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Research · Lab markers

Total cholesterol

Total cholesterol is all the cholesterol in blood, and non-HDL cholesterol is that total minus HDL cholesterol. A US panel calls total cholesterol below 200 mg/dL desirable, and other bodies use other cut points. Higher levels go with more heart disease, and trials lowering non-HDL cholesterol cut events. Low total cholesterol was tied to more bleeding strokes and deaths.

Checked 2026-11-13
Status
Part of the standard lipid panel, ordered by a clinician and also sold direct to consumers by some US laboratories. FDA classifies total cholesterol test systems as class I devices exempt from premarket notification, and its product classification also lists over-the-counter total cholesterol tests [1]. Non-HDL cholesterol is not measured. It is calculated as total cholesterol minus HDL cholesterol [2].
Measures
The amount of cholesterol in blood carried by all lipoproteins together. Non-HDL cholesterol is that total minus the cholesterol in HDL particles [2].
Also called
total cholesterol, TC, cholesterol, cholesterol total, serum cholesterol, CHOL, total chol
Tested for
heart attack risk, stroke risk, cholesterol check, deciding on cholesterol-lowering treatment, checking response to cholesterol-lowering drugs, family history of high cholesterol

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Linked in research3

Reported risks0

No risks sourced yet.

Reference ranges

Each range is the one its source published, in mg/dL. Also reported in mmol/L. Where sources differ, each is shown.

Total cholesterol: National Cholesterol Education Program, Adult Treatment Panel III, 2001

Adults aged 20 and older, total cholesterol · [2]

RangeWhat the source calls it
below 200 mg/dL"desirable"
200 to 239 mg/dL"borderline high"
240 or above mg/dL"high"

The panel's classification table covers LDL, total and HDL cholesterol. It states that when a sample is not fasting only total and HDL cholesterol are usable, and that a total of 200 mg/dL or above then calls for a follow-up lipoprotein profile. For people with triglycerides of 200 mg/dL or above it also set non-HDL cholesterol goals 30 mg/dL above its LDL goals: below 130, below 160 and below 190 mg/dL across its three risk categories [2].

Total cholesterol: European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine consensus on laboratory reporting, 2016

Adults, fasting or not, total cholesterol, as a value for laboratories to flag on reports · [3]

RangeWhat the source calls it
below 190 mg/dLNo name given
190 or above mg/dL"abnormal"

The statement asks laboratories to flag results against desirable concentration cut points in place of a population reference interval. The authors state that they used 5 mmol/L and 190 mg/dL because these are the two cut points typically used in guidelines, so the two figures are not exact conversions of each other. They estimate that 72% of adults in a typical Western or Northern European country would be flagged [3].

Total cholesterol: National Heart, Lung, and Blood Institute expert panel, 2011, children and adolescents

Children and adolescents, total cholesterol · [4]

RangeWhat the source calls it
below 170 mg/dL"acceptable"
170 to 199 mg/dL"borderline"
200 or above mg/dL"high"

Values come from an earlier US pediatric cholesterol panel. The borderline and high cut points represent approximately the 75th and 95th percentiles [4].

Total cholesterol: National Heart, Lung, and Blood Institute expert panel, 2011, young adults

Young adults, from data on people aged 20 to 24, total cholesterol · [4]

RangeWhat the source calls it
below 190 mg/dL"acceptable"
190 to 224 mg/dL"borderline high"
225 or above mg/dL"high"

Values come from the Lipid Research Clinics Prevalence Study. The high cut point is the 95th percentile for 20 to 24 year olds, and the panel states these cut points are not identical to the adult classification of Adult Treatment Panel III [4].

What has been shown to move it

Shown to lower it37

Apple cider vinegarStrong

Cholesterol

Shown to lower total cholesterol by about 6 mg/dL in adults, with no change in LDL or HDL.

The numbers and sources
Effect
ACV lowered total cholesterol by 6.06 mg/dL (95% CI -10.95 to -1.17) with no significant effect on LDL or HDL [2]. A 2025 meta-analysis of 25 trials found total cholesterol 6.72 mg/dL lower (95% CI -12.91 to -0.53, I² 50.8%), with no significant change in LDL, HDL or triglycerides [4].
Population
Adults in 9 studies [2]. 1,320 adults in 25 trials [4].
Sources
[2], [4]
Caveats
Triglyceride reductions appeared only in subgroups [2][4].
BerberineStrong

Cholesterol and triglycerides

Shown to lower LDL by about 0.46 mmol/L and lower triglycerides in adults, in trials mostly from China and Hong Kong.

The numbers and sources
Effect
In 18 placebo-controlled trials (1,788 participants), berberine lowered LDL by 0.46 mmol/L (95% CI -0.62 to -0.30), total cholesterol by 0.48 mmol/L and triglycerides by 0.34 mmol/L, and raised HDL by 0.06 mmol/L. The HDL rise was seen in women and not in men [8]. A 27-trial meta-analysis found berberine combined with lipid drugs lowered cholesterol more than the drugs alone [4].
Population
Adults, mostly in mainland China and Hong Kong, for 4 to 24 weeks [8].
Sources
[4], [8]
Caveats
15 of the 18 trials were in mainland China or Hong Kong [8].
Beta-glucanStrong

LDL cholesterol (oat beta-glucan)

Shown to lower LDL by about 0.2 to 0.25 mmol/L in adults at 3 g a day or more of oat beta-glucan.

The numbers and sources
Effect
In 28 trials, 3 g a day or more of oat beta-glucan lowered LDL by 0.25 mmol/L (95% CI 0.20 to 0.30) and total cholesterol by 0.30 mmol/L, with no change in HDL or triglycerides. Dose (3.0 to 12.4 g a day) and duration (2 to 12 weeks) did not change the result [1]. In 58 trials (3,974 people), a median 3.5 g a day lowered LDL by 0.19 mmol/L (95% CI 0.14 to 0.23), non-HDL by 0.20 mmol/L and apoB by 0.03 g/L [2].
Population
Adults, mostly with normal to raised cholesterol [1][2].
Sources
[1], [2]
Caveats
LDL heterogeneity was high in [2] (I² 79%). [1] was supported by DSM Nutritional Products and searched in-house reports at CreaNutrition, a subsidiary of an oat fiber company. FDA's health claim rests on 3 g a day or more from whole oats or barley [3].
Black seed oilStrong

Cholesterol and triglycerides

Shown to lower LDL by about 14 mg/dL and triglycerides by about 21 mg/dL in adults. HDL did not change overall.

Oil lowered total and LDL cholesterol more than powder.

The numbers and sources
Effect
In 17 RCTs, Nigella sativa lowered total cholesterol by 15.65 mg/dL (95% CI -24.67 to -6.63), LDL by 14.10 mg/dL and triglycerides by 20.64 mg/dL. HDL did not change overall (0.28 mg/dL, 95% CI -1.96 to 2.53) and rose only with seed powder. Oil lowered total and LDL cholesterol more than powder [1]. A 2025 review of 82 RCTs (5,026 participants) also reported improved total cholesterol, LDL, HDL and triglycerides [2].
Population
Adults in placebo-controlled RCTs [1]. Trials of 1 to 48 weeks [2].
Sources
[1], [2]
Caveats
The 2025 abstract lists outcomes without effect sizes [2]. Neither review measured heart attacks or strokes.
Ezetimibe and fenofibrateStrong

Ezetimibe: LDL cholesterol and ApoB

Shown to lower LDL cholesterol about 18% more than placebo when taken alone, with ApoB about 16% lower, and to lower LDL further when added to a statin.

Compared with placebo [1][2]; a statin or fenofibrate alone [3][4]

The numbers and sources
Effect
Across 8 placebo-controlled 12-week trials, ezetimibe 10 mg lowered LDL cholesterol 18.58% more than placebo (95% CI 17.48 to 19.67), total cholesterol 13.46% more and triglycerides 8.06% more, and raised HDL cholesterol 3.00% [1]. In two label trials, LDL cholesterol fell 18% and ApoB 16% on ezetimibe against a 1% rise and 2% fall on placebo [2]. Added to a statin or fenofibrate, ezetimibe lowered LDL cholesterol, total cholesterol and triglycerides further and likely raised HDL [3]. After an acute coronary syndrome, time-averaged LDL was 53.7 mg/dL on simvastatin with ezetimibe against 69.5 mg/dL on simvastatin alone [4].
Population
2,722 people with primary hypercholesterolemia in 8 trials [1]; 1,719 adults in two trials [2]; 23,499 people in 26 trials [3]; 18,144 patients [4].
Sources
[1], [2], [3], [4]
Caveats
Lipid trials alone lasted 12 weeks [1]. Heterogeneity was substantial in the combination analyses [3].
Fiber supplementsStrong

LDL cholesterol

Shown to lower LDL cholesterol by about 0.33 mmol/L with about 10 g of psyllium a day in adults with or without high cholesterol.

A 2025 meta-analysis of 41 RCTs (2,049 participants) found LDL cholesterol 8.55 mg/dL lower (95% CI -12.92 to -4.19) and total cholesterol 9.05 mg/dL lower.

