When is cholesterol too high?
A health checkup reports four lipid values. The Korean Society of Lipid and Atherosclerosis defines dyslipidemia (often called high cholesterol) as meeting any one of the criteria below. Blood should be drawn after a 9–12 hour fast for accurate results.
| Test | Dyslipidemia threshold | What it means |
|---|---|---|
| LDL cholesterol | 160 mg/dL or higher | "Bad" cholesterol that builds up in artery walls; the main treatment target |
| Total cholesterol | 240 mg/dL or higher | LDL, HDL and others combined |
| Triglycerides | 200 mg/dL or higher | Strongly affected by alcohol, sugar and overeating |
| HDL cholesterol | Below 40 mg/dL | "Good" cholesterol; lower is worse |
Korea's KDCA health portal recommends lifestyle changes from lower "borderline" levels (such as LDL 130 mg/dL or higher). And even if your result says "normal," your target is lower if you have other risk factors, as shown below.
What is my LDL target?
There is no single normal LDL level for everyone: the higher your risk of heart disease or stroke, the lower your target. The 2022 Korean dyslipidemia guideline sets these goals.
| Risk level | Who | LDL target |
|---|---|---|
| Very high | Coronary artery disease (heart attack, angina) | Below 55 mg/dL and at least 50% lower than baseline |
| High | Ischemic stroke, peripheral artery disease, carotid artery disease, abdominal aortic aneurysm / diabetes for 10+ years or with other risk factors | Below 70 mg/dL |
| Diabetes (other) | Diabetes for under 10 years with no major risk factors | Below 100 mg/dL |
| Moderate | Two or more major risk factors | Below 130 mg/dL |
| Low | Zero or one major risk factor | Below 160 mg/dL |
Major risk factors are age (men 45+, women 55+), a family history of early coronary disease, high blood pressure, smoking, and low HDL (below 40 mg/dL). For example, a 58-year-old woman with high blood pressure has two risk factors, so her LDL target is below 130 mg/dL. Ask your doctor to confirm your risk level.
Ingredients Korea's MFDS recognizes for cholesterol
The main health functional food ingredients approved for "may help improve blood cholesterol" are below. Note that omega-3 is approved for blood triglycerides, which is a different claim.
| Ingredient | What it is | LDL reduction seen in studies |
|---|---|---|
| Red yeast rice | Rice fermented with a red mold; daily amount labeled as "total monacolin K 4–8 mg" | A 2015 meta-analysis found significantly lower LDL than placebo, but long-term safety was rated uncertain |
| Plant sterols and stanols | Compounds in soybean, corn and other plant oils that reduce cholesterol absorption in the gut | About 2 g a day lowers LDL by roughly 8–10% (European Atherosclerosis Society consensus) |
| Others | Green tea extract, chitosan, oat fiber (beta-glucan) and more | Effects are generally small, and daily amounts differ by ingredient, so check the label |
Supplements vs. medication: how big is the difference?
The key differences are how much LDL falls and whether heart attacks and strokes are actually prevented.
- Statins (prescription): Lower LDL by about 30–50% or more depending on intensity. An analysis of 26 trials and 170,000 people (CTT, 2010) found that each 39 mg/dL drop in LDL cut major vascular events such as heart attack and stroke by about 22%.
- Plant sterols: About 8–10% lower LDL, roughly 13–16 mg/dL for someone at 160 mg/dL. No outcome trial yet shows fewer cardiovascular events.
- Red yeast rice: Its active compound, monacolin K, is the same molecule as the statin drug lovastatin. It lowers LDL, but content varies between products and drug-like side effects are possible.
In short, if your risk is low and LDL is borderline, a supplement can be considered alongside diet and exercise. If you are well above your target or in a high-risk group, supplements cannot replace medication.
Avoid red yeast rice, or ask first, if you
- Already take a statin: You would be doubling up on the same kind of compound, raising the risk of muscle pain and liver enzyme rises.
- Are pregnant or breastfeeding, or have liver disease; stop and see a doctor if you develop muscle pain.
- Buy products from overseas: In 2024, Japan's Kobayashi Pharmaceutical recalled red yeast rice supplements after kidney disease and deaths were reported among users. Japanese authorities pointed to a contaminant from manufacturing (puberulic acid). Korea's MFDS said the products were not officially imported and blocked direct-purchase imports.
Cholesterol myths: true or false?
| Claim | What the evidence shows so far |
|---|---|
| Avoid eggs because of their cholesterol | From the 2015 edition, the US Dietary Guidelines dropped the "300 mg a day" limit on dietary cholesterol. How much food cholesterol raises blood levels varies widely between people, and saturated fat (fatty meat, butter, processed meat) matters more. If your LDL is already high, follow your doctor's advice. |
| Slim people do not need to worry | Not true. Familial hypercholesterolemia, an inherited cause of very high LDL, occurs regardless of body type; LDL of 190 mg/dL or more warrants checking for it. |
| Supplements can replace medication | Not for people at high risk. Supplements lower LDL less than drugs, and prevention of heart attack and stroke has been shown at scale only for medication. |
| Once you start a statin, it is for life | Levels usually return when the drug stops, so many people take it long term, but doctors may adjust the dose if lifestyle changes alter your risk. Do not stop on your own. |
What to do before reaching for supplements
- Cut saturated fat: Eat less fatty pork, butter, processed meat and fried food; switch to fish, beans and nuts.
- Add fiber: Soluble fiber from oats, barley, beans and vegetables helps lower LDL.
- For triglycerides, start with alcohol and sugar: Cut back on alcohol, sweet drinks, white rice and noodles first.
- Walk and manage weight: Regular aerobic exercise raises HDL and lowers triglycerides.
Please keep in mind
- This article is based on information checked as of the date shown at the top. New research or changes in official guidelines may change the details, so please use it as a reference rather than taking it as definitive.
- For an accurate diagnosis and advice about your health, please see a doctor in person.