What Is Borderline High Cholesterol?

If your total or LDL cholesterol is elevated but not yet enough to qualify as “high,” there’s good reason to get it down now.

If your doctor has told you to watch your cholesterol, it’s worth taking note: High cholesterol raises your risk of both heart disease and stroke. The Centers for Disease Control and Prevention (CDC) estimates that 28 million Americans have high cholesterol. And more than three times that number have what’s called borderline high cholesterol—lower than the threshold for high cholesterol, but elevated enough to be a concern.

“Borderline cholesterol is when your levels are close to high, but not dangerously high yet,” says Eric Ascher, D.O., a family medicine physician at Lenox Hill Hospital in New York City, NY.

Here’s what you need to know about borderline high cholesterol—and how to make sure your levels stay in check.

First, What Is Cholesterol?

Cholesterol is a waxy, fatty substance produced by your liver. It helps make cell membranes, which are protective layers that surround each of your cells. It also helps your body make various hormones, vitamin D, and bile, a substance that aids digestion. In other words, cholesterol is a good and necessary thing.

But you can have too much cholesterol circulating in your bloodstream. While your liver produces all the cholesterol you need, you also get cholesterol in your diet, particularly from animal products high in saturated fat like red meat and full-fat dairy. Cholesterol, along with other substances, can form plaque buildups on the walls of your arteries, a process called atherosclerosis. This restricts blood flow and can result in blockages that lead to heart attack and stroke.

There are two main types of cholesterol:

• Low density lipoprotein cholesterol (LDL). Often referred to as bad cholesterol, LDL contributes to plaque buildup in your arteries. You want your level of LDL to be kept low.
• High density lipoprotein cholesterol (HDL). Considered good cholesterol, HDL helps rid your body of excess LDL. Higher levels of this type of cholesterol can help protect you from heart disease and stroke. Ideally, when your cholesterol is measured, your LDL will be low and your HDL will be high.

When your doctor shares your cholesterol reading, it refers to your total cholesterol score, which includes both of these cholesterol types as well as triglycerides, a type of fat (lipid) that circulates in your blood. High levels of triglycerides can cause problems similar to LDL cholesterol. Your total cholesterol is your LDL level plus your HDL level plus 20% (one-fifth) of your level of triglycerides.

What Does It Mean to Have Borderline High Cholesterol?

When evaluating your cholesterol, doctors use different ranges to describe where yours stands. Borderline high cholesterol is one of those ranges, and it falls in between normal and high when considering your total cholesterol level. But doctors also use the term borderline high when discussing low density lipoprotein (LDL) cholesterol specifically. In other words, “borderline high” could refer to either your total cholesterol level or your LDL. There’s no such thing as borderline high HDL since you want your HDL to be high; it’s low HDL that’s a cause for concern, as you’ll see below.

Doctors use these standard ranges to describe levels of total, LDL, and HDL cholesterol:

Total Cholesterol

• High: 240 milligrams per deciliter (mg/dL) or higher
• Borderline high: 200 mg/dL to 239 mg/dL
• Normal: Below 200 mg/dL

LDL Cholesterol

The ranges for LDL cholesterol are different depending on your unique circumstances.

If you do not have heart disease or risk factors for developing heart disease:

• Very high: 190 mg/dL or higher
• High: 160 mg/dL to 189 mg/dL
• Borderline high: 130 mg/dL to 159 mg/dL
• Near optimal: 100 mg/dL to 129 mg/dL
• Normal (a.k.a. optimal): Below 100 mg/dL

If you have heart disease, a history of heart attack, or certain prior heart surgeries:

• Very high: 160 mg/dL or higher
• High: 100 mg/dL to 159 mg/dL
• Near optimal: 70 mg/dL to 99 mg/dL
• Optimal: Below 70 mg/dL

HDL Cholesterol

• Poor: Below 40 mg/dL for men or below 50 mg/dL for women
• Better: 40 mg/dL to 59 mg/dL for men or 50 mg/dL to 59 mg/dL for women
• Best: 60 mg/dL and above for both men and women

Triglycerides

• Very high: 500 mg/dL and above
• High: 200 mg/dL to 499 mg/dL
• Borderline high: 150 mg/dL to 199 mg/dL
• Desirable: Below 150 mg/dL

When your LDL in particular is above normal—even in the “near optimal” range, which is even lower than borderline—there’s cause for concern.

“Any LDL level of 100 or above is considered high [in terms of risk],” says Carl E. Orringer, M.D., professor of clinical medicine and director of Preventive Cardiovascular Medicine at the University of Miami Miller School of Medicine in Miami, FL.

Wait, you might be thinking; how can something be both “near optimal” and “high risk”? The answer: “There is no absolute cutoff between ‘normal’ and ‘high,’” Dr. Orringer explains. “We now know that the lower the LDL and the longer the period in which it is lower, the lower the risk of heart attack and stroke.”

