• Also Known As:
  • Blood Cholesterol
  • Total Cholesterol
  • Non-Fasting Cholesterol Test
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Test Quick Guide

Cholesterol is a type of fat molecule, and cholesterol testing measures how much of it is present in the blood. Cholesterol testing can help evaluate heart health since excess cholesterol is a risk factor for cardiovascular problems like heart disease and stroke.

There are multiple types of cholesterol, often categorized as either “good” or “bad.” A total cholesterol test measures the sum of good and bad cholesterol. While total cholesterol can be tested on its own, it is more often integrated into the lipid panel test that also shows the levels of each type of cholesterol.

About the Test

Purpose of the test

Cholesterol testing is often used as part of a cardiac risk assessment. Too much cholesterol in the blood can damage arteries and blood vessels and elevate risk for stroke, heart attack, and heart disease.

Total cholesterol may be measured as part of cholesterol screening, which is looking for signs of risks to cardiovascular health in people who have not shown any symptoms. When used for screening, total cholesterol is typically one component of the lipid panel, which also determines levels of high-density lipoprotein (HDL or “good”) cholesterol, low-density lipoprotein (LDL or “bad”) cholesterol, and triglycerides.

Depending on the results from initial screening, future tests may involve only total and HDL cholesterol.

Total cholesterol and lipid panel tests may also be used to monitor people with a high risk of cardiovascular disease, to diagnose certain medical conditions, and to monitor how well treatment is working to reduce cardiovascular disease risk.

What does the test measure?

The total cholesterol test measures the combined sum of all cholesterol molecules found in the blood. This test alone does not specify the breakdown of different types of cholesterol; however, it is often combined with other tests that include measurements of HDL, LDL, and triglycerides.

When should I get a cholesterol test?

Cholesterol testing has different uses depending on your overall health situation and can be used for screening, monitoring, or diagnosis. In general, tests to measure cholesterol typically begin as an adult, usually around 35 years old.

Screening

Health screening is a way of proactively looking for potential problems before symptoms become apparent. Cholesterol tests are often used in this way to identify people who may have an above-average risk of cardiovascular problems.

There are no consensus guidelines for when to do cholesterol screening. Based on different views of the benefits and downsides of screening, expert groups have varying recommendations for when to start screening and how frequently to do repeat tests.

In general, screening occurs less often in people who do not have risk factors for cardiovascular problems. In low-risk patients, screening with a lipid panel test may begin in their 20s, 30s, or 40s and be repeated about every five years. If results are normal, screening may continue with only measurements of total cholesterol and HDL.

People with risk factors tend to start screening at a younger age and have screening tests more frequently. Some risk factors for cardiovascular disease include:

  • Being over 45 years old for men and over 50-55 for women
  • High cholesterol on a previous test
  • Prior cardiovascular problems
  • Being overweight or obese
  • Cigarette smoking
  • Unhealthy diet
  • Lack of regular physical activity
  • High blood pressure (hypertension)
  • Having a first-degree relative who had heart disease at an early age (under 55 in men and under 65 in women)
  • Diabetes or prediabetes

Depending on your risk factors and ongoing test results, you may have cholesterol tests every year or less.

Children over the age of two usually start screening as soon as any risk factors are identified. Children that don’t have risk factors often have cholesterol testing before and after puberty. Screening is more frequent in children who have an elevated risk of an inherited condition called familial hypercholesterolemia.

A summary reviewing general approaches to cholesterol screening is listed below. In the majority of cases, screening is done with a lipid test that measures total cholesterol as well as HDL, LDL, and triglycerides.

Demographic Group Risk Factors Screening Frequency
Children None Once between ages 7-11; again between 17-21
Children 1+ Every 1-3 years starting when risk factor is identified
Children High risk of familial hypercholesterolemia Age 3, between 9-11, and age 18
Adolescents and adults 1+ At least every 5 years; often annually
Men age 20-45
Women age 20-55
None Every 5 years
Men age 45-65
Women age 55-65
None Every 1-2 years
Men and women over 65 0+ Annually

Monitoring

In people who have already had cardiovascular problems, cholesterol tests can be used to monitor their heart health and see how well treatment is working to lower their cholesterol.

Diagnosis

Changes to cholesterol levels can occur as a result of other health conditions, including some that affect the pancreas, kidney, or thyroid. As a result, cholesterol testing may be part of the diagnostic workup for those conditions.

Finding a Total Cholesterol Test

How to get tested

Cholesterol tests are usually done using blood that is drawn from a vein in your arm. This procedure is typically done in a doctor’s office, clinic, or medical lab. When the laboratory analyzes your blood, total cholesterol is frequently measured along with other types of cholesterol in a lipid panel test that is ordered by your doctor.