The numbers and sources
Effect
Across 28 trials (1,924 participants), a median 10.2 g of psyllium a day lowered LDL cholesterol by 0.33 mmol/L (95% CI -0.38 to -0.27), non-HDL cholesterol by 0.39 mmol/L and apoB by 0.05 g/L (95% CI -0.08 to -0.03) [1]. A 2025 meta-analysis of 41 RCTs (2,049 participants) found LDL cholesterol 8.55 mg/dL lower (95% CI -12.92 to -4.19) and total cholesterol 9.05 mg/dL lower. Triglycerides and HDL did not change significantly [2].
Population
Adults with or without high cholesterol in RCTs of 3 weeks or longer [1]; adults in 41 RCTs [2].
Sources
[1], [2]
Caveats
LDL and non-HDL estimates were graded moderate quality because of inconsistency, and apoB high quality [1]. Heterogeneity in the 2025 review was considerable (I² 88% for LDL), and dose and duration did not explain it [2].
GarlicStrong

Cholesterol

Shown to lower total cholesterol about 10 to 17 mg/dL and LDL about 6 to 9 mg/dL in adults, more in those with high cholesterol.

A 2026 meta-analysis of 108 trials (7,137 adults) found total cholesterol fell 10.21 mg/dL (95% CI -13.69 to -6.74), LDL 5.90 mg/dL, and triglycerides 5.82 mg/dL, while HDL rose 2.18 mg/dL.

The numbers and sources
Effect
Across 39 trials, garlic lowered total cholesterol by 17 ± 6 mg/dL and LDL by 9 ± 6 mg/dL in people with total cholesterol above 200 mg/dL, when taken for longer than 2 months. HDL rose slightly and triglycerides did not change significantly [3]. A 2026 meta-analysis of 108 trials (7,137 adults) found total cholesterol fell 10.21 mg/dL (95% CI -13.69 to -6.74), LDL 5.90 mg/dL, and triglycerides 5.82 mg/dL, while HDL rose 2.18 mg/dL [4].
Population
Adults in 39 trials, effects reported in those with elevated cholesterol [3]. Adults in 108 trials [4].
Sources
[3], [4]
Caveats
The abstract of [3] describes earlier meta-analyses on this question as conflicting. The authors of [4] report larger effects in adults with unfavorable baseline risk factors and call for larger, longer, more rigorous trials. The two reviews disagree on triglycerides.
GlucomannanStrong

LDL cholesterol

Shown to lower LDL cholesterol by about 10%, about 16 mg/dL, in adults and children. Changes were not significant in adults with insulin resistance.

The numbers and sources
Effect
Across 14 studies with 531 participants, glucomannan lowered total cholesterol 19.28 mg/dL (95% CI -24.30 to -14.26), LDL 15.99 mg/dL (95% CI -21.31 to -10.67) and triglycerides 11.08 mg/dL (95% CI -22.07 to -0.09), with no change in HDL [1]. Across 12 studies with 370 participants, LDL fell 0.35 mmol/L (95% CI -0.46 to -0.25) and non-HDL cholesterol 0.32 mmol/L, about 10% and 7%. Apolipoprotein B did not change in 6 trials [2].
Population
Adults and children in RCTs [1][2].
Sources
[1], [2]
Caveats
Trials were small and short, with follow-up of at least 3 weeks in [2]. In 11 trials restricted to adults with insulin resistance-related conditions, lipid changes were not significant overall, with LDL and total cholesterol lower only in subgroups above 3,000 mg a day or at 4 weeks or less [3].
Green tea extractStrong

LDL cholesterol

Shown to lower LDL cholesterol slightly, about 2 mg/dL, and total cholesterol about 7 mg/dL in adults, with no HDL change.

The numbers and sources
Effect
Across 14 RCTs (1,136 subjects), green tea beverages or extracts lowered total cholesterol by 7.20 mg/dL (95% CI -8.19 to -6.21) and LDL cholesterol by 2.19 mg/dL (95% CI -3.16 to -1.21). HDL did not change [3]. Across 13 studies, LDL fell by 0.16 mmol/L (95% CI -0.22 to -0.09) [4].
Population
Adults in RCTs [3][4].
Sources
[3], [4]
Caveats
Both reviews pooled beverages with extracts.
Low-fat dietStrong

LDL cholesterol

Shown to lower LDL cholesterol slightly more than higher-fat and low-carbohydrate diets, by about 0.07 to 0.16 mmol/L.

Compared with diets with more fat

The numbers and sources
Effect
Against higher-fat diets in people not trying to lose weight, LDL fell 0.13 mmol/L (95% CI 0.05 to 0.21) and total cholesterol 0.23 mmol/L [1]. Against low-carbohydrate diets, LDL was lower on low-fat diets by 0.16 mmol/L (95% CI 0.003 to 0.33) [4], by 0.07 mmol/L at 6 to 12 months (95% CI 0.02 to 0.12) [5] and by 0.14 mmol/L at 6 months (95% CI 0.03 to 0.26) [8]. In postmenopausal women, LDL fell 3.55 mg/dL more than in the comparison group [9].
Population
Adults in the trials above [1][4][5]; 447 adults with BMI 25 or more in 5 trials [8]; 48,835 postmenopausal women [9].
Sources
[1], [4], [5], [8], [9]
Caveats
The differences are about 0.1 mmol/L, or about 4 mg/dL. In [8], the low-fat diets restricted energy and the low-carbohydrate diets did not. LDL is a risk marker, not a heart event.
Nordic dietStrong

LDL and total cholesterol

Shown to lower LDL cholesterol about 0.26 to 0.30 mmol/L against usual diets in adults with cardiometabolic risk factors.

Compared with control groups the source does not describe [1]; a usual or habitual Nordic diet, a usual Western diet or general healthy eating advice [2]; the participants' usual Western diet, in Swedish adults [3]; an average Nordic diet with the same calories [4]

The numbers and sources
Effect
In 5 RCTs (513 participants), a Nordic diet lowered total cholesterol by 0.38 mmol/L (95% CI -0.76 to -0.01) and LDL by 0.30 mmol/L (95% CI -0.54 to -0.06), with no change in HDL or triglycerides [1]. In 6 RCTs (717 participants), LDL fell 0.26 mmol/L (95% CI -0.52 to -0.00), with reductions in non-HDL cholesterol and apolipoprotein B [2]. In NORDIET, LDL fell 21% and HDL 5% over 6 weeks against usual diets [3]. In SYSDIET, non-HDL cholesterol fell 0.18 mmol/L (95% CI -0.35 to -0.01) against an average Nordic diet [4].
Population
Adults, mostly in Nordic countries, with raised cholesterol, metabolic syndrome or central obesity [1][2]; 88 Swedish adults with mild high cholesterol [3]; 200 adults with metabolic syndrome features [4].
Sources
[1], [2], [3], [4]
Caveats
Both meta-analyses pooled largely the same few trials. Heterogeneity was high (I² 89%) and certainty low for LDL in [2]. NORDIET lowered HDL along with LDL [3].
NutsStrong

LDL cholesterol and ApoB

Shown to lower LDL cholesterol by about 4.8 mg/dL per daily ounce of tree nuts, and by 10.2 mg/dL at about 67 g a day, along with ApoB.

Compared with control arms without nuts [4]; control diets the abstract does not describe [5]

The numbers and sources
Effect
Per 1 oz (28.4 g) serving a day, tree nuts lowered total cholesterol by 4.7 mg/dL (95% CI 4.0 to 5.3), LDL cholesterol by 4.8 mg/dL (95% CI 4.2 to 5.5), ApoB by 3.7 mg/dL (95% CI 2.3 to 5.2) and triglycerides by 2.2 mg/dL (95% CI 0.5 to 3.8). HDL cholesterol, apolipoprotein A1 and blood pressure did not change significantly. Effects were stronger at 60 g a day or more and did not differ by nut type. ApoB fell more in people with type 2 diabetes (11.5 mg/dL) than in healthy people (2.5 mg/dL) [4]. Pooled individual data from 25 trials found a mean 67 g a day lowered total cholesterol by 10.9 mg/dL (5.1%) and LDL cholesterol by 10.2 mg/dL (7.4%). Triglycerides fell 20.6 mg/dL in people starting at 150 mg/dL or higher and not in others [5].
Population
2,582 adults without cardiovascular disease in 61 trials of 3 to 26 weeks [4]. 583 adults with normal or high cholesterol not on lipid-lowering drugs, in 25 trials in 7 countries [5].
Sources
[4], [5]
Caveats
Trials were short and many are shared between the two analyses. Effects were largest in people with higher starting LDL cholesterol and lower body mass index [5].
OrlistatStrong

Cholesterol and blood lipids

Shown to lower total and LDL cholesterol slightly, by about 0.3 mmol/L, with larger drops when more weight was lost.

The numbers and sources
Effect
Orlistat lowered total cholesterol by 0.30 mmol/L and LDL cholesterol by 0.27 mmol/L. HDL cholesterol fell 0.034 mmol/L and triglycerides 0.09 mmol/L. Lipoprotein(a) did not change. LDL lowering was larger with more weight loss and shorter treatment [3]. An earlier systematic review also found greater falls in total and LDL cholesterol than with control [5].
Population
33 RCTs [3]; 28 RCTs, 17 of them with 10,041 patients over a year [5].
Sources
[3], [5]
Caveats
The changes are small. The reviews do not separate the drug from the weight lost.
OrlistatStrong

Liver enzymes in fatty liver disease

Shown to lower liver enzymes in fatty liver disease, ALT by about 9 U/L. Liver fat and scarring were not measured.

