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Total Cholesterol, LDL & HDL Calculator

Cholesterol calculator using ACC/AHA 2018 guidelines: classify Total (<200), LDL (<100 optimal), HDL (>40 men / >50 women), Triglycerides, and Non-HDL. Instant, no sign-up.

🗓️ Updated June 2026 Reviewed by
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A standard lipid panel reports five numbers — total cholesterol, LDL-C, HDL-C, triglycerides, and non-HDL cholesterol — and each carries a different weight in atherosclerotic cardiovascular disease (ASCVD) risk stratification. This calculator applies the cutoffs from the 2018 ACC/AHA Cholesterol Clinical Practice Guideline (Grundy et al., Circulation 2019), which superseded the older NCEP ATP III framework. The shift matters: ATP III emphasized rigid LDL targets, while the 2018 guideline embeds those numbers inside a 10-year ASCVD risk estimate (Pooled Cohort Equations) and a shared-decision conversation.

If you don't have a direct LDL measurement, enter your triglycerides and this calculator will estimate LDL via the Friedewald equation (LDL = Total − HDL − Trig/5), valid for triglycerides below 400 mg/dL.

The calculator also computes Non-HDL cholesterol (Total − HDL), which captures all atherogenic particles in one number. Multiple meta-analyses — including Boekholdt et al. (JAMA 2012, 62,154 patients) — showed Non-HDL outperforms LDL-C as a predictor of cardiovascular events, especially when triglycerides are elevated. Target: <130 mg/dL.

Results are educational only. Consult your physician or cardiologist for a complete cardiovascular risk assessment, which includes the ASCVD 10-year risk score, personal history, and medication review.

When to use this calculator

  • Post-physical lipid panel interpretation — A 48-year-old male gets his annual labs: Total 232 mg/dL, LDL 152 mg/dL, HDL 38 mg/dL, Triglycerides 188 mg/dL. The calculator flags Total as borderline-high, LDL as borderline-high, HDL below the male protective threshold (40), Triglycerides borderline, and Non-HDL at 194 mg/dL — well above the 130 target. He brings this breakdown to his physician, who runs the ASCVD risk estimator (10-year risk 9.2%) and recommends initiating moderate-intensity rosuvastatin 10 mg.
  • Statin eligibility screening — primary prevention — A 56-year-old woman with hypertension and a 30 pack-year smoking history: Total 218, LDL 142, HDL 48, Trig 162. Calculator confirms LDL borderline-high and HDL below the female 50 mg/dL threshold. Her 10-year ASCVD risk is 12.4%, placing her in the intermediate-to-high category. Per 2018 guidelines this triggers a clinician-patient risk discussion; she elects atorvastatin 20 mg targeting ≥30% LDL reduction.
  • Familial hypercholesterolemia suspicion — A 32-year-old man whose father had a MI at 44 gets: Total 298, LDL 218, HDL 52, Trig 140. LDL ≥190 mandates statin therapy and raises strong suspicion for heterozygous familial hypercholesterolemia. He is referred for genetic testing (LDLR, APOB, PCSK9 mutations) and cascade screening of first-degree relatives.
  • Lifestyle intervention response monitoring — A 58-year-old with metabolic syndrome adopted a Mediterranean diet and added 200 min/week of exercise. Baseline: Total 244, LDL 158, HDL 41, Trig 210. After 16 weeks: Total 198, LDL 118, HDL 49, Trig 138. Calculator shows Total and Triglycerides now in desirable range, LDL improved from borderline-high to near-optimal, consistent with the expected 10–20% LDL reduction from intensive lifestyle changes.
  • Very high triglycerides — pancreatitis risk check — A 44-year-old with poorly controlled diabetes: Total 312, HDL 28, Trig 612. Calculator flags HDL critically low and Triglycerides very-high (≥500), which carries acute pancreatitis risk. The Friedewald LDL calculation is invalid at Trig >400, so direct LDL measurement is required. Immediate referral for fibrate or icosapent ethyl therapy and glycemic optimization.

Cholesterol thresholds in mmol/L (US mg/dL ↔ international SI units)

This calculator works in mg/dL (US units), but labs in the UK, EU, Canada, Australia and India report in mmol/L. Convert your result by dividing mg/dL by 38.67 for Total/LDL/HDL and by 88.57 for triglycerides (NCBI lipid conversion factors), then match it to the ACC/AHA classification below (2026 guideline, which restored LDL-C goals by risk and replaced the 2018 version; SI thresholds align with the rounded NHS/HeartUK/ESC cut-points). Educational only — discuss your full cardiovascular risk with a physician.

