What are the health implications of having a total cholesterol level of hypercholesterolemia in an adult?

How Concerning is a Cholesterol Level of 246 mg/dL?

A total cholesterol of 246 mg/dL is classified as "high" and significantly increases your lifetime risk of coronary heart disease, warranting immediate evaluation of your complete lipid profile and other cardiovascular risk factors to determine appropriate treatment. 1

Understanding Your Risk Level

Your cholesterol level falls into the "high" category, defined as ≥240 mg/dL, which affects approximately 17-20% of American adults. 1 However, total cholesterol alone does not determine your treatment plan—your overall cardiovascular risk profile is what matters most. 1

Why This Number Matters

• Lifetime risk perspective: At age 40, men with cholesterol ≥240 mg/dL have a 57% lifetime risk of developing coronary heart disease by age 80 (compared to 31% for those with cholesterol <200 mg/dL). For women, the risk is 33% versus 15%. 2
• Continuous risk relationship: Coronary heart disease risk increases in a continuous, graded fashion with rising cholesterol levels—there is no safe threshold where risk suddenly appears. 1
• The relationship between elevated cholesterol and heart disease, the leading cause of death in the United States, is supported by consistent long-term prospective evidence. 1

What You Must Do Next

You need a complete fasting lipid profile immediately, not just total cholesterol. 1 This requires:

• 12-hour fasting before blood draw 1
• Measurement of LDL cholesterol (the primary treatment target), HDL cholesterol, and triglycerides 1, 3
• At least two measurements to ensure accuracy within 10% of true values 1

Critical Point About Risk Assessment

Do not rely on total cholesterol alone for treatment decisions. 1 The ratios of total cholesterol/HDL or LDL/HDL classify risk far better than total cholesterol by itself. 1 Your treatment plan depends on:

• Your LDL cholesterol level (primary target) 3, 4
• HDL cholesterol level 1
• Age, sex, smoking status 1
• Blood pressure and diabetes status 1
• Family history of premature heart disease (before age 55) 1

Treatment Approach Based on Risk

Immediate Lifestyle Modifications (Required for Everyone)

Start these interventions now, regardless of your complete lipid results: 1

• Dietary changes (most effective non-drug intervention):

  • Limit saturated fat to <7% of total calories 5
  • Restrict dietary cholesterol to <200-300 mg/day 5
  • Increase soluble fiber to 10-25 g/day 3
  • Add plant stanols/sterols 2 g/day 3
  • These changes can reduce LDL by 15-25 mg/dL 3

• Physical activity: ≥30 minutes of moderate-intensity aerobic exercise most days of the week 3

• Weight management if overweight 1

• Smoking cessation if applicable 1

Medication Decisions

Drug therapy is usually more effective than diet alone, but the decision depends on your complete risk profile: 1

• High-risk patients (diabetes, established cardiovascular disease, or 10-year risk >10%): Statin therapy targeting LDL <70 mg/dL 1, 3
• Moderate-risk patients: Treatment decisions based on LDL levels and number of risk factors 4
• Cholesterol-lowering drugs reduce coronary heart disease events by approximately 30% over 5-7 years in primary prevention trials 1

Common Pitfall to Avoid

Do not assume you need medication based solely on total cholesterol of 246 mg/dL. 1 If your LDL is acceptable and you have high HDL (protective), your actual risk may be lower than the total cholesterol suggests. Conversely, if you have diabetes, low HDL, or multiple risk factors, you may need aggressive treatment even if LDL seems only moderately elevated. 6

Follow-Up Timeline

• Recheck lipid panel in 4-8 weeks after initiating lifestyle changes or medication 3
• If starting statin therapy, monitor liver function tests and assess for muscle symptoms at each visit 3
• Long-term adherence to therapy is essential—this is a chronic condition requiring ongoing management 1