The numbers and sources
Effect
In people with metabolic dysfunction-associated steatotic liver disease, orlistat lowered AST by 4.01 U/L (95% CI 1.97 to 6.05), ALT by 8.70 U/L (95% CI 0.90 to 16.51) and GGT by 7.74 U/L (95% CI 0.59 to 14.88) against control. LDL cholesterol fell 5.61 mg/dL, fasting glucose 4.05 mg/dL, HOMA-IR 0.70 and BMI 0.99 kg/m². Blood pressure did not change [6]. A second meta-analysis also found lower ALT, AST, HOMA-IR, BMI, cholesterol, insulin and waist circumference [7].
Population
6 RCTs [6]; 11 studies with 582 participants [7].
Sources
[6], [7]
Caveats
Both reviews measured blood markers, not liver fat on imaging or scarring on biopsy. The trials were small and likely overlap between the reviews. The abstract of [7] does not say whether all 11 studies were randomized.
Paleo dietStrong

Cholesterol and triglycerides

Shown to lower total and LDL cholesterol and triglycerides more than comparison diets in adults, though some pooled results depended on single trials.

Compared with control diets the source does not describe [1], [3]; a diet following the Nordic Nutrition Recommendations [4]; a control group the source does not describe [5]

The numbers and sources
Effect
In people with metabolic disorders, total cholesterol fell 0.32 mmol/L (95% CI 0.15 to 0.49), triglycerides 0.29 mmol/L (95% CI 0.16 to 0.42) and LDL 0.35 mmol/L (95% CI 0.03 to 0.67) more than on control diets [5]. In 19 RCTs, total cholesterol fell 0.15, LDL 0.24 and triglycerides 0.16 more, in units the abstract does not state [3]. A third review found lower total cholesterol, triglycerides and LDL and higher HDL [1]. Triglycerides fell more than on a Nordic guideline diet at 6 and 24 months [4].
Population
Adults with metabolic disorders [5]; adults in 19 RCTs [3]; adults in 8 RCTs [1]; postmenopausal women with obesity [4].
Sources
[1], [3], [4], [5]
Caveats
In [1], lipid results changed when single studies were removed.
Soy foodsStrong

LDL cholesterol

Shown to lower LDL cholesterol by about 4.8 mg/dL, 3% to 4%, at a median 25 g of soy protein a day against non-soy protein, in pooled trials.

Compared with non-soy protein [4]; control groups the abstract does not describe [5]

In 23 trials of soy protein with its isoflavones intact, total cholesterol fell 3.77%, LDL cholesterol 5.25% and triglycerides 7.27%, and HDL cholesterol rose 3.03%.

The numbers and sources
Effect
Across 41 trials identified by the FDA, soy protein at a median 25 g a day for a median 6 weeks lowered LDL cholesterol by 4.76 mg/dL (95% CI -6.71 to -2.80) and total cholesterol by 6.41 mg/dL (95% CI -9.30 to -3.52), with no dose-response or publication bias. About 75% of trials showed a fall, though few were individually significant [4]. In 23 trials of soy protein with its isoflavones intact, total cholesterol fell 3.77%, LDL cholesterol 5.25% and triglycerides 7.27%, and HDL cholesterol rose 3.03%. Falls were larger in men and in people with high cholesterol. Tablets of extracted isoflavones did not lower total cholesterol [5].
Population
Adults with baseline LDL cholesterol of 110 to 201 mg/dL in 43 trials [4]. 23 randomized trials published 1995 to 2002 [5].
Sources
[4], [5]
Caveats
Heterogeneity was moderate (I² 55% for LDL) [4]. Most trials lasted weeks. The FDA has proposed revoking the soy protein heart claim [1], which the review authors attribute to a perceived lack of consistent LDL reduction in trials [4].
TurmericStrong

Cholesterol and triglycerides

Shown to lower triglycerides about 13 mg/dL and LDL about 6 mg/dL in adults with metabolic conditions. Smaller reviews found no significant LDL change.

Curcumin lowered LDL cholesterol by 5.84 mg/dL (95% CI -11.63 to -0.05), triglycerides by 13.15 mg/dL (95% CI -17.31 to -8.98) and total cholesterol by 7.76 mg/dL, and raised HDL by 2.4 mg/dL.

The numbers and sources
Effect
An umbrella review re-pooled 72 RCTs. Curcumin lowered LDL cholesterol by 5.84 mg/dL (95% CI -11.63 to -0.05), triglycerides by 13.15 mg/dL (95% CI -17.31 to -8.98) and total cholesterol by 7.76 mg/dL, and raised HDL by 2.4 mg/dL [10]. In 27 RCTs in prediabetes and diabetes, triglycerides fell 13.73 mg/dL, total cholesterol 5.24 mg/dL and LDL 5.72 mg/dL (95% CI -8.62 to -2.82), and HDL rose 2.14 mg/dL [11]. In 11 RCTs (662 people with metabolic disease), triglycerides and total cholesterol fell, while LDL and HDL did not change significantly under random-effects models [12]. With piperine added, 16 RCTs (1,038 participants) showed lower triglycerides and total cholesterol and no significant LDL change [13].
Population
Adults with noncommunicable diseases, with larger effects in type 2 diabetes [10]; adults with prediabetes or diabetes [11]; adults with metabolic disorders [12][13].
Sources
[10], [11], [12], [13]
Caveats
I² was 94% to 98% in the umbrella review [10] and above 80% in the diabetes review, which rated certainty low for every outcome [11]. The LDL drop did not reach significance in two smaller reviews [12][13]. The umbrella review found the total cholesterol and HDL changes smaller than their minimal clinically important differences [10].
Vegan dietStrong

LDL cholesterol

Shown to lower LDL cholesterol about 0.24 to 0.30 mmol/L against omnivorous or control diets in adults.

Compared with the participants' habitual diet, unchanged, in 3 trials in US and New Zealand adults, and in 8 trials a National Cholesterol Education Program diet, American Diabetes Association and Korean Diabetes Association diets, a portion-controlled diet, a Mediterranean diet, a low-fat diet, a healthy omnivorous diet or a high-carbohydrate lacto-ovo vegetarian diet [1]; an omnivorous diet [3]

The numbers and sources
Effect
Vegan diets lowered total cholesterol by 0.30 mmol/L and LDL by 0.24 mmol/L (95% CI -0.40 to -0.07), with no change in HDL or triglycerides [1]. In 30 RCTs of vegetarian or vegan diets, LDL fell 0.30 mmol/L (95% CI -0.40 to -0.19) and apolipoprotein B 12.92 mg/dL, with similar effects across intervention diet types [3].
Population
Adults with overweight or type 2 diabetes [1]; adults in 30 RCTs [3].
Sources
[1], [3]
Caveats
The larger review pooled vegan and vegetarian diets [3].
Vegetarian dietStrong

LDL cholesterol

Shown to lower LDL cholesterol about 0.3 mmol/L against omnivorous diets in adults. HDL also fell slightly in one review.

Compared with control diets the source does not describe [2]; an omnivorous control diet containing meat and dairy products [3]; an omnivorous diet [4]

The numbers and sources
Effect
In 11 trials, vegetarian diets lowered total cholesterol by 0.36 mmol/L, LDL by 0.34 mmol/L (95% CI -0.57 to -0.11) and HDL by 0.10 mmol/L (95% CI -0.14 to -0.06), with no triglyceride change [3]. In 30 RCTs, vegetarian or vegan diets lowered LDL by 0.30 mmol/L (95% CI -0.40 to -0.19) and apolipoprotein B by 12.92 mg/dL, with similar effects across intervention diet types and no triglyceride change [4]. In people with diabetes, LDL fell 0.12 mmol/L (95% CI -0.20 to -0.04) [2].
Population
Adults in randomized trials [3][4]; adults with diabetes [2].
Sources
[2], [3], [4]
Caveats
The reviews pooled lacto-ovo and vegan diets, though [4] found effects similar across diet types.
Whole grainsStrong

LDL cholesterol

Shown to lower LDL cholesterol slightly, by 0.09 mmol/L, against refined-grain control foods in pooled trials, with whole-grain oats lowering cholesterol most.

Compared with non-whole-grain control foods [8]; refined grains or placebo [9]

The numbers and sources
Effect
Whole grain intake lowered LDL cholesterol by 0.09 mmol/L (about 3.5 mg/dL, 95% CI -0.15 to -0.03) and total cholesterol by 0.12 mmol/L (95% CI -0.19 to -0.05), with no effect on HDL cholesterol. Triglycerides tended to fall (-0.04 mmol/L, 95% CI -0.08 to 0.01). Oats had the largest effect on total cholesterol (-0.17 mmol/L) [8]. In a second review, whole-grain oats improved total cholesterol (SMD -0.54, 95% CI -0.95 to -0.12) and LDL cholesterol (SMD -0.57, 95% CI -0.84 to -0.31), and whole-grain rice improved triglycerides [9].
Population
24 randomized trials in apparently healthy adults [8]. 25 randomized trials of 2 to 16 weeks in adults with or without cardiovascular risk factors [9].
Sources
[8], [9]
Caveats
Small changes over weeks. The second review found the LDL effect for oats, not for all whole grains combined [9]. Beta-glucan from oats is on its own page.
Alternate-day fastingModerate

Cholesterol

Shown to lower total cholesterol by about 8 mg/dL against control in adults with overweight, mostly in trials under 6 months.

