traditionally physicians looked at the total cholesterol and have told patients that if it is greater than 200mg/dl it is bad and less than 200mg/dl it is good. they have mistakenly believed that the total cholesterol number is the goal of therapy. thus it has become pretty much dogma that patients memorize their total cholesterol number so they can compare it with friends or tell their doctor. surprisingly lowering one’s total cholesterol is not even mentioned by the national cholesterol education panel (ncep) atp iii as a goal of cholesterol management. the national heart lung and blood institute (nhlbi) launched the national cholesterol education program (ncep) in november 1985. the goal of the ncep is to reduce illness and death from coronary heart disease (chd) in the united states by reducing the percent of americans with high blood cholesterol. in 1988 the first guidelines from the first adult treatment panel of ncep which was called ncep atp i were published. since that time many studies were published and guidelines have been updated. atp ii was published in 1993 and atp iii issued an evidence-based set of guidelines on cholesterol management in 2001. since this publication five major clinical trials of statin therapy were published and addressed issues that were not examined in previous clinical trials of cholesterol-lowering therapy. thus in 2004 an atp iii addendum was published with revised guidelines. these guidelines are currently used by physicians to treat high cholesterol levels. the next set of guidelines called atp iv are scheduled to be published in the fall of 2011. although physicians still talk about total cholesterol levels all the atps have lowering ldl cholesterol (the bad cholesterol) as the primary target of therapy and have never once mentioned total cholesterol! the truth is that prior to atp i based on the data from the famous mrfit trial it was shown that those patients with a total cholesterol greater than 200mg/dl were at increased risk of a cardiovascular event and those with a level less than 200mg/dl at a lower risk. apparently in the evolution of understanding lipid management and therapy it was incorrectly stated that a magic cholesterol level of 200mg/dl or less was the goal of therapy.
why is my total cholesterol number less important than my ldl (bad) cholesterol number?