Does my lipid panel below need to get better: total cholesterol: 178 hdl: 42 ldl: 115 trig:106 vldl:21?

Yes: Your cardiovascular risk depends on your age , presence of diabetes , high blood pressure and family history of heart disease. Also smoking. If u have more than 2 of these risk factors then aim for an LDL of less than 100.

Lipids: Lipids are one of many risk factors. If you have no other risk factors the levels may be ok. If you have diabetes, hypertension, smoking and/or other risks, the levels should be much lower.

No, unless...: This depends on other risk factors but esp. Depends on the particle subtypes- if your LDL is mostly small dense instead of light buoyant that would be good to address, otherwise it looks good. The role of cholesterol is over-rated & too low can be dangerous. See http://www.Cbn.Com/cbnnews/healthscience/2012/october/cholesterol-myth-what-really-causes-heart-disease/ and my comment for more links.

Depends on Particles: Both labs and risk factors are important in knowing cardiovascular (cvd) risk. More than cholesterol, cvd is related to the number of LDL (ldl-p) and HDL particles (hdl-p). Because cholesterol in LDL and HDL particles is highly variable cholesterol levels often disagree with particle number. When cholesterol and particle number disagree cvd risk tracks with ldl-p and hdl-p, not ldl-c or hdl-c.