Compared with control diets the source does not describe [1]; eating freely every day or keeping the present lifestyle [2]; no change in eating times [5]; time-restricted eating [6]

Total cholesterol, LDL and triglycerides fell against control in a second review, which reported p values only.

The numbers and sources
Effect
Total cholesterol fell 8.14 mg/dL (95% CI -14.59 to -1.69) against control [1]. Total cholesterol, LDL and triglycerides fell against control in a second review, which reported p values only [2]. Alternate-day fasting lowered total cholesterol, triglycerides and non-HDL cholesterol more than time-restricted eating [6]. Non-HDL cholesterol fell against control over 4 weeks [5].
Population
728 participants in 8 trials [1]; 269 in 7 trials [2]; 99 trials [6]; 76 adults [5].
Sources
[1], [2], [5], [6]
Caveats
In a year-long trial, LDL cholesterol ended higher on alternate-day fasting than on daily calorie restriction (see Risks) [3].
AstaxanthinModerate

Blood sugar and blood lipids

Shown to lower fasting glucose by about 16 mg/dL and triglycerides in people with prediabetes or type 2 diabetes. Reviews disagree on LDL and total cholesterol.

The numbers and sources
Effect
In prediabetes and type 2 diabetes, astaxanthin lowered fasting glucose by 16.1 mg/dL (95% CI -29.0 to -3.3), HbA1c by 0.34 points, triglycerides by 20.9 mg/dL, total cholesterol by 12.2 mg/dL and LDL by 9.4 mg/dL, and raised HDL by 3.0 mg/dL. HOMA-IR, weight and BMI did not change [4]. At 6 to 20 mg a day, a second meta-analysis found higher HDL and lower triglycerides, with no change in LDL or total cholesterol [5]. In adults at risk of metabolic syndrome, effects on total cholesterol and systolic pressure were marginal, and LDL fell [6].
Population
403 patients in 9 RCTs [4]; 8 studies with 11 results [5]; 321 adults in 7 RCTs [6].
Sources
[4], [5], [6]
Caveats
The reviews disagree on LDL and total cholesterol. All pooled small trials.
Beta-glucanModerate

Blood pressure

Shown to lower systolic blood pressure by about 1.4 mmHg in adults with overweight or obesity. Diastolic pressure did not change.

Across cereal beta-glucan, total cholesterol fell by 0.24 mmol/L and LDL by 0.19 mmol/L.

The numbers and sources
Effect
In people with a BMI of 25 or more, oat beta-glucan lowered systolic blood pressure by 1.38 mmHg (95% CI 0.09 to 2.66). Diastolic blood pressure did not change. Across cereal beta-glucan, total cholesterol fell by 0.24 mmol/L and LDL by 0.19 mmol/L [8].
Population
49 studies, 3,854 people with overweight or obesity [8].
Sources
[8]
Caveats
One meta-analysis. One author is affiliated with a food science company [8].
DASH dietModerate

LDL and total cholesterol

Shown to lower LDL cholesterol slightly in adults, by 0.10 mmol/L across trials and 0.28 mmol/L in the original feeding trial.

Compared with control diets the source does not describe [3]; the DASH trial's control diet [6]; usual, low-fat and low-antioxidant diets, behavioral programs alone and usual gestational diabetes care [7]

The numbers and sources
Effect
Across 20 trials, DASH lowered total cholesterol by 0.20 mmol/L (95% CI -0.31 to -0.10) and LDL by 0.10 mmol/L (95% CI -0.20 to -0.01) [3]. In the 8-week DASH feeding trial, total cholesterol fell 0.35 mmol/L (13.7 mg/dL) and LDL 0.28 mmol/L (10.7 mg/dL) against control, with no triglyceride change. LDL fell 11.2 mg/dL more in men than in women [6]. An umbrella review reported the same pooled figures as [3], with no effect on HDL or triglycerides [7].
Population
Adults in 20 trials of 2 to 24 weeks [3]; 436 adults with total cholesterol of 6.7 mmol/L or less, mean age 44.6, 60% African American [6].
Sources
[3], [6], [7]
Caveats
The umbrella review drew its lipid figures from the same meta-analysis, so the two are not independent [3][7]. The umbrella review rated most secondary outcomes very low to moderate certainty [7].
Ezetimibe and fenofibrateModerate

Fenofibrate: triglycerides, HDL and LDL cholesterol

Shown to lower triglycerides about 29% and LDL cholesterol 21% and to raise HDL 11% against placebo, with triglycerides 46% to 55% lower in severe high triglycerides.

Compared with placebo [7]

The numbers and sources
Effect
In four placebo-controlled trials of 3 to 6 months, fenofibrate at the 145 mg dose changed triglycerides by -28.9% against +7.7% on placebo, LDL cholesterol by -20.6% against -2.2%, total cholesterol by -18.7% against -0.4%, and HDL by +11.0% against +0.7%. ApoB fell 25.1% against a 2.4% rise. In severe high triglycerides, triglycerides fell 46.2% (baseline 432 mg/dL) and 54.5% (baseline 726 mg/dL) against -0.5% and +7.2% on placebo, while LDL cholesterol rose in both groups [7].
Population
646 adults with high cholesterol or mixed dyslipidemia in 4 trials, and 147 adults with high triglycerides in 2 trials of 8 weeks [7].
Sources
[7]
Caveats
Label trials, short-term. The label reports rare severe paradoxical drops in HDL, listed under Risks [7].
FenugreekModerate

Blood lipids

Shown to lower total cholesterol and triglycerides and raise HDL in controlled trials, more in people with diabetes. Sources disagree on LDL.

The numbers and sources
Effect
Across 15 RCTs, fenugreek lowered total cholesterol (-1.13, 95% CI -1.88 to -0.37), LDL (-1.26, 95% CI -2.09 to -0.43) and triglycerides (-1.07) and raised HDL (0.70, 95% CI 0.07 to 1.34) compared with control. Effects were larger in people with diabetes [3]. The 2023 diabetes meta-analysis reported lower total cholesterol and triglycerides, higher HDL, and no change in LDL [2].
Population
281 people on fenugreek and 255 controls in controlled trials [3].
Sources
[2], [3]
Caveats
The sources disagree on LDL. The abstract of [3] does not state the units of its pooled estimates.
Fisetin and quercetin (senolytics)Moderate

Liver enzymes and lipids in fatty liver disease (quercetin alone)

Shown to lower liver enzymes, LDL and triglycerides with quercetin alone in people with fatty liver disease, at very low to moderate certainty.

The numbers and sources
Effect
A 2025 meta-analysis of 7 RCTs (540 patients) with metabolic dysfunction-associated steatotic liver disease found that quercetin lowered ALT, AST, GGT, direct bilirubin and C-reactive protein, lowered total cholesterol, LDL and triglycerides, and raised HDL. BMI, body fat, kidney function and TNF-α did not change [10].
Population
540 patients with fatty liver disease in 7 RCTs [10].
Sources
[10]
Caveats
GRADE certainty ranged from very low to moderate. Dose, baseline BMI and age may explain heterogeneity. The abstract gives no pooled effect sizes [10]. None of the trials measured senescent cells.
Garcinia cambogiaModerate

Cholesterol and triglycerides

Shown to lower triglycerides about 24 mg/dL and raise HDL slightly in adults, with no LDL change. One 10-week trial found no lipid change.

The numbers and sources
Effect
Across 14 trials with 623 subjects, total cholesterol fell 6.76 mg/dL (95% CI -12.39 to -0.59), triglycerides fell 24.21 mg/dL (95% CI -37.84 to -10.58) and HDL rose 2.95 mg/dL (95% CI 2.01 to 3.89). LDL did not change (-1.15 mg/dL, 95% CI -16.08 to 13.78). Changes were larger in trials longer than 8 weeks [5]. In the 10-week Korean trial, garcinia extract did not change triglycerides or total cholesterol compared with placebo [4].
Population
Adults in 14 RCTs [5]; 86 overweight adults [4].
Sources
[4], [5]
Caveats
Interventions were short and heterogeneity was significant [5].
Green teaModerate

Cholesterol

Shown to lower total cholesterol by 2.8 mg/dL in trials of catechin-enriched green tea drinks. LDL, HDL and triglycerides did not change significantly in those trials.

Compared with water or other placebo drinks, no intervention, or green tea drinks low in catechins [4]

The numbers and sources
Effect
In the 9 trials that gave green tea as a drink, total cholesterol fell by 2.80 mg/dL (95% CI 0.16 to 5.43). LDL changed by -2.61 mg/dL (95% CI -5.49 to 0.27), HDL by -0.84 mg/dL and triglycerides by -0.77 mg/dL, none significant. Across all 31 trials of drinks and capsules, LDL fell by 4.55 mg/dL (95% CI 2.80 to 6.31) [4].
Population
3,321 participants in 31 randomized trials, 9 of them using a green tea drink [4].
Sources
[4]
Caveats
The drinks in these trials were green tea beverages made with extract, carrying 400 to 928 mg of catechins a day, not ordinary brewed tea. Meta-regression found no significant difference between drinks and capsules [4]. Capsule trials are on the green tea extract page.
Growth hormoneModerate

Body composition in healthy older adults

Shown to lower fat mass about 2.1 kg and raise lean body mass about 2.1 kg in healthy older adults, with no change in weight.

