Cholesterol measurement and evaluation

How are cholesterol levels determined?

If you want to know your cholesterol level, your doctor must take a blood sample. This blood sample is then analyzed in a laboratory and the LDL, HDL and total cholesterol levels are determined. Usually, the cholesterol value is also determined when donating blood.

We recommend that the blood sample is taken on an empty stomach as food affects cholesterol levels. It is also advisable to avoid high-fat food and alcohol for a few days before taking blood.

By determining cholesterol, lipid metabolism disorders can be determined and fat-lowering therapies (medication or diet) can be checked. The measurement also gives an indication of whether there is a risk of arteriosclerosis (circulatory disorders).

How is cholesterol reported?

Cholesterol is typically given in milligrams per deciliter (mg/dl), which is the concentration of cholesterol in one deciliter of blood. In some regions, however, cholesterol is predominantly given in millimoles per liter (mmol/l).

How high should the cholesterol level be?

LDL cholesterol in particular increases the cardiovascular risk. According to the European Society of Cardiology (ESC), a value below 116 mg/dl (3 mmol/l) for LDL cholesterol is low risk of cardiovascular disease. If the overall individual risk of cardiovascular disease is already increased by other factors, a lower value is desirable according to the ESC.

In short, for LDL cholesterol, the lower the better. However, for HDL cholesterol (up to a certain limit), the higher the better.

Cholesterol table

According to the recommendation of the European Society of Cardiology (ESC), the following limit values for cholesterol apply in summary for different risk groups.

risk group	total cholesterol	LDL	HDL
People at low risk	< 190 mg/dl 5 mmol/l	< 116 mg/dl 3 mmol/l	> 40 mg/dl (men), > 48 mg/dl (women)
People at medium risk	< 190 mg/dl 5 mmol/l	< 100 mg/dl 2,6 mmol/l	> 40 mg/dl (men), > 48 mg/dl (women)
People at high risk	< 190 mg/dl 5 mmol/l	< 70 mg/dl 1,8 mmol/l	> 40 mg/dl (men), > 48 mg/dl (women)
People at very high risk	< 180 mg/dl 4,64 mmol/l	< 55 mg/dl 1,4 mmol/l	> 40 mg/dl (men), > 48 mg/dl (women)

The risk group is divided by the ESC according to various criteria. These criteria are summarized in simplified form as follows.

People at medium risk

With a 10-year risk of heart attack or stroke of 1 to 5%.

People at high risk

With a 10-year risk of a heart attack or stroke of 5 to 10%. Both people with congenital familial high cholesterol, moderate kidney weakness, blood pressure values over 180/110 or smokers. The risk is also high if direct relatives have suffered a heart attack or stroke over the age of 60.

People at very high risk

If you have a 10-year risk of heart attack or stroke above 10%. Also applies to people who have already had a heart attack or stroke. If diabetics smoke or also have high blood pressure, there is also a very high risk.