An LDL of 118 mg/dL can be on target for one person and too high for another. That isn’t a contradiction. European guidelines set your LDL target from your overall risk of heart attack and stroke, not from a single “normal” range.
What LDL is
LDL (low-density lipoprotein) particles carry cholesterol through your blood. When there are more of them for many years, more cholesterol ends up in artery walls, where it forms plaque. That process, atherosclerosis, is the main cause of heart attacks and most strokes.
What matters is exposure over time: how high LDL is, and for how many years. That’s why the same number weighs differently at 36 than at 60, and differently with or without other risk factors.
Why the target depends on you
The 2019 guidelines of the European Society of Cardiology and the European Atherosclerosis Society group people by risk and give each group a target:
| Risk level | LDL target | Plus |
|---|---|---|
| Low | under 116 mg/dL · 3.0 mmol/L | — |
| Moderate | under 100 mg/dL · 2.6 mmol/L | — |
| High | under 70 mg/dL · 1.8 mmol/L | and at least 50% lower than before treatment |
| Very high | under 55 mg/dL · 1.4 mmol/L | and at least 50% lower than before treatment |
Someone who already had a heart attack is in the very-high group. A healthy 36-year-old who doesn’t smoke and has normal blood pressure usually starts in the low group, where 118 is just above the line.
How risk is estimated
For people aged 40 to 69 without known heart disease, diabetes, kidney disease or an inherited cholesterol disorder, doctors in Europe use SCORE2. It estimates the 10-year chance of a heart attack or stroke from age, sex, smoking, systolic blood pressure and non-HDL cholesterol, calibrated for your country’s risk region. From age 70 there is SCORE2-OP.
Under 40, SCORE2 doesn’t apply. Your doctor looks at individual risk factors instead: family history of early heart disease, smoking, blood pressure, and sometimes a one-time Lipoprotein(a) test, which the same guidelines suggest everyone has at least once.
How Hugse picks your target
Hugse starts from what it knows: your age, your results, and what you’ve told it about smoking, conditions and family history. If something that changes the category is missing, Hugse asks instead of assuming.
Next to every LDL result it shows the risk level it used, the reason, and the guideline. If your doctor sets a different target, you can enter it and Hugse will use that from then on.
What to do with your number
If your LDL is above your target, bring it up at your next visit. Hugse adds it to your visit summary with your trend and, where it fits, suggests tests for your doctor to approve, such as a lipid re-test or Lipoprotein(a). It never orders a test itself.
If your LDL is at target, keep testing as your doctor suggests. The trend over years tells you more than a single result.
Sources
- Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias. European Heart Journal, 2020; 41(1): 111–188.
- SCORE2 working group and ESC Cardiovascular Risk Collaboration. SCORE2 risk prediction algorithms. European Heart Journal, 2021; 42(25): 2439–2454.
- Visseren FLJ, Mach F, Smulders YM, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal, 2021; 42(34): 3227–3337.
This article explains general guidelines. It is not medical advice for you personally.