What Is Borderline Cholesterol?

Written by Alicia Racelis, PhD, Jodi Helmer
Medically Reviewed by James Beckerman, MD, FACC on August 13, 2026

If your doctor told you that your cholesterol is "borderline" high, it's above normal but not quite in the "high" range. Borderline cholesterol levels fall between 200 and 239 milligrams per deciliter (mg/dL).

"Cholesterol increases as we age — with every birthday!" says Gina Lundberg, MD, FACC, FAHA, FNLA, the clinical director of Emory Women's Heart Center and medical professor at Emory University School of Medicine in Atlanta.

Your doctor can help you lower borderline cholesterol levels, but the first step is to measure your risk for heart trouble.

Know your risk

Your doctor will also consider other things in assessing your risk for heart problems, not just your cholesterol. The American Heart Association's Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) tool helps measure certain risk factors for heart disease.

Your doctor will also consider how much of your total cholesterol is LDL ("bad") cholesterol and how much of it is HDL ("good") cholesterol.

"So when cholesterol reaches borderline levels, it's an indication that your levels are going up in an unfavorable direction," says Lundberg, who is also the 2026 Wenger awardee for Excellence in Medical Leadership and serves on the board of the National Lipid Association.

Your liver makes cholesterol, a waxy, fat-like substance, to help build cells and hormones. But you can take in more cholesterol than your body needs, especially after eating foods high in cholesterol, such as:

  • Animal meats
  • Poultry
  • Dairy products

If you have too much cholesterol in your body, it can build up inside your blood vessels (arteries) and harden into what's known as "plaque." Eventually, a process called atherosclerosis can cause the hardened plaque to narrow your blood vessels.

And the smaller space inside your blood vessels can make it harder for blood to travel through them, raising your risk for heart disease.

Why do I need a cholesterol test?

Unfortunately, high cholesterol doesn't always cause symptoms. In later stages of the hardening, though, you may have angina – severe chest pain from lack of blood flow to your heart.

If an artery gets totally blocked, it could lead to a heart attack. A routine blood cholesterol test is a far better way of finding out your cholesterol level. 

"Being informed is everything when it comes to prevention," says Lundberg.

Making simple life changes is often enough to lower borderline cholesterol to the normal range. Some people may also need to take medicine, but you won't know about borderline cholesterol unless you get a blood test. 

What does a cholesterol test measure?

This test, also called a "lipid panel," measures your total cholesterol and four kinds of blood fat:

Low-density lipoproteins (LDL). Called the "bad cholesterol," it is the main cause of plaque buildup, which raises your risk of heart disease. Generally, the lower the number, the better. But LDL is only one part of your overall risk for heart attack or stroke.

Very low-density lipoprotein (VLDL). It's another type of "bad" cholesterol that comes from your food. So if you've fasted before the blood test, higher VLDL levels can be a sign that your body isn't getting rid of cholesterol normally.

High-density lipoproteins (HDL). This "good cholesterol" helps transport the "bad cholesterol" from your bloodstream to the liver, where it leaves your body. Your HDL is another part of your risk for heart trouble. Typically, the higher the number, the better.

Triglycerides. Another type of fat in your bloodstream that is linked to heart disease. Triglycerides are also stored in the fat cells throughout your body.

The test numbers tell your doctor about your cholesterol levels and help calculate your risk for heart issues. Lowering your cholesterol can help lower your overall risk for heart problems. 

Healthy Cholesterol Levels for Children and Teens

Type of Blood Fat

Cholesterol Level (mg/dL)

Total Cholesterol

Below 170

LDL

Below 110

HDL

35-109

Healthy Cholesterol Levels for Adults (Aged 19 and above)

Type of Blood Fat

Cholesterol Level (mg/dL)

Total Cholesterol

Below 200

LDL

Below 100

VDL

Below 30

HDL

40-80 (men) or 50-80 (women)

Although not a type of cholesterol, triglycerides are a type of blood fat that also play a role in heart health. In general, your doctor may suggest keeping triglycerides:

  • Below 90 mg/dL for children and teens (10-19 years old)
  • Below 150 mg/dL for adults (aged 19 and above)

Always talk to your doctor about what your cholesterol numbers mean, of course. They'll look at all your risk factors, including other medical conditions, genetics, and family history. Depending on your risk, your LDL targets might be:

  • Below 70 mg/dl if you already have heart problems
  • Below 55 mg/dL if you've had a prior heart attack or stroke

Lowering risk for heart problems 

There are many ways to lower your cholesterol risk, such as healthy habits and treatments. But it's also important to look at all the numbers from the cholesterol test, not just the total cholesterol number. 

"Lipid testing is just one way to reduce your cardiovascular risk," says Lundberg. "But it is important."

That's because LDL and HDL levels are two top signs of potential heart disease. Your doctor can help you set the right goals to bring down your chances of having heart disease. You can still turn it around before you get high cholesterol. 

"The American Heart Association Essential 8 is a great starting place," says Lundberg. These lifestyle changes can help you lower cholesterol:

  • Eat nutritiously.
  • Stay active.
  • Get help to quit smoking.
  • Sleep seven to nine hours at night.
  • Reach your target weight.
  • Lower your cholesterol.
  • Keep your blood sugar in check.
  • Manage your blood pressure.

Here's a few tips to help you get started with the Essential 8.

Use your diet to help lower your LDL cholesterol and raise your HDL cholesterol. If you don't have other risk factors for heart disease, making some lifestyle changes may help.

“Plant-based diets, such as the DASH diet and Mediterranean Diet, have years of data on health benefits,” says Lundberg.

