday things can raise it, and some are easy to change. Your clinician can put the number in context with your HDL, LDL, triglycerides and other risk factors.
Common causes
- A high HDL ("good") cholesterol, which counts toward the total and is generally protective
- Eating a lot of saturated fat, trans fat and processed food
- Little physical activity, or carrying extra weight
- Pregnancy, when a moderate rise is expected
- Heavy alcohol use
- Family history of high cholesterol, including inherited conditions such as familial hypercholesterolemia
- An underactive thyroid (hypothyroidism)
- Diabetes, kidney disease (including nephrotic syndrome), or liver and bile duct disease
- Some medicines, including steroids, certain blood pressure pills, retinoids and some HIV and transplant medicines
What can help
- Eat in a heart-healthy way: less saturated fat and fewer processed foods, and more fiber from oats, beans, fruit and vegetables
- Be active most days. The CDC recommends 150 minutes of moderate-intensity activity a week for adults
- Work toward a healthy weight if you carry extra weight, and limit alcohol
- Ask your clinician how your result fits your overall heart risk, and whether treatment to lower cholesterol makes sense for you
- Ask whether thyroid, blood sugar, kidney or liver tests are worth checking as possible causes
Usual ranges
What labs print as the reference range, by who was tested. Ranges differ a little between labs, so the range on your own report is the one your result is judged against.
The usual range depends on age. Choose an age to see the one that applies.
- 20+up to 199 mg/dL
Sources: Mayo Clinic Laboratories (Extended Catalog copy), Quest Diagnostics (via Fullscript), Labcorp, ARUP Laboratories, NHLBI / National Institutes of Health, MedlinePlus (National Library of Medicine), European Heart Journal (joint EAS/EFLM statement, also in Clinical Chemistry)
Children and teens 1 ranges
See Total Cholesterol by age and sex, with the U.S. survey numbers where they exist.
NCEP ATP III total cholesterol categories (adults)
- Desirablebelow 200 mg/dL
- Borderline high200 to under 240 mg/dL
- High240 and above mg/dL
NHLBI total cholesterol categories (children and adolescents)
- Acceptablebelow 170 mg/dL
- Borderline high170 to under 200 mg/dL
- High200 and above mg/dL
If this applies to you
Total Cholesterol means a little more for some people. Open the one that fits you.
Taking isotretinoin
Cholesterol can rise on isotretinoin, though less often than triglycerides. In the label's data these lipid changes went back to normal after stopping.
How common is your level?
NHANES describes the US civilian, non-institutionalized population, not a 'healthy' reference group. People with disease, on medication, fasting or not (except fasting-subsample markers), smokers and so on are all included. A percentile says where a value sits among Americans of that sex and age, not whether it is normal.
Use the left and right arrow keys to read each age. Shift moves five years.
Reference data derived from CDC/NCHS National Health and Nutrition Examination Survey (NHANES), cycles 2015-2016, 2017-March 2020 (pre-pandemic), August 2021-August 2023. Analysis by bloodtesttracker.com; not endorsed by CDC, NCHS or HHS.
Explore Total Cholesterol by age and sex: every percentile as a table, with a download.
What can affect your result
- Meals: total cholesterol is on average about 8 mg/dL (0.2 mmol/L) lower after eating, so fasting is usually not needed
- Day-to-day variation: it can vary by about 10% from one day to the next, even when nothing has changed
- Diet (especially saturated and trans fat), body weight and physical activity
- Age: levels are lower in children, cutoffs differ for people under 20, and levels fall by 10-20% or more during puberty
- Pregnancy: a rise is expected
- Thyroid, liver, kidney and bile duct conditions, and diabetes
- Medicines such as thiazide diuretics, beta-blockers, retinoids, steroids and some HIV and transplant medicines
- Acute illness or a recent heart attack, which can lower cholesterol for a while
- High levels of N-acetylcysteine (a medicine used for acetaminophen overdose), and the acetaminophen byproduct NAPQI at overdose levels, can make the result read falsely low on some assays.
- Acute illness, infection or inflammation can lower cholesterol for a while. Labcorp suggests avoiding a full lipid panel for about three months after a heart attack, although total cholesterol itself can be measured within the first 24 hours.
- Pregnancy can raise total cholesterol, so a higher result during pregnancy is expected.
A few weeks. Changes in diet, activity, weight or medicine are usually rechecked 4-12 weeks later.
When to talk to a clinician
Talk with a clinician about a total cholesterol of 240 mg/dL (6.2 mmol/L) or higher, which labs call high. For a child or teen, the same applies at 200 mg/dL (5.2 mmol/L) or higher. This test cannot tell you whether you have heart disease. If you have chest pain or pressure, trouble breathing, or signs of a stroke such as face drooping, arm weakness or trouble speaking, call 911 or your local emergency number.
Questions you could ask
- Which cholesterol number do you pay the most attention to for me?
- How often should I have my cholesterol checked?
- Is my total cholesterol high because of LDL, or because my HDL is high?
- How does this result fit with my other risk factors, such as blood pressure, blood sugar and family history?
- Could my thyroid, blood sugar, kidneys or liver be playing a part?
- Should we recheck this after a few months of lifestyle changes?
Questions people ask
My total cholesterol is under 200. Does that mean my cholesterol is fine?
