Understanding Your Cholesterol Numbers
Your LDL cholesterol of 103 mg/dL is slightly elevated above the general population goal of 100 mg/dL, while your HDL cholesterol of 38 mg/dL is concerning as it falls below the threshold that marks increased cardiovascular risk (40 mg/dL for men, 45-50 mg/dL for women). 1
What These Numbers Mean
LDL Cholesterol (103 mg/dL) - "Bad Cholesterol"
- LDL cholesterol is the primary target for preventing heart disease, as it directly contributes to plaque buildup in your arteries 1
- Your level of 103 mg/dL sits just above the general goal of <100 mg/dL for most people 1
- For context, general population targets are LDL <115 mg/dL, but if you have diabetes or established heart disease, the goal should be <100 mg/dL or even <70 mg/dL 1
- Each 1% increase in LDL cholesterol is associated with approximately 2% increased risk of coronary artery disease over 6 years 2
HDL Cholesterol (38 mg/dL) - "Good Cholesterol"
- Your HDL of 38 mg/dL is below the threshold that marks increased cardiovascular risk (40 mg/dL for men, 45-50 mg/dL for women) 1
- HDL functions to remove LDL cholesterol from blood vessels and has anti-inflammatory and antioxidant properties 3
- Each 1% decrease in HDL cholesterol is associated with a 3-4% increase in coronary artery disease risk 2
- Low HDL can rival high LDL as a risk factor for heart disease 1
- Even when LDL cholesterol is well-controlled below 70 mg/dL, low HDL levels remain predictive of cardiovascular events 4
The Combined Picture
The combination of borderline-elevated LDL and low HDL creates a particularly concerning lipid pattern that increases your cardiovascular risk more than either abnormality alone 1. This pattern is commonly seen with:
What You Need to Do
Immediate Lifestyle Changes (Essential for Both Numbers)
Smoking cessation is mandatory if you smoke, as it will improve HDL levels by 5-10% 3
Weight management is critical, as excess body weight lowers HDL and raises LDL 1
Regular aerobic exercise significantly increases HDL cholesterol levels 5
Dietary modifications:
- Limit saturated fat to <7% of calories 1
- Minimize trans fats 1
- Choose lean meats and low-fat dairy products 1
- Consume fish, especially oily fish, at least twice weekly 1
- Increase whole grains, fruits, and vegetables 1
Moderate alcohol consumption may raise HDL levels, though this is not recommended solely for HDL benefits 5
Risk Assessment Needed
Your treatment intensity depends on your overall cardiovascular risk, not just these cholesterol numbers 1. Your physician needs to assess:
- Your age and sex 1
- Presence of diabetes 1
- Blood pressure levels 1
- Smoking status 1
- Family history of premature heart disease 1
- Presence of established cardiovascular disease 1
Treatment Thresholds
If you have established heart disease or diabetes, your LDL goal should be <100 mg/dL or even <70 mg/dL, meaning treatment is indicated 1
If you have 2 or more risk factors with 10-year cardiovascular risk of 10-20%, your LDL goal is <130 mg/dL, but <100 mg/dL is a reasonable option 1
If you have 0-1 risk factors, lifestyle modification is the primary approach unless LDL exceeds 160 mg/dL 1
Medication Considerations
Statin therapy is the backbone for LDL reduction and also typically raises HDL by at least 5% 3
When statins are used, aim for at least a 30-40% reduction in LDL cholesterol 1
For low HDL specifically, pharmacologic interventions beyond statins have been disappointing in clinical trials and are not routinely recommended 3
Important Caveats
Low HDL cholesterol remains highly prevalent (66%) even in patients taking statins and achieving aggressive LDL goals 6, so don't expect dramatic HDL improvements from medication alone.
HDL and LDL levels correlate poorly with each other, meaning improving one doesn't necessarily improve the other 6
The strategy of achieving the lowest possible LDL may be most appropriate when HDL remains low despite interventions 3