Lipid fractionKey cut-point (mg/dL)Same value in mmol/LWhat it marks
Total cholesterol2005.2Above this = borderline-high (NHS target <5.0)
Total cholesterol2406.2High
LDL ('bad')1002.6Optimal ceiling; goal for borderline/intermediate risk
LDL ('bad')701.8Goal for high CV risk / established ASCVD (2026: <55 mg/dL ≈ 1.4 mmol/L if very-high-risk)
LDL ('bad')1904.9Statin-mandatory; suspect familial hypercholesterolemia
HDL ('good')40 men / 50 women1.0 men / 1.3 womenBelow = ASCVD risk factor (NHS: ≥1.0 men, ≥1.2 women)
HDL ('good')601.6Protective level (both sexes)
Triglycerides150 / 5001.7 / 5.6<1.7 normal; ≥5.6 very high, pancreatitis risk

How it works

Lipid Panel Components and ACC/AHA 2018 Cutoffs

The 2018 ACC/AHA Cholesterol Clinical Practice Guideline (Grundy et al., Circulation 2019; 139:e1082–e1143) reorganized adult cholesterol management around three principles: estimate 10-year ASCVD risk with the Pooled Cohort Equations, identify risk enhancers, and engage in a shared-decision conversation before initiating statin therapy.

How it works

This calculator classifies each lipid fraction using the ACC/AHA 2018 thresholds:

Total Cholesterol (mg/dL):
  < 200        → Desirable
  200 – 239    → Borderline-high
  ≥ 240        → High

LDL Cholesterol (mg/dL):
  < 100        → Optimal
  100 – 129    → Near-optimal
  130 – 159    → Borderline-high
  160 – 189    → High
  ≥ 190        → Very high — statin mandatory (ACC/AHA 2018)

HDL Cholesterol (mg/dL):
  ≥ 60         → Protective (both sexes)
  Men ≥ 40 / Women ≥ 50  → Acceptable
  Men < 40 / Women < 50  → ASCVD risk factor

Triglycerides (mg/dL):
  < 150        → Normal
  150 – 199    → Borderline
  200 – 499    → High
  ≥ 500        → Very high — pancreatitis risk

Non-HDL Cholesterol = Total − HDL
  Target: < 130 mg/dL (= LDL target + 30)

Friedewald LDL estimation (if LDL not directly measured):

LDL = Total Cholesterol − HDL − (Triglycerides ÷ 5)

Valid when Triglycerides < 400 mg/dL. Above this threshold, direct LDL assay or the Martin-Hopkins equation (JAMA 2013) is required — the classic Friedewald equation systematically underestimates LDL at high triglyceride concentrations.

Quick Reference Table

ParameterOptimalBorderlineHigh
Total Cholesterol<200200–239≥240
LDL (healthy adult)<100130–159≥160
LDL (high CV risk / diabetes)<70—≥100
HDL — Men≥60 protective≥40 acceptable<40 risk
HDL — Women≥60 protective≥50 acceptable<50 risk
Triglycerides<150150–199≥200
Non-HDL<130130–159≥160

Non-HDL and ApoB

Non-HDL cholesterol captures all atherogenic particles (LDL, VLDL, IDL, Lp(a)) in one number. Boekholdt et al. (JAMA 2012) meta-analyzed 62,154 statin-treated patients and showed Non-HDL outperformed LDL-C as a cardiovascular event predictor, especially with elevated triglycerides. Target: <130 mg/dL.

Apolipoprotein B (ApoB) goes one step further — it counts atherogenic particles directly, one per particle. The 2018 ACC/AHA guideline lists ApoB ≥130 mg/dL as a risk enhancer; Canadian and European guidelines increasingly favor it as a primary target in metabolic syndrome and diabetes cases.

Statin Indications (ACC/AHA 2018)

Four groups derive clear benefit from statin therapy:

1. Clinical ASCVD (prior MI, stroke, PAD, revascularization) — high-intensity statin.
2. LDL ≥190 mg/dL — high-intensity statin regardless of 10-year risk score.
3. Diabetes age 40–75 with LDL 70–189 — moderate-intensity statin minimum.
4. Primary prevention age 40–75 with LDL 70–189: 10-year ASCVD risk ≥7.5% supports statin discussion; ≥20% supports high-intensity statin.

For borderline-risk patients (5–7.5%), coronary artery calcium (CAC) scoring can refine the decision — a CAC of 0 generally allows deferral of statin therapy.

Disclaimer

This calculator is educational and does not replace an in-person evaluation with your physician or cardiologist. A complete cardiovascular risk assessment includes the 10-year ASCVD risk score (ACC ASCVD Risk Estimator Plus), personal/family history, blood pressure, smoking status, diabetes status, and medication review.

