CHOL - Clinical: Cholesterol, Total, Serum

Test Catalog

Test Name

Test ID: CHOL    
Cholesterol, Total, Serum

Useful For Suggests clinical disorders or settings where the test may be helpful

Evaluation of cardiovascular risk

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Cholesterol is a steroid with a secondary hydroxyl group in the C3 position. It is synthesized in many types of tissue, but particularly in the liver and intestinal wall. Approximately 75% of cholesterol is newly synthesized and 25% originates from dietary intake. Normally, the cholesterol in the plasma or serum is 60% to 80% esterified. Approximately 50% to 75% of the plasma cholesterol is transported by low-density lipoproteins (LDL) and 15% to 40% by high-density lipoproteins (HDL).


Serum cholesterol is elevated in the hereditary hyperlipoproteinemias and in various other metabolic diseases. Moderate-to-markedly elevated values are also seen in cholestatic liver disease. Hypercholesterolemia reflects an increase of lipoproteins of 1 or more specific classes (eg, beta-LDL, alpha-1 HDL, alpha-2 HDL, or LP-X). Hypercholesterolemia is a risk factor for cardiovascular disease.


Low levels of cholesterol can be seen in disorders that include hyperthyroidism, malabsorption, and deficiencies of apolipoproteins.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

The National Lipid Association and the National Cholesterol Education Program (NCEP) have set the following guidelines for lipids (total cholesterol, triglycerides, high-density lipoprotein [HDL] cholesterol, low-density lipoprotein [LDL] cholesterol, and non-HDL cholesterol) in adults ages 18 and up:


Desirable: <200 mg/dL

Borderline high: 200-239 mg/dL

High: > or =240 mg/dL


The Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents has set the following guidelines for lipids (total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, and non-HDL cholesterol) in children 2 to 17 years of age:


Acceptable: <170 mg/dL

Borderline high: 170-199 mg/dL

High: > or =200 mg/dL

Interpretation Provides information to assist in interpretation of the test results

The National Lipid Association and the National Cholesterol Education Program (NCEP) have set the following guidelines for total cholesterol:


Desirable: <200 mg/dL

Borderline high: 200 to 239 mg/dL

High: > or =240 mg/dL


Values above the normal range indicate a need for quantitative analysis of the lipoprotein profile.


Values in hyperthyroidism usually are in the lower normal range; malabsorption values may be below 100 mg/dL, while beta-lipoprotein or apolipoprotein B deficiency values usually are below 80 mg/dL.


See Lipids and Lipoproteins in Blood Plasma (Serum) in Special Instructions.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Patients must be fasting for at least 12 to 14 hours if a lipid screen is ordered. If total cholesterol is the only lipid test ordered, fasting is not necessary.


Result can be falsely decreased in patients with elevated levels of N-acetyl-p-benzoquinone imine (NAPQI, a metabolite of acetaminophen), N-acetylcysteine (NAC), and Metamizole.

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Edited by CA Burtis, ER Ashwood. St. Louis, MO: Elsevier Saunders, 2012

2. National Institute of Health (NIH) Publication: Second Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. NIH Publication 93-3096. 1993 Sep;93:3096

3. Jacobson TA, Ito MK, Maki KC, et al: National Lipid Association recommendations for patient-centered management of dyslipidemia: Part 1-executive summary. J Clin Lipidol 2014;8(5):473-488

4. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Pediatrics. 2011;128;S213

Special Instructions and Forms Library of PDFs including pertinent information and consent forms, specimen collection and preparation information, test algorithms, and other information pertinent to test