Total cholesterol fell 0.29 mmol/L, not significantly after adjusting for body composition.

The numbers and sources
Effect
Against no growth hormone, fat mass fell 2.1 kg (95% CI 1.35 to 2.8) and lean body mass rose 2.1 kg (95% CI 1.3 to 2.9). Weight did not change (0.1 kg, 95% CI -0.7 to 0.8). Total cholesterol fell 0.29 mmol/L, not significantly after adjusting for body composition. Bone density and other lipids did not change [1].
Population
18 study populations with 220 treated participants, mean age 69, mean BMI 28, mean treatment 27 weeks [1].
Sources
[1]
Caveats
Most trials were small, and some outcomes were measured too rarely to pool [1]. The review was funded by AHRQ and the NIA. Lean body mass includes water, not only muscle.
Red light therapyModerate

Weight and waist size in obesity

Shown to reduce waist size, weight and BMI in people with obesity in one meta-analysis of 11 trials. Body fat percentage did not change.

The numbers and sources
Effect
Across 11 RCTs (569 patients), photobiomodulation improved waistline (mean difference -7.28, 95% CI -9.97 to -5.67), weight (-3.54, 95% CI -5.97 to -1.11) and BMI (-1.18, 95% CI -1.93 to -0.43), and lowered C-reactive protein, total cholesterol and HOMA-IR. Fat mass percentage (-0.28, 95% CI -1.25 to 0.69), waist-to-hip ratio and insulin did not differ [14].
Population
569 people with obesity in 11 RCTs with varied comparators, including exercise, diet and sham light [14].
Sources
[14]
Caveats
The abstract does not give units for the mean differences. Comparators varied, and the measure of body fat itself did not change. The authors call for larger multi-center trials with longer follow-up [14].
Tai chi and qigongModerate

Blood fats in hypertension

Shown in two meta-analyses to lower LDL cholesterol and triglycerides in people with hypertension. HDL cholesterol results differed between them.

Compared with control groups the source abstract does not describe [5]; no intervention [6]

The numbers and sources
Effect
Tai chi was associated with lower total cholesterol (WMD -0.49), triglycerides (WMD -0.49, 95% CI -0.92 to -0.07) and LDL cholesterol (WMD -0.86), and no significant effect on HDL cholesterol (P = 0.16) [5]. Baduanjin lowered triglycerides and LDL cholesterol and raised HDL cholesterol against no intervention [6].
Population
Adults with essential hypertension [5][6].
Sources
[5], [6]
Caveats
The first abstract gives no units, and its HDL interval does not contain its own point estimate [5]. The second gives no sizes for blood fats [6].
YogaModerate

Stress hormones, heart rate and blood fats, against active controls

Shown in one meta-analysis to lower cortisol, ambulatory systolic pressure, resting heart rate, fasting glucose and LDL cholesterol more than active control activities.

Compared with active control interventions [11]

The numbers and sources
Effect
Across 42 trials, practices including yoga postures were associated with lower evening and waking cortisol, ambulatory systolic blood pressure, resting heart rate, fasting blood glucose, cholesterol and LDL cholesterol, and higher high-frequency heart rate variability, compared with active controls [11].
Population
Participants in 42 randomized trials in various populations [11].
Sources
[11]
Caveats
The abstract gives no effect sizes and describes the interventions as heterogeneous. Some included mindfulness-based stress reduction alongside postures [11].
YogaModerate

Blood sugar and blood fats in type 2 diabetes

Shown in one meta-analysis to lower HbA1c by 0.47 points and fasting glucose by 24 mg/dL in adults with type 2 diabetes, with high heterogeneity.

Compared with control groups including usual care or standard treatment [12]

The numbers and sources
Effect
Pooled differences were -23.72 mg/dL for fasting blood glucose (95% CI -37.78 to -9.65, I² 82%), -0.47% for HbA1c (95% CI -0.87 to -0.07, I² 82%), -17.38 mg/dL for glucose after meals, -18.50 mg/dL for total cholesterol, +4.30 mg/dL for HDL cholesterol and -12.95 mg/dL for LDL cholesterol. Triglycerides did not differ (-12.57 mg/dL, 95% CI -29.91 to 4.76) [12].
Population
864 adults with type 2 diabetes in 12 trials [12].
Sources
[12]
Caveats
The authors note limited methods and heterogeneity, and long-term effects were not studied [12].
Flexitarian dietLimited

Heart disease

Limited evidence: in a review of 4 trials in healthy adults, replacing part of animal protein with plant protein lowered LDL and total cholesterol. No study measured heart disease itself.

Compared with diets with a higher share of animal protein foods [9]

LDL cholesterol, total cholesterol and body weight improved in those eating the higher share of plant protein.

The numbers and sources
Effect
A 2026 systematic review found 4 dietary interventions, reported in 7 articles, that partially replaced animal protein foods with plant protein foods in healthy adults. LDL cholesterol, total cholesterol and body weight improved in those eating the higher share of plant protein. Vitamin B12 status fell on the diets with the most plant protein [9].
Population
Healthy adults with a mean or median age of 18 to 65 in randomized trials, 3 of 7 articles at low risk of bias [9].
Sources
[9]
Caveats
The abstract gives no pooled sizes of effect [9]. Cholesterol is a risk marker, not heart disease. No cohort or trial of flexitarian eating and heart attacks or heart deaths was located.
Grape seed extractLimited

Cholesterol

Limited evidence: a 50-trial review found lower total and LDL cholesterol and triglycerides, while an earlier review found no effect on lipids.

The numbers and sources
Effect
Across 50 trials, grape seed extract lowered total cholesterol (WMD -6.03, 95% CI -9.71 to -2.35), LDL cholesterol (WMD -4.97) and triglycerides (WMD -6.55). HDL did not change [5]. An earlier meta-analysis of 9 RCTs found no significant effect on lipid levels [2].
Population
Adults in RCTs [5][2].
Sources
[5], [2]
Caveats
The two reviews disagree.
HMBLimited

Adverse effects in early trials

Limited evidence: 9 short trials at 3 g a day found no change in blood chemistry or blood counts.

Total cholesterol fell 5.8%, LDL 7.3% and systolic pressure 4.4 mmHg against placebo.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Across 9 studies giving 3 g a day for 3 to 8 weeks, HMB did not change blood chemistry or hematology markers. Total cholesterol fell 5.8%, LDL 7.3% and systolic pressure 4.4 mmHg against placebo [14].
Population
Men and women, young and old, exercising or not [14].
Sources
[14]
Caveats
A pooled summary of nine trials, not a systematic review. No independent review of long-term safety was located.

Shown to raise it9

CoffeeStrongHow often is not known

Higher LDL cholesterol from unfiltered coffee

Shown to raise total and LDL cholesterol in trials, mainly with unfiltered brews such as boiled or French press coffee. Filtered coffee raised it very little.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Across 12 randomized trials averaging 45 days, coffee raised total cholesterol by 8.1 mg/dL (95% CI 4.5 to 11.6), LDL by 5.4 mg/dL (95% CI 1.4 to 9.5) and triglycerides by 12.6 mg/dL, more with unfiltered and caffeinated coffee and in people with high cholesterol [19]. An earlier pooling of 14 trials found a dose-response rise in total and LDL cholesterol with unfiltered coffee and very little with filtered coffee [20]. Five to 6 cups a day of cafetière coffee raised LDL by 0.26 mmol/L (95% CI 0.04 to 0.47) against filtered coffee over 24 weeks. Triglycerides first rose 26% and then returned near baseline [18].
Population
1,017 participants in 12 Western trials [19]. 14 trials [20]. 46 adults aged 19 to 69 [18].
Sources
[19], [20], [18]
Caveats
The trials attribute the rise to cafestol and kahweol, oily compounds present in unfiltered coffee [21]. The lipid trials were all in Western countries [19].
EggsStrongHow often is not known

Higher LDL cholesterol in feeding trials

Shown to raise LDL cholesterol by about 8 mg/dL in randomized trials in healthy people, along with total cholesterol and apolipoprotein B.

Each extra 100 mg of dietary cholesterol a day raised total cholesterol by 2.2 mg/dL (95% CI 1.8 to 2.5).

