But, as Dr. Esselstyn wrote in Cleveland Clinic Journal of Medicine, in cholesterol lowering, moderation kills. Even if all Americans kept their total cholesterol below 200 mg/dL, millions would develop coronary artery disease. Strong evidence showed we need to keep our total cholesterol under 150 to stem America’s epidemic of coronary artery disease. What kind of evidence? Well, in many cultures, coronary artery disease is practically unheard of when total serum cholesterol levels are under 150 mg/dL. And here in the ., in the famous Framingham Heart Study, few of those with levels below 150 developed heart disease, and none died of it.