People “Stuck Between” Normal and Optimal Heart Health: A Common but Overlooked Group

As I approach 40, I’ve spent years in a weird limbo with my health.

My cholesterol and blood sugar levels are slightly elevated—still within what my doctor considers “normal,” but not ideal.

My doctor hasn’t recommended medication, but I’ve often wondered: What does this mean for my long-term health?

I think about this because research has shown that markers like cholesterol, blood sugar, and blood pressure are linked to long-term heart and metabolic health (which I’ll refer to as ‘heart health’ here).

At times, I also notice symptoms—like feeling thirsty in the morning—and question whether they could be related.

At levels like mine (for example, an HbA1c around 5.9%), most people don’t experience clear symptoms, so the answers aren’t always obvious.

Like many others, I’ve tried to take proactive steps: improving my diet, increasing physical activity, and exploring supplements.

I’ve seen some improvements, and I’m hoping to keep things on track and avoid needing medication for as long as possible.

This is my story—but I’m far from alone.

 

A Large Group in the “Middle Zone”

Many adults fall into a similar category: not clearly unhealthy, but not at optimal levels either.

This group may have:

• One or more heart health numbers near the upper end of normal range or slightly above it
• Possible signs or symptoms that may be related to these levels

This stage can be an important opportunity to take action.

 

How Do You Know Your Numbers?

The most common way to check your heart health is through routine doctor visits – such as an annual physical exam.

These visits often include blood tests and blood pressure measurements.

(I’ve also shared other ways to check your numbers in this post.)

However, barriers exist:

• A doctor visit often involves multiple steps—scheduling, traveling, waiting, tests, and follow ups—so it’s not always as quick as it sounds
• A full checkup alone can take several hours
• For many people, what seems like a simple visit can turn into a half-day commitment or require time off work

It shows up in the numbers too—only about 20% of people get annual checkups regularly. 

As a result, some people may not be aware of gradual changes in their health.

 

Key Heart Health Markers

Common markers used to assess heart health include:

Cholesterol levels:

• LDL-c (“bad” cholesterol)
• HDL-c (“good” cholesterol)
• Total cholesterol

Triglyceride (TG) levels

Blood sugar: fasting blood glucose (FBG) and hemoglobin A1c (HbA1c)

Hemoglobin A1c (HbA1c) reflects average blood sugar levels over the past few months and is sometimes considered a more stable measure than fasting blood glucose (FBG).

However, both are used together to provide a broader picture of blood sugar health.

Blood pressure: systolic and diastolic blood pressure (SBP and DBP)

Systolic blood pressure (SBP) is sometimes considered a stronger predictor of long-term heart outcomes than diastolic blood pressure (DBP), especially as people age.[1]

If you’d like a deeper dive, I’ve covered these markers in more detail in a previous post.

 

What Do Population Trends Suggest?

Let’s take a look at how key heart health markers tend to change with age.

Table 1. Average cholesterol and triglyceride levels by age and sex

Age Group	Women (LDL-c / TC / TG mg/dL)	Interpretation	Men (LDL-c / TC / TG mg/dL)	Interpretation
20–39 years	100 / 180 / 90	Near optimal LDL-c; normal TC; normal TG	113 / 190 / 110	Elevated LDL; upper normal TC; normal TG
40–59 years	122 / 205 / 120	Elevated LDL-c; elevated TC; rising TG	122 / 200 / 140	Elevated LDL; borderline TC; upper-normal TG
60+ years	113 / 220 / 130	Elevated LDL-c; elevated TC; rising TG	102 / 195 / 135	Elevated LDL; upper-normal TC; normal TG

What this suggests: 

• Many adults have LDL-c and TC levels above optimal ranges

 

Table 2. Average blood sugar levels by age and sex

Age Group	Women (FBG / HbA1c)	Interpretation	Men (FBG / HbA1c)	Interpretation
18–39 years	92–94 mg/dL / 5.1–5.2%	Normal blood sugar	95–97 mg/dL / 5.2–5.3%	Upper-normal FBG; normal HbA1c
40–59 years	97–99 mg/dL / 5.4–5.5%	Upper normal blood sugar	100–102 mg/dL / 5.5–5.6%	Elevated FBG; HbA1c upper normal
60+ years	103–105 mg/dL / 5.6–5.7%	Elevated blood sugar levels	106–108 mg/dL / 5.6–5.8%	Elevated blood sugar levels

What this suggests: 

• Average blood sugar levels tend to increase with age
• Many adults have blood sugar levels above optimal ranges

 

Table 3. Average blood pressure by age and sex[2]

Age Group	Women (SBP/DBP)	Interpretation	Men (SBP/DBP)	Interpretation
18–39 years	110/68 mm Hg	Normal	119/70 mm Hg	Upper normal SBP
40–59 years	122/74 mm Hg	Elevated SBP	124/77 mm Hg	Elevated SBP
60+ years	139/68 mm Hg	Elevated SBP	133/69 mm Hg	Elevated SBP

What this suggests: 

• Blood pressure tends to rise with age
• Many adults have SBP (the top number) above optimal ranges

 

How Many U.S. Adults Are ‘Stuck’ Between ‘Normal’ and ‘Optimal’?

