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Borderline cholesterol is total cholesterol that’s higher than ideal, which is greater than 200 milligrams per deciliter (mg/dL) but has not quite reached the range of high cholesterol, which is considered 240 mg/dL and above.

High cholesterol levels can increase your risk of developing heart disease. Addressing borderline cholesterol could reduce your risk of heart attack or stroke and reverse the effects of high cholesterol.

Cholesterol is a lipid. The fatty waxy-like substance travels through your bloodstream, supporting cell health.

If your body cannot process the lipoprotein, it may stick to the walls of your arteries and harden into plaque. The restriction can lead to heart disease and other complications.

Borderline cholesterol represents the at-risk stage of developing high cholesterol and other forms of heart disease.

Why do your cholesterol levels matter?

Your cholesterol levels are often an indicator of your overall heart health. If left untreated, high cholesterol can increase your risk of heart disease.

Heart disease is often referred to as a “silent killer” because it can go undetected for some time. Likewise, high cholesterol usually does not cause noticeable symptoms.

Regular screening is important for early diagnosis and treatment.

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A lipid panel measures the amount of cholesterol and other fats present in the blood. The lipoproteins examined are broken down into low-density (LDL) or high-density (HDL) lipoproteins.

The lipid panel measures the levels of these fats in the bloodstream:

  • total cholesterol, or the total amount of cholesterol present in the blood
  • LDL, aka “bad” cholesterol
  • HDL, aka “good” cholesterol
  • triglycerides, which is another waxy substance found in the blood

Your age and sex assigned at birth influence your expected cholesterol levels.

Additional risk factors, such as heart disease, may put you in a different acceptable range that’s considered healthy for you. It’s important to discuss your results with a physician to ensure your care plan addresses your individual needs.

According to the American College of Cardiology/American Heart Association Task Force guidelines published in 2018, optimal cholesterol levels are as follows:

Optimal cholesterol level
total cholesterolabout 150 mg/dL
LDL (“bad”) cholesterolabout 100 mg/dL
HDL (“good”) cholesterolpeople assigned male at birth: At least 40 mg/dL
people assigned female at birth: At least 50 mg/dL
triglyceridesless than 150 mg/dL

Various factors can affect cholesterol levels. Some can be addressed, including your:

  • Diet: Eating a diet rich in trans and saturated fats can increase your overall cholesterol levels. Swapping foods that contain high levels of cholesterol and saturated fats with lower-level alternatives can decrease your cholesterol levels over time.
  • Physical activity: Inactivity can lead to a buildup of plaque in the arteries. This buildup can make it more difficult for the heart to receive the blood it needs, increasing the risk of heart disease. Regular movement can help decrease your LDL cholesterol and increase HDL cholesterol, reducing your risk of high cholesterol and other complications.
  • Weight: Being overweight can increase your cholesterol levels, as well as increase the risk of heart disease. Eating a balanced diet and getting regular movement can help you maintain a moderate weight. This can help decrease your LDL and total cholesterol levels. It can also help increase your HDL cholesterol.

There are other risk factors that you cannot control, including your:

  • Age: Your cholesterol levels naturally increase over time.
  • Sex: Before menopause, people assigned female at birth have lower total cholesterol levels than people assigned male at birth who are the same age. After menopause, people assigned female at birth experience an increase in LDL cholesterol.
  • Genes: High cholesterol tends to run in families. Your genes influence how much cholesterol your body naturally makes.

High cholesterol, high blood pressure, and heart disease are more prevalent in some racial and ethnic groups. This includes people of South and East Asian, non-Hispanic Black or African American, and Indigenous (Native American and Alaska Native) ancestry.

According to research published in 2022, the higher prevalence of these conditions in certain racial and ethnic groups may likely be due to systemic inequities in society, including lack of access to quality, culturally centered healthcare.

If preventive measures are taken, borderline cholesterol can be treated. Here are a few things you can do to improve your levels:

Eat more fiber: Some foods rich in soluble fiber, like oats and citrus fruit, bind to cholesterol and carry it out of the body. Other foods high in insoluble fiber, like nuts and potatoes, cause you to feel full faster, aiding in weight management.

Eat more Omega 3s: Omega-3 fatty acids may help reduce triglyceride levels and increase HDL cholesterol levels in the bloodstream. The American Heart Association (AHA) recommends eating at least two servings of fatty fish like salmon, trout, albacore tuna, and sardines each week. If you don’t eat fish, talk with a healthcare professional about adding an omega-3 supplement to your routine.

Cut back on red meat: Red meat is usually high in saturated fat and cholesterol. If you do eat red meat, opt for lean cuts, which contain less fat.