 

Start by checking the nutrition label on your food. Knowing what is in your favorite foods can help you make better choices, including those with less:

  • Cholesterol
  • Saturated fat
  • Trans fat

You and your doctor can talk about the best fats and proteins to help keep your cholesterol levels in check. 

Limit saturated fats and cholesterol

Too much saturated fat can raise your cholesterol levels. Try to limit animal products because they contain both saturated fat and cholesterol.

"Adding high saturated fats and more animal fats in your diet is associated with more cardiovascular disease," says Lundberg.

Focus on eating lean, plant-based proteins. And try eating smaller amounts of poultry and lean meat; ask your doctor about what your daily limit should be.

Stay away from trans fat

Artificial trans fats can raise your LDL ("bad") cholesterol. You'll find it in packaged foods, including some:

  • Crackers
  • Cookies
  • Pastries
  • Microwave popcorn

Always check the ingredients, because products marked "0 grams" of trans fats per serving can have up to a gram of trans fat. Anything marked "partially hydrogenated" is trans fat, too.

Limit processed foods

It's not just about the oils; some highly processed foods can also raise your cholesterol levels. Try to snack on fresh fruits and veggies throughout the day.

"Processed foods are the most likely to accelerate cardiovascular disease," says Lundberg. She says that's because these foods are also linked to conditions such as:

Exercise can help you get your cholesterol down from the borderline range. Aim for at least 30 minutes of moderate-intensity exercise up to 150 minutes each week. You can try:

  • A brisk walk
  • Water aerobics
  • Pickleball

You can also do a more intense workout for 75 minutes a week, including:

  • Playing a team sport
  • Taking a group fitness class 
  • Riding bike

This can raise your heart rate and HDL ("good") cholesterol levels. Push yourself, if you can, but keep in mind that moderate exercise is better than none at all.

Work with your doctor to bring your cholesterol levels back down. Start with losing extra weight. "Sometimes weight loss or improved sleep can help," says Lundberg. In fact, losing as little as 5%-7% of your current body weight can lower your "bad" LDL levels.

Not sure if your weight is in a healthy place? A body mass index (BMI) above 25 might raise your risk for health problems. But ask your doctor about it, because BMI isn't the only thing your doctor will look at.

What do the studies show?

One study found that after a year of exercising, for every 1% of body weight lost, adults may lower their risk for:

Keep in mind that you can be at your target weight and still have borderline or high cholesterol. That's because other risk factors can play a role in your heart health.

If you smoke, kicking the habit can help raise your HDL ("good") cholesterol by up to 10%.

Have you tried to quit smoking before? For many people, it takes a couple of tries. Keep trying until it sticks. It's worth it, for your whole body's health.

Your doctor will check your cholesterol levels during regular screening visits to see whether your lifestyle changes have helped you meet your cholesterol goal. What you eat only changes cholesterol levels a little (20%); genetics and other factors affect the rest (80%).

If lifestyle changes aren't enough, your doctor may suggest treatment. If you aren't sure about taking cholesterol medicine, more testing can help you decide.

Your doctor will look at specific risk factors, testing, and your medical history before suggesting medicine to lower cholesterol. They may suggest medicine if you have a higher risk, such as:

  • A family history of high cholesterol or early heart disease
  • An LDL level of 160 mg/dL or higher
  • A 10-year PREVENT risk of 5% to less than 10%
  • A 10-year PREVENT risk of 3%-5%, depending on other risk factors

Which tests can help me decide?

If you aren't sure about taking cholesterol-lowering medicine, your doctor may order more tests.

Lipoprotein (a) or Lp(a). This measures a type of "bad" cholesterol with an extra protein stuck to it. Higher amounts of Lp(a) can mean more plaque buildup and a higher risk for heart problems.

Apolipoprotein B (APOB). It tells you the number of harmful cholesterol particles that can lead to plaque forming. It's a better test than LDL alone if you have high triglycerides, type 2 diabetes, obesity, or kidney disease.

Coronary artery calcium (CAC) scan. It looks for calcium deposits in the arteries of your heart, often an early sign of plaque. High scores on this CT scan can mean more plaque and a higher risk for heart issues.

Do I still need to recheck my cholesterol?

"Absolutely!" says Lundberg. "You can't be borderline year after year. The designation of borderline is still associated with some risk." 

Higher levels of cholesterol still mean you're at risk of developing plaque. Lundberg gives most people six months to work on lifestyle changes before retesting.

"If no progress has happened, I usually recommend lipid-lowering therapies that include statins and non-statins based on shared decision-making and patient preferences," says Lundberg.

Cholesterol can harden inside your blood vessels, raising your chance for heart conditions. Regular cholesterol checks help you stay informed about your levels; they also help you know if your healthy lifestyle choices are working to lower your risk for heart trouble. If not, your doctor can order more tests to help you decide whether you should start taking cholesterol medicine.

Can you have borderline cholesterol with no symptoms?

Yes, cholesterol often builds up without causing any symptoms. Many people don't show signs until the later stages of heart problems. A cholesterol test shows your levels, so you can take steps to lower your cholesterol. 

How often should cholesterol be checked?

Doctors suggest cholesterol checks every five years for most people, or yearly if you have a risk for heart conditions. "About 80% of cardiovascular disease is preventable with early detection and early intervention," says Lundberg. 

Can stress affect cholesterol levels?

Higher stress can release certain hormones, leading to poor health habits and higher cholesterol over time. To lower your daily stress levels:

  • Talk to a therapist.
  • Meditate.
  • Read a book.

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