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Cholesterol: LDL, HDL and the targets
The numbers on the lipid panel, and which one actually drives risk.
LDL carries cholesterol into the artery wall; the lower it is over a lifetime, the less plaque there is. HDL's protective story has weakened in the last decade — drugs that raised HDL did not reduce events, so the modern view treats HDL as a marker, not a target. Triglycerides matter too, especially when very high.
Targets are set by total risk, not by the number alone: for someone healthy and young, an LDL under 3.0 mmol/L (116 mg/dL) is the guideline; after a heart event or in diabetes, the target is under 1.4 mmol/L (55 mg/dL). That spread — 3.0 versus 1.4 — is why one person's "normal" is another person's "too high", and why the risk calculation comes before the target.
The numbers
- Healthy adult LDL target: under 3.0 mmol/L (116 mg/dL) — ESC.
- High-risk (diabetes, established disease): under 1.4 mmol/L (55 mg/dL).
- Total cholesterol alone is a poor judge; the panel matters.
Source: ESC — 2021 guidelines on cardiovascular disease prevention · checked 2026-09-07
Reference, not medical advice. Your targets are set by a clinician from your total risk. Chest pain, breathlessness at rest or fainting are emergency symptoms — get help, do not read on.