Total cholesterol can also be measured with rapid, point-of-care testing. This kind of test requires putting a drop of blood from your finger on a special test strip that is inserted into a small device, giving results within minutes. Point-of-care testing is used in some medical offices and clinics and may also be found at health fairs.

Can I take the test at home?

Two main types of at-home cholesterol tests are available:

  • Test kits that have you take a blood sample from your finger and send it by mail to a lab.
  • Test kits that include an at-home method for analyzing the blood sample from your finger. This may be a small electronic device or a test strip that changes color to indicate cholesterol levels.

At-home tests for total cholesterol may include other cholesterol measurements, such as HDL and LDL, that are part of a typical lipid panel.

How much does the test cost?

There is no standard price for a total cholesterol test. The cost depends on where you take the test as well as coverage that may be provided by your insurance.

Costs of testing can include the office visit, the fee for the technician to draw your blood, and the actual laboratory analysis. If your doctor recommends a cholesterol test, these costs are typically covered by insurance, but, depending on your plan, you may be responsible for copays or a deductible. Your doctor and insurance plan can provide more specific information about your costs for cholesterol testing.

A point-of-care cholesterol test at pharmacies or health clinics may cost around $100 or less. This kind of test may be free at community health fairs or similar events.

There is a wide price range for at-home test kits. Many models include a small device to conduct the test and cost under $150, but more expensive options are available. Kits commonly come with extra test strips that allow you to check your cholesterol more than once.

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Taking the Cholesterol Test

Cholesterol testing is performed on a sample of your blood. If your blood is going to be analyzed in a lab, the sample is normally drawn from a vein in your arm. In point-of-care and at-home tests, a drop of blood is taken from your fingertip.

Before the test

In many cases, it is important to fast for 9-12 hours before a cholesterol test, which means avoiding all food and all beverages other than water.

If your total cholesterol is being measured as part of a lipid panel, you will likely need to fast in order to ensure the validity of the test results. If the laboratory is only going to measure your total cholesterol and HDL, fasting may not be necessary.

Because the need to fast depends on the exact type of cholesterol test you take, it is essential to talk with your doctor’s office beforehand so that you know all of the pre-test instructions to follow.

During the test

For laboratory tests, a needle is used to take a sample of blood from a vein in your arm. An elastic band, known as a tourniquet, is tied around the upper part of your arm so that there is more blood in the vein. To prevent infection, your skin will be cleaned with an antiseptic in the area where your blood will be drawn.

There may be slight pain or a sting when the needle is inserted. After that, it usually takes less than a minute for enough blood to be drawn.

Point-of-care and at-home tests get a blood sample from a fingerstick. This is a small puncture on your fingertip that produces a drop of blood but generally causes little pain.

After the test

Once blood has been drawn from your vein, bleeding is stopped with a cotton swab and/or a band-aid. You may need to keep pressure on the puncture site for an hour or more to prevent bleeding and allow it to heal quickly.

These types of blood draws are routine. They are an out-patient procedure, so you can drive or go to work or school afterward. You may need to avoid sports or intense activity for a few hours. If you were told to fast before testing, it may be helpful to bring a light snack to eat once the test is complete.

Tests that use a fingerstick do not usually have any post-test restrictions. A band-aid can be used if bleeding continues after you’ve taken the blood sample.

Cholesterol Test Results

Receiving test results

If your cholesterol is being analyzed by a laboratory after a needle blood draw, you can expect to receive results within a few days. The doctor’s office may contact you with results or schedule an appointment to review them. You may also receive results through an online health portal or in the mail.

For point-of-care tests or at-home test kits with a device for analyzing cholesterol, results are available within minutes.

Interpreting test results

Cholesterol levels are measured in milligrams per deciliter of blood (mg/dL). General reference ranges for total cholesterol are listed below:

  • Normal: under 200 mg/dL
  • Borderline high: 200-239 mg/dL
  • High: 240 mg/dL and above

Remember that total cholesterol alone does not offer a complete picture of your risk for cardiovascular problems. The amounts of good (HDL) and bad (LDL) cholesterol are important to consider, which is why these are evaluated as part of a complete lipid panel.

Your cholesterol test results are also not the only factor determining your heart health. Your age, family history, and health habits are elements that affect your cardiovascular disease risk. Your doctor may use a risk calculator to help analyze your test scores alongside these other factors.

Depending on your test scores and overall risk, treatment may be suggested to lower your cholesterol. Examples of treatment include lifestyle changes, such as quitting smoking or changing your diet, as well as medications that help decrease cholesterol. Your doctor can best discuss the benefits and risks of these approaches in your situation.

