Is 220 cholesterol bad?
On its own, it can’t tell you. A total of 220 mg/dL (5.7 mmol/L) can be mostly HDL or mostly LDL, and the 2026 US guideline sets no goal for the total at all. Its goals are for LDL and non-HDL, so put your other numbers in.
What we’d do
Skip the total and look two lines down. Take your HDL off the 220 and you have your non-HDL, the cholesterol in every particle that can clog an artery. Hold that and your LDL against the goal for your risk, and you have the real answer to this question.
Why the total fools people
It’s printed first, it’s one number, and 200 and 240 sound like clear lines. But the total adds the HDL you’re told is good to the LDL you’re told is bad. A total is like a $220 grocery bill. It can be vegetables or candy, and the bill won’t tell you which.
Two people at 220
Here are two made-up panels with the same total. The LDL comes from the newer NIH equation the guideline prefers.
| Person A | Person B | |
|---|---|---|
| Total | 220 | 220 |
| HDL | 78 | 38 |
| Triglycerides | 90 | 210 |
| Non-HDL (total minus HDL) | 142 | 182 |
| LDL | 126 | 144 |
| Over the non-HDL goal of under 130 | by 12 | by 52 |
That goal of under 130 is for borderline or intermediate risk. Person B is more than four times as far from it, and B’s triglycerides of 210 are over both the fasting line (150) and the line after a meal (175). If A’s doctor puts A at low risk, the guideline sets no number goal at all, and A’s plan is food and exercise.
How common 220 is
In US adults from 2021 to 2023, 11.3% had a total of 240 or more. The surprise is who. Over 60, it was 16.4% of women and 5.6% of men. The guideline adds that about a quarter of US adults have an LDL of 130 or more.
What to do with a 220
- Put all four numbers into the check below. It works out your LDL and non-HDL and holds them against the goal for your risk.
- Start with a doctor if your LDL comes out at 190 or more, or a parent, brother or sister had a heart attack or stroke young (men before 55, women before 65).
- If you’re over your goal, the biggest single food changes in trials took off about 13 points (10 g of psyllium a day) and about 11 (moving 5% of your calories from saturated fat to vegetable oils). See how to lower your cholesterol.
- Retest at the same lab. At a total of 220, a change of about 27 points can happen by chance, and only a change of about 41 or more is very likely real. Did it really go down? does the sum for you.
Your LDL on that report was probably calculated, not measured, which is its own story in why does my report say my LDL is calculated?
7 sources
- Blumenthal RS, Morris PB, Gaudino M and others, 2026 ACC/AHA guideline on the management of dyslipidemia, JACC, 2026doi.org
- The same guideline, full text, Circulation, 2026api.iscpcardio.org
- CDC NCHS Data Brief 515, Total and high-density lipoprotein cholesterol in adults: United States, August 2021 to August 2023cdc.gov
- Sampson M and others, A new equation for calculation of low-density lipoprotein cholesterol in patients with normolipidemia and/or hypertriglyceridemia, JAMA Cardiology, 2020pubmed.ncbi.nlm.nih.gov
- Smith SJ, Cooper GR, Myers GL and Sampson EJ, Biological variability in concentrations of serum lipids, Clinical Chemistry, 1993pubmed.ncbi.nlm.nih.gov
- CDC Clinical Standardization Programs, certification criteria for cholesterol test manufacturerscdc.gov
- Jovanovski E and others, Effect of psyllium fiber on LDL cholesterol and alternative lipid targets, non-HDL cholesterol and apolipoprotein B, American Journal of Clinical Nutrition, 2018pubmed.ncbi.nlm.nih.gov