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Against control groups, eating more eggs raised LDL cholesterol (mean difference 8.14 mg/dL, P < 0.0001), with larger effects in trials of over two months [3]. Across 66 trials, eggs raised total cholesterol, LDL and apolipoprotein B100, did not change triglycerides, and LDL rose nonlinearly with dose [4]. Each extra 100 mg of dietary cholesterol a day raised total cholesterol by 2.2 mg/dL (95% CI 1.8 to 2.5) [2].
Population
Healthy participants in 17 randomized trials [3]. 3,185 participants in 66 randomized trials [4]. 556 participants in 17 feeding studies [2].
Sources
[3], [4], [2]
Caveats
Short trials. One review found the rise came with eating more than one egg a day for under 12 weeks [4].
TMGStrongHow often is not known

Higher cholesterol

Shown to raise total cholesterol, about 14 mg/dL in one review, at 4 g a day or more. Reviews differ on whether LDL rises.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
At 4 g a day or more, betaine raised total cholesterol by 0.34 mmol/L (95% CI 0.02 to 0.65). LDL, HDL and triglycerides did not change significantly [7]. A second meta-analysis found total cholesterol 14.12 mg/dL higher (95% CI 9.23 to 19.02) and LDL 10.26 mg/dL higher (95% CI 6.14 to 14.38). Triglycerides, HDL, glucose, CRP, liver enzymes and blood pressure did not change [2].
Population
Adults in 6 RCTs from 2002 to 2018 [7]; RCTs pooled up to February 2021 [2].
Sources
[7], [2]
Caveats
The reviews differ on LDL. Subgroup analysis suggested the rise appears at 4 g a day or more [2]. In uncontrolled liver pilot trials at 2 to 8 g a day, LDL did not change and HDL rose at 2 and 4 g [6].
Added sugarModerateHow often is not known

Blood fats and blood pressure

Shown to raise triglycerides, total and LDL cholesterol and blood pressure in trials of higher against lower sugar intake, independent of body weight.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Higher sugar intake raised triglycerides by 0.11 mmol/L (95% CI 0.07 to 0.15), total cholesterol by 0.16 mmol/L (95% CI 0.10 to 0.24), LDL cholesterol by 0.12 mmol/L (95% CI 0.05 to 0.19) and HDL cholesterol by 0.02 mmol/L (95% CI 0.00 to 0.03). In trials of 8 weeks or longer, systolic pressure rose 6.9 mmHg (95% CI 3.4 to 10.3) and diastolic 5.6 mmHg [11]. A liter of regular cola a day for 6 months raised triglycerides 32% and total cholesterol 11% more than milk, diet cola or water [12].
Population
37 trials reporting lipids and 12 reporting blood pressure, each at least 2 weeks [11]. 47 overweight adults [12].
Sources
[11], [12]
Caveats
Heterogeneity was moderate to high (I² 36% to 75%) [11]. The cola trial was small.
GnRH drugs for fibroidsModerateStudied in womenVery common

Cholesterol rises

Shown to raise total and LDL cholesterol in women. On Myfembree, 13.7% with normal cholesterol rose to 200 to 239 mg/dL, against 7.7% on placebo.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
Among women with total cholesterol under 200 mg/dL, 13.7% on Myfembree rose to 200 to 239 mg/dL and 1.7% to 240 or above, against 7.7% and 0.6% on placebo. LDL rose to 130 to 159 mg/dL in 9.3% against 6.5% [2]. On Oriahnn, total cholesterol, LDL, triglycerides and apolipoprotein B rose, and 9 of 54 women with LDL of 130 to 159 mg/dL rose to 190 or above, against none on placebo [6]. On leuprolide, mean cholesterol rose 11 to 29 mg/dL in women with fibroids [10].
Population
Premenopausal women with fibroids in the placebo-controlled trials [2][6][10].
Sources
[2], [6], [10]
Caveats
Shifts between bands, measured at the end of 6-month trials.
IsotretinoinModerateVery common

Raised triglycerides and cholesterol

Shown to raise triglycerides markedly in 25% of people in trials, lower HDL in 15% and raise cholesterol in 7%. The changes reversed after stopping.

A meta-analysis found statistically significant changes in mean lipid values during treatment, with means of 119.98 mg/dL for triglycerides and 184.74 mg/dL for total cholesterol, and found the mean changes did not reach its high-risk thresholds and few people had abnormal results.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
In clinical trials, marked rises in serum triglycerides occurred in 25%, falls in HDL in 15% and rises in cholesterol in 7%, reversing after the drug was stopped. Triglycerides above 800 mg/dL have been reported, and the rise is dose related [3]. A meta-analysis found statistically significant changes in mean lipid values during treatment, with means of 119.98 mg/dL for triglycerides and 184.74 mg/dL for total cholesterol, and found the mean changes did not reach its high-risk thresholds and few people had abnormal results [9].
Population
Isotretinoin capsule trials [3]; 1,574 patients aged 9 to 35 in 26 studies [9].
Sources
[3], [9]
Caveats
The meta-analysis abstract gives values during treatment, not the size of the change from baseline [9]. The label states the heart consequences are unknown [3].
MirtazapineModerateVery common

Raised cholesterol and triglycerides

Shown to raise nonfasting cholesterol to 20% or more above the normal limit in 15% against 7% on placebo, and triglycerides to 500 mg/dL or more in 6% against 3%.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
In US controlled studies, nonfasting cholesterol rose to at least 20% above the upper limit of normal in 15% on mirtazapine and 7% on placebo, and nonfasting triglycerides rose to 500 mg/dL or more in 6% against 3% [7].
Population
Adults in US controlled studies of mirtazapine [7].
Sources
[7]
Caveats
Nonfasting samples in short trials. No trial here measured heart attacks or strokes.
SaltModerateHow often is not known

Hormone and blood fat changes on low-sodium diets

Shown to raise renin, aldosterone, noradrenaline, total cholesterol and triglycerides slightly when sodium was cut sharply in trials. LDL and HDL cholesterol did not change significantly.

Total cholesterol rose 5.19 mg/dL (95% CI 2.1 to 8.3, 27 trials) and triglycerides 7.10 mg/dL (95% CI 3.1 to 11.1, 20 trials).

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
During sodium reduction, renin rose 1.56 ng/mL/hour (82 trials), aldosterone 104 pg/mL (66 trials) and noradrenaline 62.3 pg/mL (35 trials). Total cholesterol rose 5.19 mg/dL (95% CI 2.1 to 8.3, 27 trials) and triglycerides 7.10 mg/dL (95% CI 3.1 to 11.1, 20 trials). LDL cholesterol changed by 2.46 mg/dL (95% CI -1 to 5.9) and HDL by -0.3 mg/dL (95% CI -1.66 to 1.05) [5].
Population
917 participants for cholesterol, 712 for triglycerides and 2,904 for renin, in randomized trials of low against high sodium diets [5].
Sources
[5]
Caveats
Many trials were short and cut sodium further than guidelines ask. The review authors note these changes were more consistent than the blood pressure effect in people with normal blood pressure [5].
Carnivore dietLimitedHow often is not known

LDL cholesterol rise

Limited evidence: LDL cholesterol rose from a median of 157 to 256 mg/dL in 24 followers who shared before and after blood tests.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Median total cholesterol rose from 224 to 305 mg/dL (p < 0.0001) and LDL from 157 to 256 mg/dL (p 0.00024). No other blood marker changed significantly [3]. Survey respondents who reported current lipids had LDL of 172 mg/dL and HDL of 68 mg/dL [1]. A scoping review identified elevated LDL and total cholesterol across the human studies [2].
Population
24 German followers [3]; a subset of 2,029 survey respondents [1]; 9 human studies [2].
Sources
[1], [3], [2]
Caveats
Small, self-selected groups without controls. No study measured heart attacks or strokes.

Studies disagree4

Physical activityStrong

Blood fats

Shown to lower triglycerides in pooled trials of aerobic training, with HDL cholesterol rising modestly in two reviews and not changing overall in a third.

Compared with control groups in randomized trials [8][9]; no exercise, or diet alone [10]

In sedentary adults with metabolic syndrome factors, aerobic training lowered triglycerides by 0.17 to 0.18 mmol/L, total cholesterol by 0.19 to 0.29 mmol/L and LDL cholesterol by 0.12 to 0.20 mmol/L, and raised HDL cholesterol by 0.05 to 0.10 mmol/L.

The numbers and sources
Effect
HDL cholesterol rose by 2.53 mg/dL against controls, from a minimum of about 120 minutes of exercise a week, and rose more with longer sessions [8]. In sedentary adults with metabolic syndrome factors, aerobic training lowered triglycerides by 0.17 to 0.18 mmol/L, total cholesterol by 0.19 to 0.29 mmol/L and LDL cholesterol by 0.12 to 0.20 mmol/L, and raised HDL cholesterol by 0.05 to 0.10 mmol/L [9]. In adults with overweight or obesity, aerobic exercise lowered triglycerides and did not change total, HDL or LDL cholesterol overall [10].
Population
25 randomized trials [8]. 2,990 participants in 48 data sets of trials of at least 12 weeks [9]. 619 adults with overweight or obesity in 9 trials [10].
Sources
[8], [9], [10]
Caveats
Changes were modest. The populations differed across reviews, which may explain the HDL difference.
Olive oilModerate

Cholesterol

Shown to raise HDL cholesterol slightly in trials. LDL fell with high-polyphenol olive oil, but other plant oils lowered LDL more than olive oil did.

Compared with other plant oils [9]; low-polyphenol olive oil [10][11]

The numbers and sources
Effect
Against other plant oils, olive oil raised HDL more (1.37 mg/dL, 95% CI 0.4 to 2.36) and lowered total cholesterol (by 6.27 mg/dL), LDL (by 4.2 mg/dL, 95% CI 1.4 to 7.01) and triglycerides (by 4.31 mg/dL) less. Apolipoproteins A1 and B did not differ [9]. Against low-polyphenol olive oil, high-polyphenol oil lowered total cholesterol by 4.5 mg/dL and raised HDL by 2.37 mg/dL [10]. A later pooling found higher HDL (1.13 mg/dL, 95% CI 0.45 to 1.80), lower LDL only at the highest polyphenol level (-4.28 mg/dL) and no change in total cholesterol [11].
Population
1,089 participants in 27 randomized trials [9]. 26 randomized trials [10]. 10 randomized trials, mostly crossover, in mostly healthy Europeans [11].
Sources
[9], [10], [11]
Caveats
The changes are a few mg/dL. The comparison decides the direction: olive oil looks favorable against low-polyphenol olive oil and less favorable for LDL against other plant oils.
Red meat and processed meatModerate

Cholesterol and blood pressure in trials

Not shown to change cholesterol or blood pressure against all comparison diets combined. Against plant proteins, LDL fell less on red meat. Against fish, it fell more.