The main focus of cholesterol testing is on identifying cases of high cholesterol, but, although rare, it is possible to have very low levels. This is most often tied to an underlying health condition or malnutrition.

Are test results accurate?

Cholesterol testing is widely regarded as reliable. Although no test is perfect, laboratories follow strict protocols that help standardize cholesterol tests and make their results dependable. When these procedures and pre-test instructions are followed, inaccurate results are unlikely.

Point-of-care and at-home cholesterol tests are relatively accurate but are subject to more variation than laboratory testing. If abnormal results are found on one of these tests, follow-up testing by a laboratory is commonly recommended.

Do I need follow-up tests?

Repeat cholesterol testing is usually recommended for people who have previously had high cholesterol or who have risk factors for heart problems. The exact schedule for testing depends on your situation and likely involves a full lipid panel or measurement of HDL along with total cholesterol.

If you are not at high risk for cardiovascular problems and have had normal cholesterol levels in the past, follow-up testing is usually done every five years.

More specific or specialized tests may be needed in some circumstances. For example, the doctor may order a test to directly measure your levels of bad (LDL) cholesterol. Expanded lipid testing or non-laboratory tests like a cardiac stress test may be used as a way of evaluating your overall heart health.

Follow-up testing with a lipid panel and/or other tests is expected if you are found to have high cholesterol on an at-home or point-of-care test.

Questions for your doctor about test results

The following questions may be helpful as you discuss your cholesterol test results with your doctor:

  • What is my risk for cardiovascular disease? What factors affect that risk?
  • What do the cholesterol test results indicate about my heart health?
  • Have my cholesterol levels changed over time?
  • Do I need any follow-up tests?
  • How often should I have a cholesterol test?
  • Do you recommend treatment to lower my cardiovascular risk? What are the treatment options and their benefits and risks?

Related Tests

How is a total cholesterol test different from a lipid panel?

A total cholesterol test measures only the sum of all kinds of cholesterol. A lipid panel includes the total cholesterol measurement but also determines the levels of HDL, LDL, and triglycerides. For this reason, a lipid panel offers more detail and is more commonly used as a test for initial cholesterol screening.

How is a total cholesterol test different from an HDL test?

HDL is a type of cholesterol that is often referred to as good cholesterol. While HDL is included in total cholesterol, an HDL test measures the amount of this specific kind of cholesterol in the blood.

Total cholesterol and HDL are minimally affected by recent food consumption, so non-fasting cholesterol tests frequently include these two measurements. In some people, these measurements are sufficient to calculate a person’s level of bad cholesterol.

How is a total cholesterol test different from a direct LDL test?

A total cholesterol test does not differentiate between good and bad cholesterol, but the bad LDL cholesterol plays an important role in determining cardiovascular disease risk.

In a standard lipid panel, LDL is calculated based on the levels of other fat molecules. However, in some cases, those calculations can be thrown off, especially if a person has high levels of triglycerides. A direct LDL test avoids the need for calculation by measuring LDL specifically.

What is the difference between laboratory and point-of-care or at-home cholesterol tests?

Traditionally, cholesterol tests have been done in laboratories where clear procedures are in place for proper sample collection and analysis. These mechanisms help make sure that rest results are reliable.

New technologies have made point-of-care and at-home tests more widely available. When their instructions are correctly followed, these tests have nearly the same accuracy as laboratory tests.

For at-home and point-of-care tests, blood is taken from your fingertip instead of from a vein in your arm. Because results do not need to be sent to a laboratory, results are provided within minutes instead of days.

Laboratory testing is considered to be standard and is what doctors rely on to make medical decisions. That said, at-home and point-of-care tests are convenient and may help with ongoing monitoring of cholesterol.

Other related tests

Sources and Resources

These resources provide detailed information about cholesterol and its role in cardiovascular health:

Sources

A.D.A.M. Medical Encyclopedia. Familial hypercholesterolemia: MedlinePlus Medical Encyclopedia. Published February 26, 2021. Accessed March 25, 2021. https://medlineplus.gov/ency/article/000392.htm

American Heart Association. How To Get Your Cholesterol Tested. Updated November 9, 2020. Accessed March 11, 2021. https://www.heart.org/en/health-topics/cholesterol/how-to-get-your-cholesterol-tested

American Society for Clinical Pathology. Screening for cardiovascular disease. Published September 14, 2016. Accessed March 25, 2021. https://www.choosingwisely.org/clinician-lists/american-society-clinical-pathology-expanded-lipid-panels-to-screen-for-cardiovascular-disease/

Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in Circulation. 2019 Sep 10;140(11):e649-e650] [published correction appears in Circulation. 2020 Jan 28;141(4):e60] [published correction appears in Circulation. 2020 Apr 21;141(16):e774]. Circulation. 2019;140(11):e596-e646. doi:10.1161/CIR.0000000000000678

ARUP Consult. Atherosclerotic cardiovascular disease risk markers. Updated March 2021. Accessed March 11, 2021. https://arupconsult.com/content/cardiovascular-disease-traditional-risk-markers#toc-screening

Centers for Disease Control and Prevention. Cholesterol Reference Method Laboratory Network (CRMLN). Updated July 6, 2017. Accessed March 12, 2021. https://www.cdc.gov/labstandards/crmln.html

Chrostek L, Supronowicz L, Panasiuk A, Cylwik B, Gruszewska E, Flisiak R. The effect of the severity of liver cirrhosis on the level of lipids and lipoproteins. Clin Exp Med. 2014;14(4):417-421. doi:10.1007/s10238-013-0262-5

Davidson MH. Dyslipidemia. Merck Manuals Professional Edition. Updated December 2019. Accessed March 12, 2021. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/lipid-disorders/dyslipidemia

de Ferranti SD, Newburger JW. Dyslipidemia in children: Definition, screening, and diagnosis. In: Fulton DR, ed. UpToDate. Updated March 3, 2020. Accessed March 25, 2021. https://www.uptodate.com/contents/dyslipidemia-in-children-definition-screening-and-diagnosis

Food and Drug Administration. Cholesterol. Updated February 4, 2018. Accessed March 12, 2021. https://www.fda.gov/medical-devices/home-use-tests/cholesterol

Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in J Am Coll Cardiol. 2019 Jun 25;73(24):3234-3237]. J Am Coll Cardiol. 2019;73(24):3168-3209. doi:10.1016/j.jacc.2018.11.002

Kafonek SD, Donovan L, Lovejoy KL, Bachorik PS. Biological variation of lipids and lipoproteins in fingerstick blood. Clin Chem. 1996;42(12):2002-2007

MedlinePlus: National Library of Medicine. Cholesterol Levels. Updated July 30, 2020. Accessed March 30, 2021. https://medlineplus.gov/lab-tests/cholesterol-levels/

MedlinePlus: National Library of Medicine. Heart Diseases. Updated December 31, 2020. Accessed March 25, 2021. https://medlineplus.gov/heartdiseases.html

National Heart, Lung, and Blood Institute. Blood Cholesterol. Date unknown. Accessed March 12, 2021. https://www.nhlbi.nih.gov/health-topics/blood-cholesterol

National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention. How and when to have your cholesterol checked. Updated January 4, 2021. Accessed March 11, 2021. https://www.cdc.gov/cholesterol/checked.htm

National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention. Getting your cholesterol checked. Updated September 8, 2020. Accessed March 25, 2021. https://www.cdc.gov/cholesterol/cholesterol_screening.htm

Panz VR, Raal FJ, Paiker J, Immelman R, Miles H. Performance of the CardioChek PA and Cholestech LDX point-of-care analysers compared to clinical diagnostic laboratory methods for the measurement of lipids. Cardiovasc J S Afr. 2005;16(2):112-117

Pignone MP, Phillips CJ, Lannon CM, et al. Screening for Lipid Disorders. AHRQ Publication No. 01-S004. Agency for Healthcare Research and Quality; 2001. Accessed March 25, 2021. https://www.ahrq.gov/downloads/pub/prevent/pdfser/lipidser.pdf

Rosenson RS. Measurement of blood lipids and lipoproteins. In: Freeman MW, ed. UpToDate. Updated January 16, 2020. Accessed March 25, 2021. https://www.uptodate.com/contents/measurement-of-blood-lipids-and-lipoproteins

Tolfrey K. Intraindividual variability of children’s blood lipid and lipoprotein concentrations: a review. Prev Cardiol. 2002;5(3):145-151. doi:10.1111/j.1520-037x.2002.00563.x

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https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lipid-disorders-in-children-screening

U.S. Preventive Services Task Force. Statin use for the primary prevention of cardiovascular disease in adults: Preventive medication. Published November 13, 2016. Accessed March 25, 2021.

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Vijan S. Screening for lipid disorders in adults. In: Freeman MW, Elmore JG, eds. UpToDate. Updated February 28, 2020. Accessed March 25, 2021. https://www.uptodate.com/contents/screening-for-lipid-disorders-in-adults

Yang EH. Lipid Management Guidelines. Cloutier M, ed. Medscape. Updated November 30, 2018. Accessed March 19, 2021. https://emedicine.medscape.com/article/2500032-overview#a2

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