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Cholesterol testing

Cholesterol is a soft, wax-like substance found in all parts of the body. Your body needs a small amount of cholesterol. Too much cholesterol can clog your arteries and lead to heart disease, stroke, and other problems.

Some types of cholesterol are considered "good" and some are considered "bad." Different blood tests are used to measure each type.

A coronary risk profile is a group of blood tests that measure your cholesterol and triglyceride levels. The profile can help determine your risk for heart disease.

How the Test is Performed

A blood sample is needed. Most of the time blood is drawn from a vein located on the inside of the elbow or the back of the hand.

You may only have your total cholesterol level measured as the first test. This may include measurement of your HDL cholesterol levels. You may not need more cholesterol tests if your cholesterol is in the normal range.

You may also have a lipid (or coronary risk) profile, which includes:

  • Low density lipoprotein (LDL or "bad" cholesterol)
  • High density lipoprotein (HDL or "good" cholesterol)
  • Total cholesterol
  • Triglycerides
  • Very low density lipoprotein (VLDL cholesterol, though this is often calculated from the triglyceride level)

People who also have high triglyceride levels may get a test called a direct VLDL cholesterol (direct VLDL-C).

Other blood tests, such as C-reactive protein (CRP), may be added to the profile in some labs.

How to Prepare for the Test

If you are having only a cholesterol level test, you may not be able to eat before the test.

If you are having a lipid profile, you should not eat or drink anything except water 9 to 12 hours before having your blood drawn.

How the Test will Feel

You may feel slight pain or a sting when the needle is inserted. You may also feel some throbbing at the site after the blood is drawn.

Why the Test is Performed

Cholesterol blood tests help you and your doctor better understand your risk for heart disease, stroke, and other problems caused by blocked arteries.

ADULTS

Some guidelines recommend having the first test done at age 20. Everyone should have their first screening test by age 35 for men, and age 45 for women.

People who have diabetes, heart disease, stroke, or high blood pressure should always have a cholesterol test done, no matter what their age.

Follow-up testing should be done:

  • Every 5 years if your results were normal
  • More often for people with diabetes, high blood pressure, heart disease, stroke, or blood flow problems to the legs or feet.
  • More often if you are taking medications to control high cholesterol.

CHILDREN

Not all experts agree on when to first check levels in children.

  • Some experts recommend only screening children who have risk factors, such as a family history of high cholesterol or heart attacks before age 55 in men, and before age 65 in women.
  • Others recommend screening all children. The US Preventive Task Force feels there is not enough evidence to recommend for or against cholesterol screening in children.

Normal Results

The desired values in most healthy adults are:

  • LDL cholesterol: lower than 130 mg/dL (lower numbers are desired)
  • HDL cholesterol: greater than 40 - 60 mg/dL (higher numbers are desired)
  • Total cholesterol: less than 200 mg/dL (lower numbers are desired)
  • Triglycerides: 10 - 150 mg/dL (lower numbers are desired)
  • VLDL: 2 - 30 mg/dL

The ideal values for you depend on whether you have heart disease, diabetes,or other risk factors.

Talk to your health care provider about the ideal levels in children.

Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

The examples above show the common measurements for results for these tests. Some laboratories use different measurements or may test different specimens.

What Abnormal Results Mean

Abnormal values may be a sign that you are at higher risk for heart disease, stroke, and other problems caused by blocked arteries.

You may need treatment if your cholesterol is high. This can include medicines and lifestyle changes.

An active illness such as a flare-up of arthritis, can change your total cholesterol number. You should have the test repeated if you had illness in the 3 months before the test.

Alternative Names

Lipoprotein/cholesterol analysis; Lipid profile; Lipid panel; Hyperlipidemia - testing; Cholesterol and triglyceride test: coronary risk profile

References

Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the 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). JAMA. 2001;285:2486-2497.

Grundy SM, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004 Jul 13;110(2):227-39.

Semenkovich CF. Disorders of lipid metabolism. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 213.

Update Date: 5/5/2013

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.

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