Compared with diets replacing red meat with legumes, soy or nuts, fish, poultry, mixed animal protein, refined carbohydrates or the usual diet [4]

Against high-quality plant proteins, total cholesterol fell 0.264 mmol/L less and LDL 0.198 mmol/L less.

The numbers and sources
Effect
Against all comparison diets combined, red meat made no significant difference to total, LDL or HDL cholesterol, apolipoproteins A1 and B, or blood pressure, and gave a smaller fall in triglycerides (0.065 mmol/L). Against high-quality plant proteins, total cholesterol fell 0.264 mmol/L less and LDL 0.198 mmol/L less. Against fish, LDL fell 0.173 mmol/L more and HDL 0.065 mmol/L more. Against refined carbohydrates, triglycerides fell 0.181 mmol/L more [4].
Population
1,803 participants in 36 randomized trials [4].
Sources
[4]
Caveats
The result depends on what replaced the red meat. Trials measured blood markers, not heart events.
ReishiModerate

Blood sugar, cholesterol and blood pressure

Not shown to change HbA1c, fasting glucose, cholesterol or blood pressure against placebo, with one spore oil trial finding lower lipids.

In 110 adults with dyslipidemia, a spore oil extract for 12 weeks lowered total cholesterol, triglycerides and LDL and raised HDL compared with placebo.

The numbers and sources
Effect
In a Cochrane review of 5 trials (398 participants), 1.4 to 3 g a day for 12 to 16 weeks did not change HbA1c (WMD -0.10%, 95% CI -1.05 to 0.85), total cholesterol, LDL or BMI against placebo. Fasting glucose, blood pressure and triglycerides did not differ. Post-meal glucose results were inconsistent [2]. A 2025 meta-analysis of 17 RCTs (971 participants) at 200 to 11,200 mg a day for 1 to 24 weeks found no effect on blood pressure, fasting glucose or the lipid profile. BMI fell by 0.43 (95% CI 0.10 to 0.77) and heart rate by 3.92 beats a minute (95% CI 0.40 to 7.45) [3]. In 110 adults with dyslipidemia, a spore oil extract for 12 weeks lowered total cholesterol, triglycerides and LDL and raised HDL compared with placebo. The abstract gives no effect sizes [4].
Population
Adults with type 2 diabetes in the analyzed trials [2]. Healthy, at-risk and chronically ill adults [3]. Adults with dyslipidemia [4].
Sources
[2], [3], [4]
Caveats
Data in [2] came from 3 small trials, and risk of bias was unclear in 4 of 5 [2]. The 2025 review rated the certainty of evidence very low for every outcome [3]. The spore oil trial tested a different product and disagrees with both reviews on lipids [4].

Tested, and not shown to change it4

5:2 dietModerate

Weight loss compared with no diet or brief advice

Shown to lower body weight against control diets in adults with overweight or obesity. As one-off self-help instructions, it matched standard brief advice at one year.

Compared with a daily energy-restricted diet or a routine diet [7]; standard brief weight-management advice [8]

Visceral fat, total cholesterol, triglycerides, HDL, diastolic pressure, fasting glucose and HbA1c did not differ.

The numbers and sources
Effect
In 20 articles with 1,393 participants, 5:2 lowered body weight, BMI, waist circumference, body fat percentage, fat mass, fat-free mass, LDL cholesterol, systolic blood pressure and HOMA-IR against control groups. Visceral fat, total cholesterol, triglycerides, HDL, diastolic pressure, fasting glucose and HbA1c did not differ [7]. One-off 5:2 self-help instructions lost 1.9 kg at one year against 1.8 kg with standard brief advice (p 0.79), and 18% against 15% lost at least 5% of body weight [8].
Population
Adults with overweight or obesity in 20 trials [7]; 300 UK adults with obesity followed for one year [8].
Sources
[7], [8]
Caveats
The meta-analysis abstract reports significance without effect sizes [7]. Adherence to self-help 5:2 fell over the year [8].
High-protein dietModerate

Blood pressure and triglycerides

Mixed results: triglycerides fell more on higher-protein diets in two meta-analyses, while blood pressure fell slightly in one and did not differ in another.

Compared with diets with less protein

Total and LDL cholesterol, C-reactive protein and HbA1c did not change.

The numbers and sources
Effect
Across 74 trials, higher-protein diets lowered systolic (SMD -0.21, 95% CI -0.32 to -0.09) and diastolic blood pressure (SMD -0.18, 95% CI -0.29 to -0.06) and triglycerides (SMD -0.51, 95% CI -0.78 to -0.24). Total and LDL cholesterol, C-reactive protein and HbA1c did not change [6]. In energy-restricted trials, triglycerides fell 0.23 mmol/L more (95% CI 0.12 to 0.33), and blood pressure and total, LDL and HDL cholesterol did not differ [1].
Population
Adults in 74 trials [6] and in 24 weight-loss trials [1].
Sources
[1], [6]
Caveats
Restricting to studies at lower risk of bias reduced the triglyceride effect [6]. In type 2 diabetes, blood pressure changes were not significant [8].
KetoanaloguesModerate

Nutritional status

Nutritional measures such as albumin and lean mass did not differ from a low-protein diet alone in adults with chronic kidney disease.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Albumin, mid-arm muscle circumference, lean body mass and subjective global assessment did not differ from a low-protein diet alone [1]. Albumin and cholesterol did not fall against placebo [3]. In the 15-month trial, nutritional measures did not change and no adverse reactions occurred [5]. Across protein restriction trials, 12 studies reported no protein energy wasting and 3 reported small numbers in each group [6].
Population
Adults with CKD [1][3][5][6].
Sources
[1], [3], [5], [6]
Caveats
The 15-month trial enrolled well-nourished patients who had followed the diet in a run-in phase [5]. Few studies reported weight [6].
CuppingLimitedStudied in men

LDL cholesterol, wet cupping

One small trial found LDL cholesterol fell after wet cupping in 47 healthy young men, with no significant change in total cholesterol, HDL or triglycerides.

Compared with no treatment [12]

Triglycerides did not change, and total cholesterol (7% lower) and HDL (3% higher) did not differ significantly.

The numbers and sources
Effect
Over 3 weeks after one wet cupping session, LDL cholesterol and the LDL to HDL ratio fell in the treated group against untreated controls (p < 0.0001). Triglycerides did not change, and total cholesterol (7% lower) and HDL (3% higher) did not differ significantly [12].
Population
47 healthy men aged 18 to 25 [12].
Sources
[12]
Caveats
One small trial in young men without high cholesterol, with no sham. Wet cupping removes blood, and the authors compare it with phlebotomy [12].

Type in your own result

How it compares with the reference method

Matched the reference method1

Moderate

Fasting against not fasting

Shown to read slightly lower after eating: total cholesterol was at most 0.2 mmol/L (8 mg/dL) lower than fasting, 3 to 5 hours after a meal.

The numbers and sources
Compared with
A fasting blood sample
Effect
In 33,391 Danish adults, total cholesterol was reduced for up to 3 to 5 hours after the last meal, with a maximum change from fasting of -0.2 mmol/L, and non-HDL cholesterol did not change [13]. A joint European consensus statement put the maximal mean change 1 to 6 hours after habitual meals at -0.2 mmol/L (8 mg/dL) for both total and calculated non-HDL cholesterol, judged it not clinically significant, and attributed the fall in total cholesterol to fluid intake [3]. A US panel states that total cholesterol is usable from a sample that is not fasting [2].
Population
33,391 adults aged 20 to 95 in the Copenhagen General Population Study [13].
Sources
[13], [3], [2]
Caveats
A cross-sectional comparison of people sampled at different times after eating, not the same people tested twice [13]. The consensus sets its non-HDL cholesterol flag 5 mg/dL higher for non-fasting samples [3].

Mixed results1

Moderate

Variation from one test to the next

Mixed results: a review of 30 studies put within-person variation of total cholesterol at about 6%, the lowest of the standard lipid panel values.

The numbers and sources
Compared with
Repeat measurements in the same person
Effect
Pooling 30 studies published from 1970 to 1992, the average within-person biological variation was 6.1% for total cholesterol, with estimates from different models ranging from 6.0% to 6.4%. It was 7.4% for HDL cholesterol, 9.5% for LDL cholesterol and 22.6% for triglycerides [14].
Population
30 published studies of repeat lipid measurements [14].
Sources
[14]
Caveats
The review is from 1993 and gives no figure for non-HDL cholesterol. Its estimates rose with the number of people studied and with the variation of the assay used. It states no threshold for agreement, so the result is given as numbers only [14].

What studies tie it to

Linked in research3

Strong

Death from coronary heart disease and total cholesterol

Linked to more coronary heart disease deaths at higher levels: each 1 mmol/L (39 mg/dL) lower total cholesterol went with a third fewer at ages 50 to 69.