Here, we’re talking about people whose numbers aren’t ideal, but also aren’t high enough to require a diagnosis or medication.

Based on commonly used ranges, many adults fall into these ‘in-between’ categories:

Cholesterol levels:

• LDL-c 100-159 mg/dL: about 40-55% of adults[3]
• TC (200–239 mg/dL): about 20-30% of adults[4]
• HDL-c: does not have a standard borderline category like LDL-c or TC

 

Triglyceride levels:

• 150-199 mg/dL: about 15% adults[5]

 

Blood sugar:

• FBG 100-125 mg/dL or HbA1c 5.7-6.4%: More than 2 in 5 adults[6]

 

Blood pressure:

• SBP 120-129 mm Hg: about 10-15% of adults.[7]

 

What this suggests:

• For a single marker, about 1 in 10 to 1 in 2 U.S. adults (roughly 10-50%) fall into this ‘in-between’ range.
• As a result, it’s common to have at least one marker that isn’t at optimal levels.

 

Do People Feel Symptoms?

Often, people in this range feel no noticeable symptoms.

When symptoms do occur, they are usually nonspecific, such as:

• Fatigue
• Mild sleepiness after meals
• Increased thirst

It’s important to note that these symptoms can have many causes and are not specific to heart health conditions.

 

Final Thoughts

Being “in between” normal and optimal heart health is common.

Over time, less-than-optimal heart health markers may be associated with increased health risks, which is why many people choose to take proactive steps early.

While it may not require medication, it can be a meaningful time to build habits that support long-term health.

Some practical steps to consider include:

• Regular checkups with a healthcare provider (for example, annual visits) to understand your numbers
• Reviewing your results over time to track changes
• Applying the “FUEL” approach—food, use of supplements, exercise, and other lifestyle choices”—to support heart health

In the end, small, consistent changes—guided by a qualified healthcare professional—can make a difference over time.

 

Sincerely,

Derek Tang, PhD, MS, BSPharm

Truth Full Health

Your Trusted Supplement Partner

 

Disclaimer: All blogged content is for informational purposes only and does not replace professional medical advice. Statements made about vitamins or supplements (officially called “dietary supplements”) have not been evaluated by the U.S. Food and Drug Administration (FDA). Dietary supplements are not intended to diagnose, treat, cure, or prevent any disease. Always consult with a qualified healthcare provider before beginning any new supplement, diet, or lifestyle program.

 

[1] Title: Effect of systolic and diastolic blood pressure on cardiovascular outcomes. First author: AC Flint.
Journal: New England Journal of Medicine. Year of publication: 2019.

[2] CommonSpirit Health. Normal Blood Pressure by Age and Gender - Blood Pressure Chart. Accessed April 21, 2026. https://www.commonspirit.org/blog/normal-blood-pressure-by-age

[3] O’Riordan M. Very high LDL cholesterol declines in US adults, but progress is slow. TCTMD. November 2, 2023. Accessed April 23, 2026. https://www.tctmd.com/news/very-high-ldl-cholesterol-declines-us-adults-progress-slow

[4] Title: Increase in prevalence of self-reported high blood cholesterol among adults, United States, 2019–2023. First author: K Xu. Journal: Preventing Chronic Disease. Year of publication: 2026.

[5] Title: Estimated ASCVD risk according to statin use in US adults with borderline triglycerides: Results from National Health and Nutrition Examination Survey (NHANES) 2007–2014. First author: W Fan. Journal: American Journal of Preventive Cardiology. Year of publication: 2020

[6] Centers for Disease Control and Prevention. A US report card. Updated February 11, 2026. Accessed April 23, 2026. https://www.cdc.gov/diabetes/communication-resources/diabetes-statistics.html

[7] Title: Potential US population impact of the 2017 ACC/AHA high blood pressure guideline. First author: P Muntner. Journal: Journal of the American College of Cardiology. Year of publication: 2018