Can total cholesterol be SO high, 1,000 vs. 500, that anything higher would not make a difference in how at risk the patient is for a heart attack? What about treatment options; would they differ?

It’s possible for cholesterol totals to be 1,000. There’s even more people with total cholesterol numbers of 500.

Of course, 500 is way beyond the cutoff point at which a doctor will want aggressive treatment to improve the patient’s lipid profile.

Cholesterol of 1,000 vs. 500

“Both levels are quite elevated and indicate potential trouble,” says Morton Tavel, MD, Clinical Professor Emeritus of Medicine, Indiana University School of Medicine, and author of “HEALTH TIPS, MYTHS, AND TRICKS: A Physician’s Advice.”

Dr. Tavel explains, “Congenital problems in handling cholesterol are often marked by such high levels and predispose to early cardiovascular disease even in the very young.”

When young people have sky-high cholesterol totals, there is likely a genetic component, and these exceptional cases are no reason for the general population to disregard guidelines for cardiovascular health.

Following the guidelines, such as regular exercise, maintaining a healthy weight and controlling sodium intake, really DO make a tremendous difference.

  • Now when it comes to unbelievably high total cholesterol, does the treatment change whether it’s 1,000, 700 or 500?
  • the risk for cardiovascular events even change?

Dr. Tavel explains, “In general, since both high levels are bad, it makes little difference from the standpoint of risk whether one is worse than the other.

“In the general population, both levels signify elevate risk for cardiovascular disease, but much depends upon the presence, if any, of coexisting problems.

“For instance, if combined with other risk factors for cardiovascular disease such as high blood pressure, diabetes or cigarette smoking, even a mildly elevated cholesterol may present an inordinate risk and must be treated in an aggressive way, aiming to lower cholesterol to levels below accepted normal.”

For example, this could be “aiming to lower total cholesterol to below 200, combined with driving the ‘bad’ cholesterol component (LDL), to 70 or below.

“In general, any situation in which cholesterol is above approximately 300 does require treatment, but, in the absence of other risk factors, acceptable levels of total cholesterol may be more lenient and lowered to levels below a total of 250, and LDL to around 100.”

High cholesterol, like high blood pressure, is a so-called silent medical condition, in that it does not cause symptoms.

BUT…a very poor lipid profile is a marker or predictor for future cardiovascular disease that can lead to a heart attack. A total number of 1,000 is no laughing matter.

morton tavel, MD

Dr. Tavel’s medical research includes over 125 publications, editorials and book reviews in peer-reviewed national medical journals. He was formerly director of the cardiac rehabilitation program at St. Vincent Hospital in Indiana.