Just What Is A Total Cholesterol Count?

DEAR DR. GOTT:
I’m an 85-year-old woman in good health. I take no medication of any kind, but am on over-the-counter red yeast rice capsules and policosanol. My only problem is my cholesterol level. I recently had a blood test that revealed an HDL of 78, LDL of 16 and triglycerides of 81. My total cholesterol was slightly elevated at 243. I can’t understand why that would be, since my other readings were in the normal range.

DEAR READER:
You are in the majority when you think you can add your HDL, LDL and triglycerides to come up with a total cholesterol count. Unfortunately, that’s not how it works. Total cholesterol is a combination of high density lipoproteins (HDL), low density lipoproteins (LDL) and very low density lipoproteins (VLDL).

Before going any further, I would like to make an observation. You claim that your LDL is 16. If this is true, you might just have the lowest LDL in the world. But also, by taking your reading of 243 and subtracting your HDL and LDL, your VLDL is 149. This is incredibly high. Normal VLDL levels range between 5 and 40. LDL levels in general should be below 130. Below 100 is considered optimal. HDL should be 40 or higher. Triglycerides should be below 150.

So assuming you simply forgot to write a third number on your LDL level and you meant that it was 116 (meaning the VLDL would be 49) or 160 (VLDL would be 5), you are likely fine. Were I your physician, I would not be concerned your total cholesterol is slightly elevated. Based on your age (no disrespect intended), and the general normalcy of your numbers, I would leave well enough alone. My only recommendation would be for periodic lab testing since red yeast rice can affect the liver because it is a natural statin similar to Mevacor. Adverse effects of these products include muscle problems and kidney impairment commonly associated with prescription statins.

Also, a research study published in 2006 in JAMA, showed that policosanol did not improve cholesterol levels over that of a placebo.

For those readers who are considering alternative methods of cholesterol lowering, I urge you to speak with your physician for direction on the specific product you wish to try.

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