The numbers and sources
Effect
In a meta-analysis of 61 prospective studies, each 1 mmol/L lower usual total cholesterol went with lower death from ischemic heart disease in both sexes: hazard ratio 0.44 (95% CI 0.42 to 0.48) at ages 40 to 49, 0.66 (0.65 to 0.68) at ages 50 to 69 and 0.83 (0.81 to 0.85) at ages 70 to 89, with no apparent threshold. The ratio of total to HDL cholesterol predicted these deaths more than twice as informatively as total cholesterol alone [5].
Population
Almost 900,000 adults without previous disease in 61 prospective studies, mostly in western Europe or North America, with more than 55,000 vascular deaths [5].
Sources
[5]
Caveats
Observational. The proportional difference in risk was smaller at older ages and at higher blood pressure [5].
Strong

Cardiovascular disease and non-HDL cholesterol

Linked to more cardiovascular disease at higher non-HDL cholesterol, about 50% more coronary heart disease for each 43 mg/dL higher across 68 pooled cohorts.

The numbers and sources
Effect
In 68 prospective studies, coronary heart disease rates per 1,000 person-years were 2.3 in the bottom third and 6.7 in the top third of non-HDL cholesterol, and the adjusted hazard ratio was 1.50 (95% CI 1.39 to 1.61) per 43 mg/dL higher [6]. In a consortium of 38 cohorts, 30-year cardiovascular event rates rose from 7.7% at non-HDL cholesterol below 2.6 mmol/L (about 100 mg/dL) to 33.7% at 5.7 mmol/L (about 220 mg/dL) or above in women, and from 12.8% to 43.6% in men. Adjusted hazard ratios for the highest against the lowest category were 1.9 (95% CI 1.6 to 2.2) in women and 2.3 (2.0 to 2.5) in men [7].
Population
302,430 people without vascular disease in 68 prospective studies [6]. 398,846 people in 38 cohorts, median follow-up 13.5 years, 54,542 cardiovascular events [7].
Sources
[6], [7]
Caveats
Observational. In the pooled cohorts the hazard ratios were at least as strong in participants who did not fast as in those who did [6].
Strong

Cardiovascular events in trials that lowered non-HDL cholesterol

Shown in trials: each 1 mmol/L (39 mg/dL) of non-HDL cholesterol lowered went with about 21% fewer major vascular events across 49 trials.

The numbers and sources
Effect
In a meta-regression of 24 trials of non-statin drugs and 25 statin trials, the risk ratio for major vascular events was 0.79 (95% CI 0.76 to 0.82) per 1 mmol/L reduction in non-HDL cholesterol [8]. Among patients on statins in 8 trials, each standard deviation higher on-treatment non-HDL cholesterol went with a hazard ratio of 1.16 (95% CI 1.12 to 1.19) for major cardiovascular events, against 1.13 (1.10 to 1.17) for LDL cholesterol, a significant difference [9]. Statin trials found that each 1.0 mmol/L reduction in LDL cholesterol lowered major vascular events with a rate ratio of 0.78 (95% CI 0.76 to 0.80) [10].
Population
374,358 patients in 49 trials, with 46,180 major cardiovascular events [8]. 62,154 patients in 8 statin trials, of whom 38,153 were allocated to a statin [9]. About 170,000 participants in 26 statin trials [10].
Sources
[8], [9], [10]
Caveats
The meta-regression compares trials with each other, not people within a trial, and covers drugs that lower non-HDL cholesterol in different ways [8].

Mixed results2

Strong

Stroke

Mixed results: higher total cholesterol went with fewer bleeding strokes in pooled cohorts, and higher non-HDL cholesterol with slightly more ischemic strokes.

The numbers and sources
Effect
In a meta-analysis of 23 prospective studies, the relative risk of hemorrhagic stroke was 0.69 (95% CI 0.59 to 0.81) for high against low total cholesterol and 0.85 (0.80 to 0.91) per 1 mmol/L higher [11]. In 61 prospective studies, total cholesterol showed no independent positive association with death from stroke, and at ages 70 to 89 and at systolic blood pressure above about 145 mm Hg it was negatively related to death from hemorrhagic and total stroke [5]. In 68 pooled cohorts, the hazard ratio for ischemic stroke was 1.12 (95% CI 1.04 to 1.20) per 43 mg/dL higher non-HDL cholesterol [6].
Population
1,430,141 participants with 7,960 hemorrhagic strokes [11]. Almost 900,000 adults with about 12,000 stroke deaths [5]. 302,430 people with 2,534 ischemic strokes [6].
Sources
[11], [5], [6]
Caveats
Observational. The authors of the largest analysis call the absence of a positive link with stroke death unexplained, and note that statin trials reduce total stroke rates [5].
Moderate

Death from any cause

Mixed results: a Korean cohort of 12.8 million linked both low and high total cholesterol to more deaths, while statin trials found 10% fewer deaths per 1 mmol/L lowered.

The numbers and sources
Effect
In 12.8 million Korean adults, the association with death from any cause was U-shaped. Below 200 mg/dL, each 39 mg/dL higher total cholesterol went with 23% lower mortality (95% CI 23 to 24). From 200 mg/dL upward, each 39 mg/dL higher went with 7% higher mortality (6 to 7). The levels with the lowest mortality were 210 to 249 mg/dL in most age and sex groups, and lower in men aged 18 to 34 (180 to 219 mg/dL) and women aged 18 to 34 (160 to 199 mg/dL) [12]. Across 26 statin trials, death from any cause fell 10% per 1.0 mmol/L reduction in LDL cholesterol (RR 0.90, 95% CI 0.87 to 0.93) [10].
Population
12,815,006 Korean adults who had routine health examinations in 2001 to 2004, followed until 2013, with 694,423 deaths [12]. About 170,000 participants in 26 statin trials [10].
Sources
[12], [10]
Caveats
The cohort finding is observational, and illness that lowers cholesterol before death (reverse causation) cannot be ruled out. The trials tested lowering with a statin in people selected for trials, over about 5 years.

Related

Non-HDL cholesterol (non-HDL-C)

Sources

  1. US Food and Drug Administration. 21 CFR 862.1175, Cholesterol (total) test system. Electronic Code of Federal Regulations, with the FDA product classification entry for over-the-counter total cholesterol tests (product code NFX). https://www.ecfr.gov/current/title-21/section-862.1175
  2. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001. https://doi.org/10.1001/jama.285.19.2486
  3. Nordestgaard BG, Langsted A, Mora S, et al. Fasting is not routinely required for determination of a lipid profile: clinical and laboratory implications including flagging at desirable concentration cut-points. A joint consensus statement from the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine. European Heart Journal. 2016. https://doi.org/10.1093/eurheartj/ehw152
  4. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report. Pediatrics. 2011. https://doi.org/10.1542/peds.2009-2107C
  5. Prospective Studies Collaboration. Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55 000 vascular deaths. The Lancet. 2007. https://doi.org/10.1016/S0140-6736(07)61778-4
  6. Emerging Risk Factors Collaboration. Major Lipids, Apolipoproteins, and Risk of Vascular Disease. JAMA. 2009. https://doi.org/10.1001/jama.2009.1619
  7. Brunner FJ, Waldeyer C, Ojeda F, et al. Application of non-HDL cholesterol for population-based cardiovascular risk stratification: results from the Multinational Cardiovascular Risk Consortium. The Lancet. 2019. https://doi.org/10.1016/S0140-6736(19)32519-X
  8. Marston NA, Giugliano RP, Im K, et al. Association Between Triglyceride Lowering and Reduction of Cardiovascular Risk Across Multiple Lipid-Lowering Therapeutic Classes: A Systematic Review and Meta-Regression Analysis of Randomized Controlled Trials. Circulation. 2019. https://doi.org/10.1161/CIRCULATIONAHA.119.041998
  9. Boekholdt SM, Arsenault BJ, Mora S, et al. Association of LDL Cholesterol, Non-HDL Cholesterol, and Apolipoprotein B Levels With Risk of Cardiovascular Events Among Patients Treated With Statins: A Meta-analysis. JAMA. 2012. https://doi.org/10.1001/jama.2012.366
  10. Cholesterol Treatment Trialists' (CTT) Collaboration. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials. The Lancet. 2010. https://doi.org/10.1016/S0140-6736(10)61350-5
  11. Wang X, Dong Y, Qi X, Huang C, Hou L. Cholesterol Levels and Risk of Hemorrhagic Stroke: A Systematic Review and Meta-Analysis. Stroke. 2013. https://doi.org/10.1161/STROKEAHA.113.001326
  12. Yi SW, Yi JJ, Ohrr H. Total cholesterol and all-cause mortality by sex and age: a prospective cohort study among 12.8 million adults. Scientific Reports. 2019. https://doi.org/10.1038/s41598-018-38461-y
  13. Langsted A, Freiberg JJ, Nordestgaard BG. Fasting and Nonfasting Lipid Levels: Influence of Normal Food Intake on Lipids, Lipoproteins, Apolipoproteins, and Cardiovascular Risk Prediction. Circulation. 2008. https://doi.org/10.1161/CIRCULATIONAHA.108.804146
  14. Smith SJ, Cooper GR, Myers GL, Sampson EJ. Biological variability in concentrations of serum lipids: sources of variation among results from published studies and composite predicted values. Clinical Chemistry. 1993. https://doi.org/10.1093/clinchem/39.6.1012

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