Lipid Panel

The lipid panel measures the amount of specific fat molecules called lipids in the blood. As a panel test, it measures multiple substances, including several types of cholesterol.

The lipid panel is used in both children and adults to evaluate risk of cardiovascular diseases like heart disease, heart attack, and stroke.

Purpose of the test

The lipid panel helps evaluate cardiovascular health by analyzing cholesterol in the blood. Too much cholesterol can build up in the blood vessels and arteries, damaging them and heightening the risk of problems like heart disease, stroke, and heart attack.

A lipid panel can be ordered for several reasons:

• Screening: This is routine testing to determine if your cholesterol is normal or falls into a borderline-, intermediate-, or high-risk category.
• Monitoring: If you have abnormal results on earlier testing or other risk factors for heart disease, lipid testing can monitor the cholesterol in your blood.
• Measuring response to treatment: If you have been told to make lifestyle changes or take cholesterol medications, a lipid panel can evaluate your response to treatment.
• Diagnosis: Testing lipid levels can be part of the diagnosis of other medical conditions, such as diseases that affect the liver.

What does the test measure?

Lipids are types of fat molecules in the blood. Cholesterol and triglycerides are two important types of lipids that are carried inside particles called lipoproteins.

The lipid panel analyzes your blood to measure different types of lipids:

• Total cholesterol: This measures your overall cholesterol level.
• Low-density lipoprotein (LDL) cholesterol: This type of cholesterol, known as “bad cholesterol,” can collect in blood vessels and increase your risk of cardiovascular disease.
• High-density lipoprotein (HDL) cholesterol: This type of “good cholesterol” helps reduce the buildup of LDL.
• Triglycerides: Excess amounts of this type of fat are associated with cardiovascular disease and pancreatic inflammation.

While these are the principal measurements in the standard lipid panel, some versions of the test may report additional measurements.

When should I get a lipid panel test?

There are a number of circumstances in which it is appropriate to get a lipid panel test. Depending on the medical context, the test may be used for screening, diagnosis, or monitoring.

Screening

Screening is looking for a health problem before any immediate signs or symptoms have appeared. The lipid panel can be used to identify people at high risk of cardiovascular disease before they develop problems like heart disease or heart attack.

Recommendations for cardiac screening with the lipid panel vary between medical organizations. Screening may provide early warning to prevent problems, but it can be costly, cause anxiety, and lead to potentially unnecessary treatments. Different groups of experts evaluate the evidence and come to different conclusions about who should get screened and how often screening should take place.

In adults without risk factors for cardiovascular disease, screening may be done about every five years. Evidence is unclear about the optimal age to start screening in low-risk patients. A doctor may recommend a first lipid test in a person’s 20s, 30s, or 40s depending on their situation.

People who have one or more risk factors typically have more frequent screening and often have their first test at a younger age. Examples of risk factors include:

• Age over 45 for men and 50-55 for women
• High cholesterol on a prior test
• Previous cardiovascular problem
• Smoking cigarettes
• Being overweight or obese
• Eating an unhealthy diet
• Not getting enough physical activity
• Having high blood pressure (hypertension)
• Having a first-degree relative who developed heart disease at an early age (under 55 in men and under 65 in women)
• Having diabetes or prediabetes

If you have one or more risk factors, you may receive a lipid test every year or every few years. The frequency of testing may depend on the results of prior tests.

For adults over 65, annual lipid testing is recommended by some experts. Other doctors may slow or stop regular screening if a patient’s levels appear to be stable.

In children, screening may begin once risk factors are identified starting at the age of two. Follow-up testing is generally continued at least every few years depending on test results and risk assessment.

Children without risk factors may still have a lipid panel test before starting puberty. Another test may be performed after age 16. Changes to blood lipids during puberty can reduce test accuracy from ages 12-16, so the test is less often used in children of that age range who do not have risk factors.

Children who are at a high risk of an inherited condition called familial hypercholesterolemia generally have more regular screening. Because this condition can cause heart problems at a young age, screening is often done at age 3, between 9-11, and at age 18.

While there is no firm consensus about screening with lipid tests, the table below summarizes common approaches to this testing.

Monitoring

The lipid panel is frequently used for ongoing monitoring of cardiovascular risk after a person has had high cholesterol on a prior test or after a previous cardiac event like a heart attack or stroke.

In many cases, people who are at higher risk of cardiovascular problems make lifestyle changes or take medications to help reduce that risk. A lipid panel may be used to monitor their response to treatment and adjust their treatment plan as necessary.

Diagnosis

While most lipid tests are used for screening or monitoring, they are sometimes used as part of the diagnostic process for health conditions that can affect lipid levels, such as pancreatitis, chronic kidney disease, or hypothyroidism.

