Borderline Cholesterol: What It Means and How to Lower It for Better Heart Health

Updated July 2026

The risks of high cholesterol are clear: it raises your chances of a heart attack or stroke. But what if your doctor tells you your cholesterol is only "borderline high"? Can you simply watch it?

What counts as borderline cholesterol?

A total cholesterol between 200 and 239 mg/dL. The CDC calls a total cholesterol under 200 desirable and 240 or higher high, which leaves borderline in the middle. If you have landed there, you have plenty of company. About 86 million American adults have a total cholesterol above 200.

If you do not know your numbers, ask for a blood test at your next primary care visit, and if it has been a while, rechecking is a good idea. As a rough rule of thumb, have your cholesterol checked once in childhood, twice in your twenties, three times in your thirties, four times in your forties, at least five times in your fifties, and yearly after that, assuming your numbers are acceptable. If they are ever elevated or borderline, more frequent checks may make sense.

Is 239 really that different from 240?

No. The line between borderline and high is somewhat arbitrary. There is nothing magical about 239 versus 240; cholesterol falls on a continuum, so it is not as though you suddenly need medication at 240 and are in the clear at 239. It is far more nuanced than that.

What else should you consider?

The rest of your risk picture. Do you have other risk factors for heart disease, like high blood pressure, elevated blood sugar, or smoking? Is there a strong family history? The more non-cholesterol risk factors you carry, the more any number over 200 matters. That is why simply watching a borderline number is an unwise strategy. Watched or not, an elevated reading still adds to an already elevated risk profile.

What is your total cholesterol actually made of?

Three parts, and the mix matters more than the total. Your total is the sum of good (HDL) cholesterol, bad (LDL) cholesterol, and triglycerides, related by a simple formula:

Total cholesterol = LDL + HDL + TG/5

So two people with the same total can have very different risk. If your total is up because HDL is high while LDL is low, ideally at or below 100, and you have no other risk factors or very high triglycerides, you can relax. That elevated total is not a meaningful risk. But if LDL is the part that is high, regardless of your HDL, pay attention and work to bring it down. The good news is that most people can lower LDL meaningfully with a few simple changes, often without medication.

How do you lower a borderline number?

With the usual, powerful basics. If you smoke, quit. Exercise regularly. And eat a whole-food, plant-centric diet. Lowering LDL this way is within reach for most people, and Step One Foods makes eating this way easier. Our foods are clinically proven to lower LDL, a good place to start if your numbers are off but you are not ready for a full plant-based Mediterranean overhaul. If your cholesterol sits in that murky middle, your doctor may also suggest a coronary calcium scan to see how much plaque has actually built up. In my own practice I use this test often, because it is a great way to identify people at very low risk who can safely defer medication.

The bottom line

Sometimes borderline numbers will not budge despite your best efforts. If that is you, do not despair. There is so much more to heart-disease risk, and to health in general, than a cholesterol result. If you are living in a way that should lower your cholesterol, even when it does not, you are also living in a way that lowers blood pressure, improves blood sugar, helps prevent cancer, and reduces your chances of developing dementia. Whether your cholesterol is high, borderline, or perfect, doing your best around lifestyle is never wasted effort.

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