Total cholesterol 220 24. May 2011 William Davis (17) Talking about total cholesterol is like wearing a tie-dyed t-shirt with the peace sign emblazoned on the front: So totally 60s and out of date.But talk of total cholesterol somehow keeps on coming back. After I spend 45 minutes discussing a patient's lipoprotein patterns, for instance, they'll asking something like, "But what's my total cholesterol?"To help put this ridiculous notion of total cholesterol to rest, let me paint several pictures of what total cholesterol can tell you. Let's start with a theoretical, but very common, total cholesterol value of 220 mg/dl. Recall that:LDL cholesterol = total cholesterol - HDL cholesterol - triglycerides/5Note that LDL cholesterol is nearly always a calculated value. (Yes, your doctor has been treating a calculated, what I call "fictitious," value.)Rearranging the equation:Total cholesterol = LDL cholesterol + HDL cholesterol + Triglycerides/5This relationship means that a great many variations are possible, all under total cholesterol = 220 mg/dl. For example:LDL 95 mg/dl + HDL 105 mg/dl + Triglycerides 100 mg/dl(a relatively low-risk pattern for heart disease)LDL 160 mg/dl + HDL 50 mg/dl + Triglycerides 50 mg/dl (an indeterminate risk pattern, potentially moderate risk)LDL 120 mg/dl + HDL 30 mg/dl + Triglycerides 350 mg/dl(a potentially high-risk pattern)LDL 60 mg/dl + HDL 25 mg/dl + Triglycerides 675 mg/dl(an indeterminate risk pattern) That's just a sample of the incredible variation of patterns that can all fall under this simple observation, total cholesterol 220 mg/dl.Total cholesterol is an outdated concept, one ready long ago for the junk heap of outdated ideas. It's time to throw total cholesterol out in the trash along with beliefs like high-fat intake causes diabetes, whole grains are healthy, and the tooth fairy will leave you money when you leave your molars under the pillow.