How to get tested

Many lipid tests are done with a blood draw in a doctor’s office, lab, medical clinic, or hospital. The test is usually ordered by your doctor. After being taken, your blood sample is sent to a laboratory for analysis.

Point-of-care lipid testing involves a drop of blood taken from your finger that is immediately analyzed by a small device. This type of test is used in some clinics and at events like health fairs.

Can I take the test at home?

There are two primary ways that lipid testing can be done at home:

• You take a small blood sample and send it to a laboratory for analysis.
• You prick your finger and put a small drop of blood on a piece of paper. The paper either changes color or is analyzed by a small machine to determine cholesterol levels.

How much does the test cost?

The cost of a lipid panel depends on where the test is taken and if you have insurance coverage.

When prescribed by a doctor, this type of bloodwork is normally covered by insurance, but you may still have costs for a copay or deductible. There can also be fees charged by the technicians who draw your blood. Check with your doctor and insurance plan about the cost of the test.

Point-of-care testing at walk-in clinics or pharmacies often costs less than $100. Point-of-care testing at health fairs is usually done at no charge or very low-cost.

At-home testing kits that include the device that analyzes your blood frequently cost less than $150, although more expensive models are also available. Kits generally allow you to test your cholesterol multiple times with separate test strips.

The lipid panel requires a blood sample.

• For laboratory testing, the blood sample is drawn from your vein with a needle and sent to a lab.
• For point-of-care and at-home testing, blood is drawn from your fingertip.

Before the test

For laboratory lipid testing, you typically must fast for 9-12 hours before your blood is drawn. This means not eating and drinking only water before the test.

In some cases, lipid testing without fasting is possible, but you should ask your doctor’s office in advance about whether you need to fast and always follow any pre-test instructions you are given.

During the test

In most lipid tests, a blood sample is taken with a needle inserted into a vein in your arm. Before your blood is drawn, an elastic band is tied around your upper arm to increase blood in the veins, and the puncture location is wiped clean with an antiseptic.

A needle blood draw may cause a temporary sting. The blood draw normally lasts for less than a minute.

Sometimes a drop of blood is collected by puncturing the skin on a fingertip. This fingerstick sample is used when a lipid panel is being measured on a portable testing device, for example, at a pharmacy or health fair. It involves a quick sting but little pain or bleeding.

After the test

After blood is drawn from a vein, a cotton swab and/or band-aid is placed over the puncture site. You will normally be instructed to keep this in place for an hour or more to prevent any unwanted bleeding.

This is a routine out-patient procedure, and you can typically drive and return to basic activities as soon as the test is over. If fasting was required, you may want to bring something to eat for right after the test. You may be advised to restrict intense exercise or physical activity for a few hours after the test.

Fingerstick cholesterol tests do not usually require any special post-test restrictions.

The lipid panel requires a blood sample.

• For laboratory testing, the blood sample is drawn from your vein with a needle and sent to a lab.
• For point-of-care and at-home testing, blood is drawn from your fingertip.

Before the test

For laboratory lipid testing, you typically must fast for 9-12 hours before your blood is drawn. This means not eating and drinking only water before the test.

In some cases, lipid testing without fasting is possible, but you should ask your doctor’s office in advance about whether you need to fast and always follow any pre-test instructions you are given.

During the test

In most lipid tests, a blood sample is taken with a needle inserted into a vein in your arm. Before your blood is drawn, an elastic band is tied around your upper arm to increase blood in the veins, and the puncture location is wiped clean with an antiseptic.

A needle blood draw may cause a temporary sting. The blood draw normally lasts for less than a minute.

Sometimes a drop of blood is collected by puncturing the skin on a fingertip. This fingerstick sample is used when a lipid panel is being measured on a portable testing device, for example, at a pharmacy or health fair. It involves a quick sting but little pain or bleeding.

After the test

After blood is drawn from a vein, a cotton swab and/or band-aid is placed over the puncture site. You will normally be instructed to keep this in place for an hour or more to prevent any unwanted bleeding.

This is a routine out-patient procedure, and you can typically drive and return to basic activities as soon as the test is over. If fasting was required, you may want to bring something to eat for right after the test. You may be advised to restrict intense exercise or physical activity for a few hours after the test.

Fingerstick cholesterol tests do not usually require any special post-test restrictions.

Receiving test results

When a blood sample for a lipid test is taken with a needle, lab analysis is usually completed and available within a few days. Your results may be sent to you in the mail or made accessible through an online health portal. Your doctor’s office may also contact you about your results. A follow-up appointment may be recommended to review your results and any necessary next steps.

Point-of-care and at-home tests provide results within a few minutes.

Interpreting test results

The results of your lipid panel are reported for each type of cholesterol and triglycerides. These are measured in milligrams per deciliter of blood (mg/dL).

