Total Cholesterol
Total-C· also: TC, Total Cholesterol
Clinical Overview
Total cholesterol is the sum of all cholesterol in the blood including LDL, HDL, VLDL, and IDL fractions. While it provides a general cardiovascular risk overview, total cholesterol alone is an insufficient cardiovascular risk marker — it does not distinguish between protective HDL and atherogenic LDL cholesterol.
Why This Test Matters
Total cholesterol is used primarily as a screening test and as part of cardiovascular risk calculators. High total cholesterol is a risk factor for coronary artery disease, stroke, and peripheral artery disease. Treating hypercholesterolemia with statins reduces LDL and cardiovascular events regardless of total cholesterol level. Guidelines now focus on LDL-C reduction targets rather than total cholesterol targets.
Reference RangesWHO/IFCC standards
| Age Group | Reference Range | Unit | Notes |
|---|---|---|---|
| Adults (18–64) | 0 – 200 | mg/dL | Desirable |
| Adults (18–64) | 200 – 239 | mg/dL | Borderline high |
| Adults (18–64) | 240 – 9999 | mg/dL | High |
Also reported in: mmol/L.
What Causes Abnormal Results?
High Total-C Causes
- Familial hypercholesterolemia (genetic)
- High saturated and trans fat diet
- Hypothyroidism
- Diabetes mellitus and metabolic syndrome
- Nephrotic syndrome
- Cholestatic liver disease
- Obesity
- Medications: corticosteroids, thiazides, beta-blockers
Low Total-C Causes
- Malnutrition and malabsorption
- Hyperthyroidism
- Liver disease (reduced synthesis)
- Cancer and chronic illness
- Statin therapy (treatment effect)
Signs & Symptoms to Watch For
How to Prepare for This Test
Fast for 9–12 hours. Water, plain coffee, and medications are generally allowed. Maintain your usual diet for 2–3 weeks before the test. Avoid heavy alcohol use 24 hours before.
Factors That Can Affect Results
- Recent high-fat meal (raises triglycerides and total cholesterol)
- Acute illness (total cholesterol drops during acute infection or MI)
- Pregnancy (physiological rise in all lipids)
- Hypothyroidism (raises cholesterol)
- Posture (standing raises cholesterol by ~5–10% compared to lying)
Related Topics
Frequently Asked Questions
Is total cholesterol a good measure of heart disease risk?
Total cholesterol alone is a poor cardiovascular risk predictor because it includes both "good" HDL and "bad" LDL cholesterol. A person with high total cholesterol due to high HDL may have lower cardiovascular risk than someone with lower total cholesterol but very low HDL. The non-HDL cholesterol (total cholesterol minus HDL) and LDL cholesterol are better predictors. Modern risk calculators (ASCVD risk score) use age, sex, blood pressure, smoking status, and diabetes alongside cholesterol values.