In other words, borderline high is still high. Adding to the complexity of this equation, says Dr. Orringer, most heart attacks occur in people who have “near optimal” LDL, which is even lower than borderline. So even if you’re otherwise in good health, under 100 mg/DL is really the only place you want your LDL to be.

Factors That Can Affect Your Cholesterol

The single biggest modifiable factor that can elevate your cholesterol level is your diet, says Dr. Orringer. “The dietary factors that raise cholesterol and increase cardiac risk include eating foods that are high in saturated fat,” he says. Those foods include:

• Baked goods like cakes and cookies and some fried foods
• Beef
• Butter
• Cheese
• Cream
• Ice cream
• Lamb
• Lard
• Poultry, especially if eaten with the skin
• Pork
• Processed meats
• Tropical vegetable oils (coconut oil, palm oil)

What about foods that are high in dietary cholesterol, like egg yolks? Though eggs do have a lot of cholesterol, it turns out that the cholesterol you get from food doesn’t affect your blood cholesterol as much as saturated fats and trans fats do. The American Heart Association (AHA) has advised that adults with healthy cholesterol levels can eat up to seven eggs per week without boosting their risk of heart disease. If you have elevated cholesterol, your doctor might recommend limiting your intake of eggs and other foods high in dietary cholesterol, such as shrimp—especially if you eat those foods along with foods that have a lot of saturated fat. In other words: You’ll need to rethink bacon and eggs as a breakfast staple.

Dr. Ascher points out that your family history and genetics also can influence your cholesterol level. Familial hypercholesterolemia (FH), for example, is a genetic condition that you can inherit from your parents. It causes your LDL level to be unsafely high. FH can lead to heart disease at a younger age, and it increases your risk of heart disease 20-fold, according to the AHA. While people with elevated cholesterol sometimes can manage their cholesterol with lifestyle changes, FH usually requires medication in order to lower cholesterol to a healthy range. The CDC estimates that it affects about one in 250 people.

How to Manage Borderline Cholesterol and Get It Down to a Healthy Level

The most important things that you can do to lower your cholesterol, say both Dr. Orringer and Dr. Ascher, are improve your diet and get regular exercise.

Follow a Heart-Healthy Diet

A good example of this is the Mediterranean diet, which favors fruits, vegetables, whole grains, beans and other legumes, nuts, and olive oil. It greatly limits the amount of red meat, processed meat, and sugar in your diet. It allows a moderate amount of poultry and seafood and a small amount of dairy (think a few times a week). When eating dairy on the Med diet, opt for less-processed cheeses, like feta and part skim mozzarella, and plain Greek yogurt rather than flavored yogurts, which can be sugar bombs.

There’s good evidence backing this tasty approach to healthy eating. According to Harvard T. H. Chan School of Public Health, studies have consistently found that the Mediterranean diet reduces the risk of heart disease. In one important study of nearly 26,000 women, published in JAMA Network Open, the diet reduced the risk of cardiac events such as heart attacks by about 25%.

Get Moving

Exercise is a powerful weapon against unhealthy cholesterol. Make sure to get at least 150 minutes of aerobic exercise per week, such as walking, running, biking, and swimming. You can break this down into small amounts—think 30 minutes a day, five days a week—as long as it adds up to 150 minutes. More is even better! In an Italian study of 176 people with metabolic syndrome (a cluster of symptoms tied to increased cardiac risk), walking briskly for an hour five days a week raised HDL and lowered triglycerides substantially over 24 weeks.

Making big lifestyle changes can be tough, of course. Dr. Ascher says to be aware that it may take time to adapt and that the first things you try might not stick. For example, you may resolve to exercise at a local gym but find you don’t like working out in that atmosphere. That’s OK. Don’t give up on exercise. Instead, try something else until you find a workout you prefer.

“I always encourage my patients to do a trial of diet and exercise for three months, then retest the cholesterol levels,” he says.

How Long Does It Take to Lower Borderline Cholesterol?

Lifestyle changes alone may be enough to get your cholesterol down to normal reasonably fast. “With appropriate lifestyle changes, you can start to see cholesterol lower in three months,” says Dr. Ascher. However, if you already have heart disease, you likely will need to start a cholesterol-lowering medication such as a statin drug. And if that’s the case, you can expect to see improvement in your cholesterol reading in an even shorter period of time.

“With the use of cholesterol-lowering medicine, significant lowering of LDL may occur within a few weeks,” says Dr. Orringer.

The most important thing to know is that however you get there, getting there is important: Higher LDL and triglyceride numbers—even those that are borderline high—can spell trouble for your heart and overall health in the future. So start chipping away today!