Assess Your Risk
How much you need to bring your cholesterol down depends on your coronary heart disease (CHD) risk factors.
In a nutshell, the greater your risk for a heart attack or stroke — in other words, the more risk factors you have — the lower your ideal cholesterol level.
If you have high cholesterol, the main goal is to lower your LDL (low-density lipoprotein). Why, you might ask, is this true when your ratios of HDL (high-density lipoprotein) and LDL to total cholesterol are what count the most? First, because it’s much easier to lower LDL than raise HDL. Few drugs or supplements reliably raise HDL (niacin is probably the best). Intense physical activity is effective, but few people are willing to work that hard. Alcohol also moves the needle, but of course the “dose” is limited by alcohol’s inherent dangers. Lowering LDL is also the most direct way to slow plaque buildup, since LDL plays the most direct role in forming the stuff.
Perhaps the best way to think about your cholesterol goal is in terms of improving your HDL/LDL ratio. This can be done by raising HDL, lowering LDL, or both. And since it’s easier to reduce LDL, that’s where the focus falls.
To figure out how low your LDL target should be, you should assess your heart disease risk. Take into consideration factors such as smoking, high blood pressure, HDL cholesterol, family history, and age. Remember, the greater your risk, the lower your cholesterol target should be.
Personalizing Your Goals
Healthy lifestyle changes, such as a balanced diet, regular exercise, and not smoking, is ideal for anyone, regardless of your cholesterol level. But special attention must be given to particular areas if you have metabolic syndrome or high triglycerides. For instance, you may need to exercise more, limit calories, and take certain supplements.