Ideal risk factors are non-smoking, total cholesterol (TC) ≤ 4 mmol/L (≤ 155 mg/dL), and SBP ≤120 mmHg.

"US population studies^{S2.1.2-1,S2.1.2-2} suggest that optimal total cholesterol levels are about 150 mg/dL (3.8 mmol/L), which corresponds to an LDL-C level of about 100 mg/dL (2.6 mmol/L). Adult populations with cholesterol concentrations in this range manifest low rates of ASCVD.^S2.1.2-3"

"A theoretical-minimum-risk distribution of cholesterol (i.e. one that would yield the lowest population risk of adverse health outcomes) was taken as 3.8 standard deviation 0.6 mmol/l (usual) for all age, sex and subregional groups. The main basis for this estimate was the level of cholesterol down to which epidemiological relationships with cardiovascular disease outcomes are observed, and clinical trial data showing benefits from cholesterol lowering among those with below-average cholesterol levels. This theoretical minimum was also consistent with the levels of cholesterol in populations with little cardiovascular disease."

[In the Framingham Heart Study], "total cholesterol was between 150-200 mg/dL in 35% of the patients with heart attacks."

However, as Dr. Esselstyn wrote in the Cleveland Clinic Journal of Medicine, in regard to cholesterol lowering, moderation kills. “Even if all Americans kept their total cholesterol below 200 mg/dL, as recommended by the American Heart Association, millions would develop coronary artery disease.” Strong evidence shows we need to keep our total cholesterol under 150 mg/dL in order to stem the American epidemic of coronary artery disease, our number-one killer. What kind of evidence? In many cultures, coronary artery disease is practically unheard of when total serum cholesterol levels are under 150 mg/dL. In the United States, the famous Framingham Heart Study demonstrated that few of those with levels below 150 mg/dL developed heart disease, and none died from it.

In my video Everything in Moderation? Even Heart Disease? you can see the data from a 26-year follow-up of the Framingham Heart Study comparing the cholesterol levels of people who get heart attacks and the cholesterol levels of those who don’t. The study suggests that because we now know that 35% of heart attacks occur in people with total cholesterol levels of 150-200 mg/dL, a target level of only 200 mg/dL guarantees that millions of U.S. citizens will die from coronary artery disease.

Cholesterol: If your level is above 180 mg/dl, you should consider it a warning sign of potential circulatory problems. Ideal is below 150 mg/dl. Sometimes results are broken down into HDL ["good"] and LDL ["bad"] cholesterol levels, but I feel total cholesterol is the most significant.

The optimal “bad cholesterol” (LDL) level is 50 to 70. Accumulating data from multiple lines of evidence consistently demonstrate that that’s where a physiologically normal LDL level would be. That appears to be the threshold above which atherosclerosis and heart attacks develop. That’s what we start out at birth with, that’s what fellow primates have, and that’s the level seen in populations free of the heart disease epidemic. One can also look at all the big randomized controlled cholesterol lowering trials.

In the blood pressure and cholesterol assessment, a theoretical minimum-risk exposure distribution with a mean of 115mmHg for systolic blood pressure and 3.8mmol/l for total cholesterol (each with a small standard deviation) were used (Ezzati et al. 2002). This distribution corresponds to the lowest levels at which the dose-response relationship has been characterized in meta-analyses of cohort studies (Chen et al. 1991; Eastern Stroke and Coronary Heart Disease Collaborative Research Group 1998; MacMahon et al. 1990; Prospective Studies Collaboration 1995). Further, these levels of blood pressure and cholesterol are consistent with levels seen in populations which have low levels of cardiovascular disease, such as the Yanomamo Indians (Carvalho et al. 1989) and rural populations in China (He et al. 1991a, 1991b), Papua New Guinea (Barnes 1965; Carvalho et al. 1989), and Africa (Mann et al. 1964).

"US population studies[S2.1.2-1,S2.1.2-2] suggest that optimal total cholesterol levels are about 150 mg/dL (3.8 mmol/L), which corresponds to an LDL-C level of about 100 mg/dL (2.6 mmol/L). Adult populations with cholesterol concentrations in this range manifest low rates of ASCVD. [S2.1.2-3]"