Example: 48-year-old male, routine physical

Total Cholesterol: 232 mg/dL
HDL: 38 mg/dL, sex: Male
LDL: 152 mg/dL, Triglycerides: 188 mg/dL
Calculator classifies: Total borderline-high (200–239), LDL borderline-high (130–159), HDL risk factor for males (<40), Triglycerides borderline (150–199), Non-HDL 194 mg/dL (above optimal <130).
Overall: borderline-to-elevated profile — medical evaluation and lifestyle intervention advised.
Borderline-high profile — consult physician

Frequently asked questions

What's a good LDL cholesterol level?
Per the 2018 ACC/AHA Cholesterol Guideline, optimal LDL is below 100 mg/dL for primary prevention. Near-optimal is 100–129, borderline-high 130–159, high 160–189, and very high at 190 or above. For patients with established ASCVD (prior heart attack, stroke, revascularization, or PAD), the target tightens to below 70 mg/dL; 2019 ESC guidelines push toward below 55 mg/dL after a recent event. For diabetics aged 40–75, moderate-intensity statin therapy is recommended for LDL 70–189 even at lower risk scores. Any LDL ≥190 mg/dL is itself a statin indication and should trigger evaluation for familial hypercholesterolemia.
Why is HDL above 60 mg/dL considered protective?
HDL particles perform reverse cholesterol transport: they accept free cholesterol from peripheral tissues including arterial macrophages and deliver it to the liver for excretion as bile acids. Higher HDL is associated with lower cardiovascular events in observational cohorts (Framingham, ARIC). However, Mendelian randomization studies and trials of HDL-raising drugs (CETP inhibitors like torcetrapib and evacetrapib, niacin) failed to show that pharmacologically raising HDL reduces cardiovascular events. The current consensus is that HDL functionality (cholesterol efflux capacity) matters more than absolute level; very high HDL above 90–100 mg/dL may not confer additional benefit.
When is the Friedewald equation inaccurate?
The Friedewald equation (LDL = Total − HDL − Trig/5) was derived in 1972 and assumes a fixed Trig:VLDL-cholesterol ratio of 5:1. It systematically underestimates LDL when triglycerides exceed 400 mg/dL because actual VLDL composition shifts. It also performs poorly at LDL <70 mg/dL — exactly the range where statin-treated high-risk patients live. The Martin-Hopkins equation (JAMA 2013) uses an adjustable divisor matched to triglyceride and non-HDL strata and is accurate up to Trig ~800 mg/dL; it has become the default in most major US health systems since 2018. For triglycerides above 400, a direct LDL assay is the standard.
What is Non-HDL cholesterol and why does it matter?
Non-HDL cholesterol = Total Cholesterol − HDL. It captures every atherogenic particle in one number: LDL, VLDL, IDL, chylomicron remnants, and Lp(a). Boekholdt et al. (JAMA 2012, 62,154 statin-treated patients) showed non-HDL outperformed LDL-C as a predictor of cardiovascular events. The non-HDL target is LDL goal + 30, so optimal is <130 mg/dL. Non-HDL is especially useful when triglycerides are elevated, making the Friedewald LDL estimate unreliable — Non-HDL remains accurate regardless of triglyceride levels.
If my cholesterol is borderline, do I need a statin?
Borderline cholesterol alone does not equal statin indication — the 2018 ACC/AHA framework decides therapy on overall ASCVD 10-year risk, not isolated LDL values within 70–189 mg/dL. Use the ASCVD Risk Estimator Plus (free at tools.acc.org). For primary prevention adults 40–75 with LDL 70–189: risk <5% generally favors lifestyle alone; 5–7.5% warrants a risk discussion and possibly coronary artery calcium (CAC) scoring; 7.5–20% supports moderate-intensity statin; ≥20% supports high-intensity statin. Risk enhancers like family history of premature ASCVD, LDL ≥160, metabolic syndrome, elevated Lp(a), or elevated hs-CRP can shift a borderline case toward treatment.
Triglycerides over 500 — is this dangerous?
Triglycerides ≥500 mg/dL are in the 'very high' category, and the immediate concern is acute pancreatitis, which becomes substantial at Trig >1000 mg/dL. If you have abdominal pain, nausea, or vomiting, seek emergency care. Without symptoms, prompt evaluation is still warranted. Treatment includes urgent dietary fat restriction (<15% of calories), strict alcohol avoidance, optimization of diabetes if present, and pharmacotherapy with fibrates (fenofibrate 145 mg/day) or high-dose omega-3 (icosapent ethyl 2 g BID per REDUCE-IT). Secondary causes: uncontrolled diabetes, hypothyroidism, nephrotic syndrome, estrogen therapy, atypical antipsychotics, and excessive alcohol.
Can a plant-based diet replace a statin?
