What Happens To Your Early Death Risk After A High Cholesterol Diagnosis

You do your part in staying healthy. You exercise five days a week and don't smoke. You try to eat relatively healthy (aside from those buffalo wings at happy hour), and you know that eating too many foods high in saturated and trans fat isn't great for your heart health. Yet you're shocked when your doctor tells you your cholesterol is high. The World Health Organization says high cholesterol contributes to your risk of heart disease and stroke, leading to 2.6 million deaths worldwide every year. Almost 40% of people around the world have high cholesterol.

Your body needs a certain amount of cholesterol to produce hormones and break down fat. Having zero cholesterol isn't the aim, but an optimal total cholesterol is about 150. Your doctor might suggest options to help lower your cholesterol if it's above 200. Yet 200 isn't so bad if your high-density lipoprotein, or HDL, is well above 50. Your HDL carries blood cholesterol to the liver to be processed and eliminated from the body. On the other hand, low-density lipoprotein (LDL) cholesterol should be below 100 because this is the stuff that likes to hang out in your blood vessels. If your doctor gives you a high cholesterol diagnosis, your risk of early death from any cause could be up to 26%, depending on your HDL and LDL cholesterol levels. However, too much of HDL and too little of LDL could also increase your early death risk.

If you have your current cholesterol numbers, take the total cholesterol and divide it by your HDL cholesterol. That's considered your total cholesterol/high-density lipoprotein cholesterol (TC/HDL) ratio. While a high HDL is considered good for your heart health, a low HDL isn't. Therefore, you might wonder if it means that a low TC/HDL ratio is good. Interestingly, the answer is yes, but not totally, according to a 2022 article in Frontiers in Endocrinology. 

The study looked at the TC/HDL ratios of more than 30,000 people with an average age of 43 and normal blood pressure. People whose TC/HDL ratios were 5.07 or above had a 26% higher risk of all-cause mortality. Those whose TC/HDL ratios were 4.22 or higher had a 13% greater risk of cardiovascular mortality. However, those with a higher HDL, which calculated a lower TC/HDL ratio, also had a significantly greater risk of all-cause mortality. Meanwhile, people whose TC/HDL ratio was 2.86 or below had an 18% higher risk of early death.

Although the general recommendation is for your LDL cholesterol to be below 100, your doctor might set a different goal for you depending on your risk of heart disease (per Johns Hopkins Medicine). 

A 2020 article in BMJ found that people whose LDL cholesterol was above 189 had a 15% higher risk of death compared to those whose LDL levels fell within the 132 to 154 range. Among this Danish population, the LDL associated with the lowest mortality risk was 140. Those taking statins to lower their cholesterol had the lowest mortality risk if their LDL was 89. Having an LDL cholesterol that's too low might seem to be healthy, but researchers found that those whose LDL cholesterol was below 70 had a 25% higher risk of all-cause mortality. While this might not seem to make sense, the researchers found that the people with the lowest LDL levels had more coexisting medical conditions.