What is Total Cholesterol?
Cholesterol is a waxy, fat-like molecule primarily produced by the liver and necessary for building cell membranes, supporting vitamin D synthesis, and serve as the building block for hormones such as estrogen, testosterone, and cortisol.
Elevated total cholesterol levels are most concerning on a blood test when LDL (“bad” cholesterol) or ApoB particles are elevated and HDL (“good” cholesterol) is low. On the other hand, very high HDL can also push total cholesterol up, even when heart risk is still low.
That’s why doctors don’t rely on total cholesterol by itself. They usually look at LDL, ApoB, triglycerides, and HDL together to get a clearer picture of heart health.
Why Does Total Cholesterol Matter?
- Supports healthy cellular function by forming and stabilizing cellular membranes
- Enables hormone production by serving as the precursor to hormones including estrogen, testosterone, and cortisol
- Promotes strong bones and muscle function by supporting vitamin D production
- Supports brain and nervous system function by insulating and protecting nerves
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How to Interpret Total Cholesterol
(Ranges may vary slightly by lab)
Standard reference ranges represent the middle 95% of healthy individuals but don’t necessarily reflect levels associated with longevity.
Optimal ranges depend on overall cardiovascular risk and are derived from clinical guidelines, peer-reviewed research, and real-world outcomes data, with an emphasis on levels associated with peak functioning and reduced disease risk.
Benefits of Optimizing Total Cholesterol
- Improved cardiovascular function and health
- Reduced risk of stroke and heart attacks
- Improved vascular function
- Reduced long-term cardiovascular mortality risk
- Lower systemic inflammation
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Low Total Cholesterol Levels
Low total cholesterol doesn’t cause symptoms on its own. Symptoms are typically caused by the condition that is causing cholesterol to be low in the first place.
Symptoms:
- Diarrhea
- Poor muscle control
- Tremors
- Mood changes
- Fat malabsorption
Causes:
- Hyperthyroidism
- Liver disease
- Crohn’s disease or celiac disease
- Chronic infections
- Anemia
- Certain drugs (e.g., lipid-lowering therapy)
- Chronic alcohol use
- Very low-fat diets
Healthspan Impacts:
High Total Cholesterol Levels
Symptoms:
- Often asymptomatic until cardiovascular disease develops
Causes:
- Chronic inflammation
- High intake of saturated and trans fats
- Lack of physical activity
- Obesity
- Smoking
- Thyroid dysfunction
- Diabetes
- Excessive alcohol consumption
- Genetic lipid disorders
Healthspan Impacts:
- Higher risk of atherosclerosis
- Increased risk of heart attack and stroke
- Increased risk of cardiovascular mortality4
How Hone Treats Out of Range Total Cholesterol
Hone prioritizes early, proactive identification of cardiovascular risk through comprehensive biomarker testing. Total cholesterol is interpreted alongside LDL, HDL, triglycerides, ApoB, inflammatory markers, and metabolic health indicators to assess cardiovascular risk. Treatment plans focus on reducing atherogenic particles, improving metabolic health, and lowering long-term cardiovascular risk.
- Statins (e.g. Rosuvastatin)* – to reduce high LDL cholesterol, triglycerides, and ApoB and modestly increase HDL cholesterol
- Cholesterol absorption inhibitors (e.g. Ezetimibe)* – to reduce total and LDL cholesterol and ApoB
- GLP-1 receptor agonists — to lower triglycerides and ApoB which contribute to total cholesterol
- Estradiol — to lower cholesterol in women experiencing symptoms of menopause
- Fibrates* – to lower high triglycerides
*Your Hone Physician does not prescribe these treatments but will recommend further evaluation and help coordinate care with your primary care provider when medical treatment is indicated.
- Limit alcohol consumption
- Eat more fruits, vegetables, and whole grains
- Avoid tobacco
- Get regular physical activity
- Reduce saturated fat and trans fat intake
- Incorporate flaxseed into your diet7
Alameda-Guijarro, M. et al. (2023) Total cholesterol as an independent prognostic factor in cancer patient survival: A single institution experience. Annals of Oncology.
↑Sun, S., et al. (2015). Reduced cholesterol is associated with the depressive-like behavior in rats through modulation of the brain 5-HT1A receptor. Lipids in Health and Disease.
↑Jeong, C., et al. (2024). Association between fluctuations in blood cholesterol levels and the risk of suicide death in the general population. Journal of Psychosomatic Research.
↑Jung, E., et al. (2022). Serum Cholesterol Levels and Risk of Cardiovascular Death: A Systematic Review and a Dose-Response Meta-Analysis of Prospective Cohort Studies. International Journal of Environmental Research and Public Health.
↑Poli, A., et al. (2021). Phytosterols, Cholesterol Control, and Cardiovascular Disease. Nutrients.
↑Trogkanis, E., et al. (2024). Safety and Efficacy of the Consumption of the Nutraceutical “Red Yeast Rice Extract” for the Reduction of Hypercholesterolemia in Humans: A Systematic Review and Meta-Analysis. Nutrients.
↑Edel, A. L., et al. (2015). Dietary flaxseed independently lowers circulating cholesterol and lowers it beyond the effects of cholesterol-lowering medications alone in patients with peripheral artery disease. The Journal of Nutrition.
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Reviewed for Accuracy by Our Medical Review Board
This biomarker information has been reviewed by a member of Hone’s medical review board. As part of the medical review team, physicians fact-check this content against the latest research and their own experience treating their patients.
Ashley Winter, M.D., is a board-certified urogynecologist trained at Weill Cornell and Cleveland Clinic. She specializes in female and male sexual dysfunction, urinary issues, genital pain, and hormone therapy.
James Staheli, D.O., is the Medical Director for Broad Health, Hone Health’s affiliated medical practice and a family medicine doctor in Atlanta, Georgia.
