Beginning in childhood, the waxy substance called cholesterol and other fatty substances known as lipids start to build up in the arteries, hardening into plaques that narrow the passageway. During adulthood, plaque buildup and resulting health problems occur not only in arteries supplying blood to the heart muscle but in arteries throughout the body (a problem known as atherosclerosis). For both men and women in the United States, the number one cause of death is heart disease, and the amount of cholesterol in the blood greatly affects a person's chances of suffering from it.
Problems with the heart and arteries surface most often in men over age 45 and women after age 55. According to the American Heart Association (AHA), 82% of people who die of coronary heart disease are 65 or older, and older women who have heart attacks are more likely to die from them within a few weeks than men are.
Screening for high cholesterol, specifically high LDL cholesterol (the "bad" cholesterol), is important because it may not cause any symptoms and yet, according to the Centers for Disease Control and Prevention (CDC), two out of three adults have it.
The National Cholesterol Education Program (NCEP) and the AHA recommend:
- Every 5 years, all adults 20 years of age and older should have a complete, fasting lipid profile.
If you fast for 9 to 12 hours before taking this blood test, the test provides 4 measurements: 1) total cholesterol, 2) LDL cholesterol, which you want to be low because it contributes to buildup and blockage, 3) HDL cholesterol, which you want to be high, and 4) triglycerides, which are another form of fat in your blood. This fasting test is the preferred initial test, according to the NCEP. Without fasting, two useful measurements can be obtained: total cholesterol and HDL cholesterol.
- If one or more of the following applies to you as a young adult, you may need more frequent testing:
- Your total cholesterol result is 200 mg/dL or higher
- You are a man over the age of 45 or a woman over the age of 50-55
- Your HDL cholesterol is under 40 mg/dL
- You have other risk factors for heart disease and stroke
The U.S. Preventive Services Task Force (USPSTF) recommends screening for high cholesterol as follows:
- For men aged 35 and older: strongly recommends screening
- For women aged 45 and older: strongly recommends screening if they are at increased risk for coronary heart disease
On what age to stop getting tested, the USPSTF says:
- An age to stop screening has not been established. After age 65, you may not need to keep getting tested. Lipid levels are less likely to increase at this age; however, anyone over age 65 who has never been tested should have their cholesterol levels measured.
You also are more vulnerable and would want more frequent testing if you have any known risk factors, such as:
- Hypertension (blood pressure of 140/90 mm Hg or higher, or you take antihypertensive medications)
- Obesity or overweight
- Physical inactivity
- Family history of early heart disease
Men have greater risk for heart attack than women, and risk for heart disease increases with age.
University of Maryland Heart Center: Heart Disease Risk Calculator
National Heart, Lung, and Blood Institute: What is Cholesterol?
College of American Pathologists: MyHealthTestReminder.com - Cholesterol Tests
Sources Used in Current Review
Centers for Disease Control and Prevention. FASTSTATS – Leading Causes of Death (2009 data). Available online at http://www.cdc.gov/nchs/fastats/lcod.htm through http://www.cdc.gov. Accessed October 2012.
Centers for Disease Control and Prevention. National Cholesterol Education Month. Page last updated: September 10, 2012. Available online at http://www.cdc.gov/Features/CholesterolAwareness/index.html through http://www.cdc.gov. Accessed October 2012.
American Heart Association. How To Get Your Cholesterol Tested. Updated June 14, 2012. Available online through http://www.heart.org. Accessed October 2012.
American Heart Association. Understand Your Risk of Heart Attack. Available online throughhttp://www.heart.org. Accessed October 2012.
National Cholesterol Education Program (NCEP) guidelines for a cholesterol test: Healthwise Medical Information on eMedicineHealth. Available online at http://www.emedicinehealth.com/script/main/art.asp?articlekey=128039&ref=129085 through http://www.emedicinehealth.com. Accessed October 2012.
U.S. Preventive Services Task Force. Screening for Lipid Disorders in Adults. Release Date: June 2008. Available online at http://www.uspreventiveservicestaskforce.org/uspstf/uspschol.htm. Accessed October 2012.