Peel the skin off poultry: Removing the skin from chicken and fish can help decrease the amount of fat you’re consuming. Broiling, baking, grilling, and roasting meat instead of frying it can also help reduce saturated fats.

Swap dairy products for low fat, fat-free, or plant-based alternatives: Whole milk and cheese are typically high in saturated fat. Plant-based alternatives can be good options.

Stay active: Experts recommend that children and adolescents move their bodies for at least 60 minutes daily, whereas it’s recommended that adults typically aim for about 45 minutes daily or 5 hours weekly. This could include anything from a brisk walk around the neighborhood or park to swimming or cycling.

Maintain a moderate weight: Obesity affects how your body uses cholesterol and slows down your body’s ability to remove LDL cholesterol from your blood. A healthcare professional may recommend losing weight as part of your treatment plan. Losing weight can help lower your borderline cholesterol levels. Consult with a doctor or other healthcare professional about what’s considered a healthy weight for you.

Limit or avoid alcohol: Excess alcohol consumption can increase your total cholesterol and triglyceride levels. According to the Centers for Disease Control and Prevention (CDC), excess consumption is defined as more than one drink a day for people assigned female at birth and more than two drinks a day for people assigned male at birth.

Limit or avoid nicotine and tobacco products: Smoking cigarettes or vaping nicotine can damage your blood vessels, harden your arteries, and increase your overall risk of heart disease. If you smoke, quitting can give your immune system a boost and improve your LDL and HDL cholesterol levels.

Manage other underlying conditions: When coupled with high cholesterol, a history of heart disease, high blood pressure, and diabetes can increase the risk of heart attack or stroke.

If you’ve consistently tried lowering your levels for 3 to 6 months without improvement, it may be time to talk with a doctor or other healthcare professional about medication.

There are several types of drugs available, including:

  • Statins: Statins are the most common treatment for high cholesterol. These medications prevent cholesterol production in the liver. Examples include lovastatin, pravastatin, simvastatin, fluvastatin, and atorvastatin.
  • Bile acid sequestrants: These medications bind to — and also inhibit the reabsorption of — bile acids. Both actions eventually lead to lowered cholesterol levels. Examples of these medications include cholestyramine, colestipol, and colesevelam.
  • Niacin: This B vitamin limits the production of blood fats in the liver. It helps reduce triglycerides and has mild LDL-lowering action.
  • Fibrates: These medications help lower triglyceride levels and have a mild LDL-lowering action. Examples include gemfibrozil, clofibrate, and fenofibrate.
  • Cholesterol absorption inhibitors: Cholesterol absorption inhibitors, like Zetia, are the most commonly used non-statin agents. These drugs prevent cholesterol absorption in the intestine.
  • PCSK9 inhibitors: PCSK9 inhibitors bind to and inactivate the PCSK9 protein in the liver to lower LDL cholesterol. Examples include alirocumab and evolocumab.

Why is LDL cholesterol considered “bad”?

Excess LDL cholesterol builds up on artery walls and triggers a release of inflammatory substances that increase the risk of a heart attack. The process is called atherosclerosis. Excess lipids and lipoproteins are established risk factors for developing heart disease.

Why is HDL cholesterol considered “good”?

Having a high HDL cholesterol level is considered good because these proteins take cholesterol away from the arteries by moving it out of the bloodstream to the liver for excretion.

What are triglycerides?

Triglycerides are another waxy lipid that can be found in the blood. The body uses triglycerides for energy. Eating foods high in cholesterol, saturated fat, and trans fat, and drinking alcohol can increase your triglyceride levels.

How often should you get your cholesterol levels checked?

If you’re age 20 years or older, the AHA recommends getting your cholesterol levels checked at least once every 4 to 6 years. If you have a history of high cholesterol or other risk factors, your clinician may recommend a more frequent testing schedule.

Borderline cholesterol is the intermediate stage of a lipid panel showing cholesterol levels of 200 mg/dL to 239 mg/dL. This reading is just past optimal total cholesterol levels but precedes the diagnosis of high cholesterol.

If left untreated, high cholesterol can increase the risk of heart disease. High cholesterol typically does not cause symptoms, so regular screening is key to detection.

Catasha Gordon is a sexuality educator from Spencer, Oklahoma. She’s the owner and founder of Expression Over Repression, a company built around sexual expression and knowledge. You can typically find her creating sex education materials or building some kinky hardware in a fresh set of coffin nails. She enjoys catfish (tail on), gardening, eating off her husband’s plate, and Beyoncé. Follow her everywhere.