Not always. Total cholesterol adds up the "good" and "bad" kinds. A result under 200 can still hide high LDL with low HDL, or high triglycerides. Clinicians usually look at the whole lipid panel, plus your age, blood pressure, blood sugar, smoking and family history, to judge your overall risk.
Do I need to fast before a total cholesterol test?
Usually not. Eating changes total cholesterol only a little, by about 8 mg/dL lower on average. Some labs still ask you to fast for 9-12 hours when triglycerides are measured on the same panel. Follow the instructions your lab or clinician gives you.
How do I convert mg/dL to mmol/L?
Divide mg/dL by 38.67 to get mmol/L. To go the other way, multiply mmol/L by 38.67. For example, 200 mg/dL is about 5.2 mmol/L. Some labs report g/L, where 1 g/L is 100 mg/dL. Triglycerides use a different factor, so do not reuse this one for them.
Which total cholesterol number is considered good?
US labs call below 200 mg/dL (5.2 mmol/L) desirable, 200-239 borderline high, and 240 or higher high. For people under 20, below 170 mg/dL is the usual cutoff. Some European reports flag results at 5 mmol/L (about 190 mg/dL). These are population cutoffs, not personal targets. Your own goal depends on your overall risk, and clinicians often focus on LDL or non-HDL cholesterol.
Can total cholesterol be too low?
Lower is usually better for heart health. A very low level without treatment is unusual and can sometimes go along with an overactive thyroid, liver disease or poor nutrition. If yours is very low and you do not take cholesterol-lowering medicine, mention it to your clinician.
Show the science and sources
Units
- 1 mg/dL = 1 mg/dL
- 1 mg/dL = 0.02586 mmol/L
- 1 mg/dL = 0.01 g/L
Open the Total Cholesterol unit converter
Is a change real?
Total Cholesterol naturally varies about 5.18% from test to test in the same healthy person. Between two results from the same lab, a change of roughly 15% or more is unlikely to be day-to-day noise or lab variation (95% reference change value). Source: The European Biological Variation Study (EuBIVAS): a summary report.
For clinicians and researchers
Total cholesterol is the free plus esterified cholesterol in every lipoprotein class: chylomicrons and remnants, VLDL, IDL, LDL (including the cholesterol in lipoprotein(a)) and HDL. Labs measure it with an enzymatic colorimetric method. In mg/dL it is approximately LDL-C + HDL-C + triglycerides/5 (the Friedewald relation, with triglycerides/5 standing in for VLDL cholesterol), and non-HDL-C is TC minus HDL-C. Within-person variation is about 10% day to day (Merck Manual), and the mean change after habitual meals is about -0.2 mmol/L (8 mg/dL), so the EAS/EFLM consensus recommends non-fasting samples for routine profiles. High N-acetylcysteine and NAPQI (at acetaminophen-overdose concentrations) interfere negatively with some assays (ARUP). The adult categories come from NCEP ATP III (desirable <200, borderline high 200-239, high >=240 mg/dL) and the pediatric categories from the 2011 NHLBI expert panel (<170, 170-199, >=200 mg/dL). EAS/EFLM suggest flagging at >=5 mmol/L (190 mg/dL). Current US guidance does not set a total cholesterol treatment target: the 2026 ACC/AHA dyslipidemia guideline, the first full revision since the 2018 cholesterol guideline, uses LDL-C and non-HDL-C goals by risk, and total and HDL cholesterol are inputs to the PREVENT-ASCVD risk equations. A 2026 Circulation review notes total cholesterol has limited clinical utility on its own but still features in familial hypercholesterolemia scoring. Labcorp's lipid panel notes that cholesterol is below 70 mg/dL in abetalipoproteinemia.
LOINC 2093-3 (primary), 14647-2, 35200-5. Specimen: serum-or-plasma.
Sources
- Cholesterol, Total (test 001065), Labcorp
- Lipid Panel (test 303756), Labcorp
- Lipid Panel, Serum (test ID LPSC1), Mayo Clinic Laboratories (Extended Catalog copy) (2026)
- Cholesterol, Serum or Plasma (test 0020031), ARUP Laboratories
- Lipid Panel with Ratios, Quest Diagnostics (reference ranges as listed by Fullscript), Quest Diagnostics (via Fullscript)
- Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Executive Summary, NHLBI / National Institutes of Health (2001)
- Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report, NHLBI / Pediatrics (2011)
- Fasting is not routinely required for determination of a lipid profile: clinical and laboratory implications including flagging at desirable concentration cutpoints. A joint consensus statement from the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine, European Heart Journal (joint EAS/EFLM statement, also in Clinical Chemistry) (2016)
- Cholesterol Levels: MedlinePlus Medical Test, MedlinePlus (National Library of Medicine)
- Total cholesterol: MedlinePlus Medical Encyclopedia, MedlinePlus (National Library of Medicine)
- Dyslipidemia (Hyperlipidemia), Merck Manual Professional Edition
- Cholesterol (PubChem CID 5997), PubChem (National Library of Medicine)
- Lipid Profile Testing and Interpretation (summarizes the 2026 ACC/AHA Dyslipidemia Guideline), Circulation (Nguyen, Ahmad, Navar) (2026)
- Adult Activity: An Overview, US Centers for Disease Control and Prevention
AI-verified against cited sources. Awaiting expert review. Last reviewed 2026-10-03. How we build and check these pages.