For patients with low to intermediate ASCVD risk and modest LDL elevation, a structured plant-based or Portfolio diet can produce LDL reductions of 13–30%, sometimes comparable to a low-intensity statin. The Portfolio Diet (Jenkins et al., JAMA 2003) combines plant sterols 2 g/day, soluble fiber 25–30 g/day from oats/barley/psyllium/legumes, soy protein, and tree nuts — average LDL reduction ~30% in compliant patients. However, for LDL ≥190 mg/dL, established ASCVD, familial hypercholesterolemia, or diabetes with 10-year risk ≥7.5%, lifestyle is adjunctive — not a substitute for statin therapy. The mortality benefit of statins in high-risk groups is established across CTT meta-analyses covering hundreds of thousands of patients.
How often should I get a lipid panel?
ACC/AHA and USPSTF recommend baseline lipid screening starting at age 20, with re-screening every 4–6 years if results are normal and risk is low. After age 40, more frequent screening (every 1–2 years) is reasonable given the ASCVD risk calculator becomes more actionable. Patients on statin therapy typically get a follow-up panel 4–12 weeks after initiation to confirm response (target ≥30% LDL reduction with moderate intensity, ≥50% with high intensity), then every 3–12 months. Children with family history of premature ASCVD or FH should be screened starting at age 9–11 per AAP guidelines.
What is Lp(a) and should I be tested?
Lipoprotein(a) — Lp(a) — is an LDL-like particle with apolipoprotein(a) covalently attached. Its concentration is ~90% genetically determined and changes little with lifestyle or statins. Elevated Lp(a) above 50 mg/dL (or 125 nmol/L) is an independent ASCVD risk factor present in ~20% of the global population. The 2018 ACC/AHA guideline lists Lp(a) ≥50 mg/dL as a risk-enhancing factor. Current recommendation is to measure Lp(a) at least once in adulthood, especially with personal or family history of premature ASCVD, recurrent events on optimal statin therapy, or familial hypercholesterolemia. Antisense oligonucleotide drugs targeting LPA mRNA (pelacarsen) are in phase 3 trials.
What is familial hypercholesterolemia (FH) and how serious is it?
Heterozygous FH affects approximately 1 in 250 people globally — more common than type 1 diabetes — but only about 10% are diagnosed. Suspect FH when LDL is ≥190 mg/dL in adults (≥160 in children) without secondary causes, especially with personal or family history of premature ASCVD (men <55, women <65). Genetic testing covers LDLR, APOB, and PCSK9 mutations. Cascade screening of first-degree relatives is recommended. Untreated heterozygous FH patients have a ~50% risk of coronary heart disease by age 50 in men and age 60 in women. High-intensity statin therapy (rosuvastatin 40 mg or atorvastatin 80 mg) is the cornerstone of treatment, often combined with ezetimibe or a PCSK9 inhibitor.
Can I have normal cholesterol and still develop heart disease?
Yes — roughly 50% of patients hospitalized with coronary heart disease have LDL below 100 mg/dL. ASCVD risk also depends on Lp(a), ApoB particle number, inflammation (hs-CRP), hypertension, smoking, diabetes, family history, sleep apnea, kidney disease, and psychosocial stress. Coronary artery calcium (CAC) scoring via non-contrast cardiac CT can detect subclinical atherosclerosis in patients with apparently normal lipids — a CAC of 0 carries very low 10-year event risk regardless of other risk factors, while a CAC ≥100 or ≥75th percentile for age moves toward statin therapy even with 'normal' LDL.
Are non-fasting lipid panels accurate enough?
Yes, for most screening purposes. The 2016 European Atherosclerosis Society consensus and the 2018 ACC/AHA guideline both endorse non-fasting lipid panels for routine cardiovascular risk assessment. Total cholesterol, HDL, and ApoB change minimally with eating. Triglycerides rise 10–20% postprandially; if non-fasting triglycerides are <175 mg/dL, the test is considered valid. Calculated Friedewald LDL becomes unreliable when triglycerides are elevated, which is why the Martin-Hopkins equation has become the default. A fasting panel is still preferred if triglycerides are being treated or hypertriglyceridemia is suspected.

Methodology & trust

Editorial

Calculadora de salud revisada por el equipo editorial de Hacé Cuentas, contrastada con ACC/AHA 2018 Cholesterol Guideline — Grundy et al., Circulation 2019, según nuestra política editorial y metodología.

Updates

Última revisión: June 17, 2026. Los parámetros se verifican periódicamente con las fuentes citadas.

Privacy

Calculations run 100% in your browser. We do not store or transmit your data.

Limitations

Indicative results. For critical decisions, consult a professional.

📌 How to cite this calculator

Rodríguez, M. (2026). Total Cholesterol, LDL & HDL Calculator. Hacé Cuentas. https://hacecuentas.com/cholesterol-total-ldl-hdl-levels

Contenido bajo licencia CC-BY 4.0 — reutilizable citando la fuente con enlace a Hacé Cuentas.

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