The optimal or target level for each part of the standard lipid test are listed below:

• Total cholesterol: Below 200 mg/dL
• HDL (good) cholesterol: Above 60 mg/dL
• LDL (bad) cholesterol: Below 100 mg/dL (For people with diabetes: Below 70 mg/dL)
• Triglycerides: Below 150 mg/dL

Values that do not meet these targets may be classified as borderline-, intermediate-, or high-risk. In general, higher-than-target levels of total cholesterol, LDL, and triglycerides and lower-than-target levels of HDL can heighten the risk of cardiovascular problems.

Test results are interpreted in the context of your overall health and other risk factors. Many doctors use special risk calculators that incorporate your test results, age, and other factors to determine the most appropriate next steps.

Continued cholesterol monitoring, lifestyle changes, and/or medications may be recommended to lower cholesterol and decrease cardiovascular risk, but there is not a universal consensus about when these types of interventions are optimal.

Cholesterol-lowering medications, such as a class of drugs called statins, are most likely to be recommended for patients with very high LDL or elevated LDL combined with other risk factors such as diabetes or past cardiovascular problems.

Abnormally low levels of cholesterol are rare and usually associated with a health condition causing malnutrition.

Are test results accurate?

Cholesterol testing is routine and reliable. While no test is 100% accurate, careful laboratory procedures help ensure dependable test results. If proper test procedures and preparation are followed, including fasting when needed, false positive or false negative results are rare.

Point-of-care lipid testing, which is performed on-site and not in a laboratory, has more variability than laboratory testing but still provides a meaningful reference point for measuring cholesterol. When point-of-care or at-home tests show abnormal lipid levels, follow-up testing is often recommended in a certified laboratory.

Do I need follow-up tests?

If you have risk factors for heart disease or abnormal lipid levels, repeat testing may be conducted at regular intervals in the future. Your doctor can recommend a schedule for future testing.

If your lipid levels are normal, you may not need repeat testing for another five years unless your overall health or risk factors change.

In some cases, other types of cholesterol testing, such as direct LDL testing, may be needed if you have high levels of triglycerides. While not included in the standard lipid panel, expanded lipid measurements, such as LDL particle testing, may be ordered. Additional types of tests, such as a cardiac stress test, may also be considered as part of an overall cardiovascular risk assessment.

If you take a point-of-care or at-home test that shows abnormal cholesterol levels, it is common to have follow-up testing done by a laboratory.

Questions for your doctor about your test results

When reviewing your test results with your doctor, some questions that may be helpful include:

• What are my risk factors for cardiovascular disease?
• What do my test results show about my cardiovascular health?
• Have my lipid levels changed over time?
• Do I need any follow-up tests? When should I have another cholesterol test?
• Are any treatments recommended based on my test results? What are my treatment options and their benefits and risks?

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

A total cholesterol test measures all of the cholesterol in your blood sample without providing the separate results for LDL, HDL, and triglycerides included in a lipid panel.

Sometimes a total cholesterol test is used for initial screening instead of the lipid panel; however, even in these cases, it is usually combined with an HDL cholesterol measurement to assure that you have a healthy proportion of “good” versus “bad” cholesterol. Total cholesterol and HDL can generally be measured without fasting beforehand.

How is a lipid panel different from a direct LDL test?

On a normal lipid panel, the level of LDL is determined based on a calculation using other measurements in the panel. However, this calculation is not valid if triglycerides are over 400 mg/dL. Some other health conditions, such as liver diseases, can also affect the accuracy of calculating LDL in this way.

When LDL cannot be calculated from the lipid panel, a direct LDL cholesterol test is used. Some labs automatically do a direct LDL analysis when triglycerides are high, or your doctor may request direct LDL measurement if you have a history of high triglycerides. If not, a separate blood sample may be needed for direct LDL testing.

How are laboratory and at-home cholesterol tests different?

Many lipid tests are conducted in a laboratory because it offers clearer quality control for sample collection and analysis. However, at-home tests are nearly as accurate if all instructions are followed.

At-home tests do not require taking blood from a vein. Instead, the blood sample comes from your fingertip. Depending on the type of at-home test, you may get results immediately compared to within a few days when lipids are measured by a lab.

Some at-home tests only measure total cholesterol, which is distinct from the more detailed lipid panel. The exact measurements as well as their accuracy can vary depending on the brand.

For most doctors, laboratory testing is the standard, especially for making decisions about treatment, but at-home tests can offer convenience for people who want to have their cholesterol checked.

Other related tests

• Total cholesterol test
• Direct LDL cholesterol
• HDL cholesterol test
• Triglycerides test
• VLDL cholesterol test
• Vertical Auto Profile (VAP) test
• Cardiac risk assessment

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

• National Library of Medicine: Cholesterol
• National Heart, Lung, and Blood Institute: Blood Cholesterol
• CDC: Cholesterol
• National Heart, Lung, and Blood Institute: Heart-Healthy Living

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