Total Cholesterol Levels Matter Most

What are healthy cholesterol levels?
Image by Mohamed Hassan @Pixabay

Cholesterol levels are used to determine certain disease risks during a check-up. Typically, only certain lipids in a lower cholesterol range indicate a healthier patient. But it’s the total cholesterol levels that matter most, especially for people of colour.

What is cholesterol? 

Cholesterol is a steroid hormone made up of different types of fats (lipids) called sterols. These lipids include very low-density lipoproteins (VLDL), low-density lipoproteins (LDL), and high-density lipoproteins (HDL). In recent years, what is considered a healthy ratio of these components that make up cholesterol (LDL, VLDL, and HDL) has been reevaluated regarding cardiovascular health. 

LDLs. Low-density lipoproteins are known as “bad” cholesterol. LDLs indicate higher rates of coronary heart disease (CHD).1

VLDLs. Very-low-density lipoproteins are described as being the most harmful if levels are high in the blood.

HDLs. High-density lipoproteins are often considered “good” cholesterol. HDL has been shown to protect against inflammation, acts as an antioxidant, and helps prevent excessive blood clotting that can lead to heart and circulation problems.2 

Racial imbalance in health data

Unfortunately, most health studies leading to the understanding of cholesterol levels and how to interpret them have been based on white populations.1 A new study published in the Journal of American College of Cardiology highlights the need to investigate how cholesterol levels can be interpreted differently for people of colour.1 

Results show that high LDL levels increase there is an equal risk of coronary heart disease in all adults.1 Low HDL levels increase the risk for CHD in white adults but not adults of colour.1 The Journal of American College of Cardiology study also highlights that high HDL levels do not indicate a reduction in CHD risk for all races. 

Race and gender matters

Coronary heart disease significantly differs for white versus men of colour.1 Still, CHD was higher in women of colour compared to white women.1 CHD is also more fatal in men and women of colour compared to white women.1 

Updating cholesterol level information

The current health guidelines to predict and determine disease risk are not inclusive. The evidence continues to mount that there are racial (and gender) differences relating to what is considered healthy. This discussion on cholesterol levels is just one example of a need for change. Referring to total cholesterol levels when determining disease risk is crucial. However, more research can help better testing and guidelines for all people. 


  1. Zakai N, Minnier J, Safford M, et al. Race-dependent association of high-density lipoprotein cholesterol levels with incident coronary artery disease. J Am Coll Cardiol. 2022 Nov, 80 (22) 2104–2115.
  2. Ben-Aicha S, Badimon L, Vilahur G. Advances in HDL: Much more than lipid transporters. International Journal of Molecular Sciences. 2020; 21(3):732.
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