Cholesterol Screening Recommendations

Finding out what your cardiovascular risk is requires that you see your physician periodically to have your cholesterol, blood pressure, blood sugar, and weight checked. From there, your health-care team may recommend a variety of tests and investigations to determine your level of risk and develop a plan to minimize it.

Guidelines from medical organizations differ somewhat in terms of when and how frequently to screen for high cholesterol and other risk factors for atherosclerotic cardiovascular disease. Here’s a guide to some of the cholesterol screening recommendations:

American College of Cardiology/American Heart Association

The American College of Cardiology (ACC)/American Heart Association (AHA) guidelines (which were established in 2013) recommend lipid screening every four to six years for all adults ages 20 and older at average risk, and more frequently for those at increased risk. The AHA also recommends the following:

• Blood pressure: Measurements at each health-care visit or at least once every two years if blood pressure is 120/80 mmHg or lower; more frequently if blood pressure is higher.
• Blood sugar: Blood glucose testing at least every three years. Note, the American Diabetes Association recommends screening for prediabetes and type 2 diabetes for all people starting at age 45 or anyone at any age if you are overweight or obese. The organization notes that if test results are normal, follow-up testing at three-year intervals is reasonable.
• Weight: Physicians should measure weight and calculate body mass index during routine health-care visits; waist circumference may be included if body mass index is 25 or higher.

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American Association of Clinical Endocrinologists/American College of Endocrinology

In their guidelines for managing dyslipidemia and preventing cardiovascular disease (updated in 2017), the American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE) took a more age-specific approach to cholesterol screening. Among their recommendations:

• Younger adults: Dyslipidemia screening every five years for all men ages 20 to 45 and women ages 20 to 55 as part of a global risk assessment.
• Middle-aged adults: In the absence of cardiovascular risk factors, dyslipidemia screening at least every 1-2 years for men ages 45 to 65 and women ages 55 to 65; more frequent screening for people with multiple cardiovascular risk factors.
• Older adults (over age 65): Annual screening for older adults with zero or one cardiovascular risk factor; the guidelines also note that older adults should undergo a lipid assessment if they have multiple cardiovascular risk factors (other than age), and that older women should be screened in the same way as older men.
• Adults with diabetes: Annual dyslipidemia screening for all adults with type 1 or type 2 diabetes.
• Familial hypercholesterolemia (FH): Screening for FH in patients with elevated cholesterol levels consistent with FH; screening for patients with a family history of premature cardiovascular disease (having a father or brother who suffered a heart attack or cardiac death before age 55 or a mother or sister who suffered these outcomes before age 65).
• Children/adolescents: For children at risk of FH due to family history of premature cardiovascular disease or dyslipidemia, screening starting at age 3, again between ages 9 and 11, and again at age 18; screening every five years or more frequently for adolescents over age 16 with cardiovascular risk factors, a family history of premature cardiovascular disease, or who are overweight/obese or have other elements of metabolic syndrome.

U.S Preventive Services Task Force (USPSTF)

In its 2013 guidelines, the USPSTF, an influential government advisory panel, recommended screening for lipid disorders in the following populations:

• Men: Screening strongly recommended (an “A” grade recommendation, meaning there is a high certainty of substantial benefit) for men age 35 and older; the task force gave a “B” grade (high certainty of moderate benefit or moderate certainty of moderate to substantial benefit) to screening of men ages 20 to 35 at increased risk of coronary heart disease.
• Women: Screening strongly recommended (an “A” grade) for women age 45 and older at increased risk for coronary heart disease; the task force gave a “B” grade to screening of women ages 20 to 45 at increased risk of coronary heart disease.

The USPSTF noted that the ideal interval for screening is uncertain, but that screening every five years (or more often for people with higher lipid levels) is reasonable.

Measuring Your Cholesterol

Your physician measures your cholesterol using a simple blood test known as a complete lipid profile or complete lipid panel. A small sample of blood is drawn from your arm or finger and is then sent to a lab for analysis. The test is usually done in the morning because you’ll have to fast for nine to 12 hours beforehand. Fasting can be inconvenient and difficult, especially for people with diabetes, older adults, and people at work. However, for the majority of patients, fasting does not significantly influence LDL cholesterol readings, and some experts contend that non-fasting lipid levels are more predictive of a person’s cardiovascular risk.

For instance, guidelines from the European Society of Cardiology and European Atherosclerosis Society note that fasting is not routinely necessary to determine a lipid profile, although fasting may still be necessary in certain patients. Your physician will instruct you on whether you need to fast.

What’s Measured?

The complete lipid profile measures LDL, HDL, and triglyceride levels, as well as total cholesterol (calculated by adding HDL, LDL, and 20 percent of your triglyceride level). Be aware that total cholesterol can be misleading and may not provide an accurate assessment of your overall risk. For example, your total cholesterol might fall in a normal range, but you might have very low HDL and very high LDL levels and thus be at higher risk. On the flip side, your total cholesterol might be somewhat elevated, but that might be due primarily to a very high HDL, which is good. That’s why health-care professionals focus more on your lipid breakdown because your LDL and HDL levels reflect your risk more accurately than total cholesterol.

Sometimes, other information calculated from these test results may be included in the lipid profile, such as:

• Very low-density lipoprotein, based on triglyceride levels
• Non-HDL cholesterol, calculated by subtracting your HDL from your total cholesterol level.

For more information about cholesterol screenings, purchase Managing Your Cholesterol at www.UniversityHealthNews.com.

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