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Cholesterol Tests: Guideline Recommendations

Recommendations for when to get a cholesterol test can differ a little based on the guideline that your doctor follows. When a cholesterol test is right for you can depend on your age, health, and risk factors for heart disease.

The following organizations are common sources of recommendations for cholesterol testing.

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Under the Affordable Care Act, many health insurance plans will cover preventive care services, including blood pressure and cholesterol screenings, at no cost to you. Learn more. 

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National Cholesterol Education Program (NCEP)

The National Cholesterol Education Program (NCEP), an expert group of doctors and scientists affiliated with the National Institutes of Health, recommends that all people older than age 20 have a fasting blood test called a lipoprotein profile every 5 years. NCEP guidelines suggest:7

  • If total cholesterol is less than 200 mg/dL (5.17 mmol/L) and HDL cholesterol is at least 40 mg/dL (1.04 mmol/L), testing for high cholesterol should be repeated every 5 years.
  • If total cholesterol is less than 200 mg/dL (5.17 mmol/L) but HDL cholesterol is less than 40 mg/dL (1.04 mmol/L), a more extensive cholesterol test may be done (lipoprotein analysis).
  • If total cholesterol is between 200 mg/dL to 239 mg/dL (5.17 mmol/L to 6.18 mmol/L), you are considered to have borderline-high cholesterol. The next step depends on your HDL level and whether you have other coronary artery disease (CAD) risk factors.
    • If HDL cholesterol is at least 40 mg/dL (1.04 mmol/L) and there are fewer than two other CAD risk factors, cholesterol testing should be done again in 1 to 2 years.
    • If HDL cholesterol is less than 40 mg/dL (1.04 mmol/L) or there are two or more other CAD risk factors, a more extensive total cholesterol test called a lipoprotein analysis may be done.
  • If total cholesterol is 240 mg/dL (6.21 mmol/L) or more, a more extensive cholesterol test (lipoprotein analysis) may be done.

U.S. Preventive Services Task Force

For adults, the U.S. Preventive Services Task Force recommends testing for total and HDL cholesterol for the following people:1

  • Men age 35 and older
  • Men ages 20 to 35 who have risk factors for heart disease
  • Women age 20 and older who have risk factors for heart disease

For children, the USPSTF does not recommend for or against routine cholesterol screening.2

American Diabetes Association

Most adults who have diabetes should be tested at least once a year.3

American Academy of Pediatrics

The American Academy of Pediatrics (AAP) and the American Heart Association suggest that children and teens have their cholesterol levels tested if they have a family history of early coronary artery disease or have other risk factors.4, 5

The AAP suggests that a child's risk of high cholesterol, based on a physical exam and family history, be checked at ages 2, 4, 6, 8, and 10 years, and then every year through age 21. The AAP also suggests a cholesterol screening test for young adults at age 18, 19, 20, or 21.6

Citations

  1. U.S. Preventive Services Task Force (2008). Screening for lipid disorders in adults. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspschol.htm.

  2. U.S. Preventive Services Task Force (2007). Screening for lipid disorders in children. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspschlip.htm.

  3. American Diabetes Association (2011). Standards of medical care in diabetes - 2011. Diabetes Care, 34(Suppl 1): S11-S61.

  4. Kavey RW, et al. (2003). American Heart Association guidelines for primary prevention of atherosclerotic cardiovascular disease beginning in childhood. Circulation, 107(11): 1562-1566.

  5. Daniels SR, et al. (2008) Lipid screening and cardiovascular health in childhood. Pediatrics, 122(1): 198-208.

  6. American Academy of Pediatrics (2008). Recommendations for preventive pediatric health care. In Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd ed., p. 591. Elk Grove Village, IL: American Academy of Pediatrics. Also available online: http://brightfutures.aap.org/pdfs/Guidelines_PDF/20-Appendices_PeriodicitySchedule.pdf.

  7. Grundy S, et al. (2002). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (NIH Publication No. 02-5215). Bethesda, MD: National Institutes of Health. Also available online: http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf.

By Healthwise Staff
Primary Medical Reviewer Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Specialist Medical Reviewer Carl Orringer, MD - Cardiology, Clinical Lipidology
Last Revised July 13, 2011

WebMD Medical Reference from Healthwise

Last Updated: July 13, 2011
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

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Answer:
Desirable
0-199
Borderline
200-239
High
240+

Your level is currently

Congratulations! Your total cholesterol level is in the Desirable range, and your level of "bad" LDL cholesterol is optimal.

Congratulations! Your total cholesterol level is in the Desirable range, and your level of "bad" LDL cholesterol is near optimal.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is borderline high. If your LDL goes higher, your total cholesterol level could become Borderline High. Consider reducing the amount of foods you eat with saturated fats and increasing physical activity. If you get more exercise, your level of "good" HDL cholesterol may increase, which could also help to keep your levels of LDL and total cholesterol in check.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL. The HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is Very High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL because the HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is Borderline High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. But your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol is High, but your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol is High, but your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is Borderline High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe medication, such as statins. Following medication, dietary, and exercise instructions should result in improvements.

Your total cholesterol level is High, and your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe statins or other cholesterol-lowering medications.

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