We see many patients every day who come in for a physical exam, a general check-up to make sure everything is okay. Frequently patients want to have routine blood work done to check for a variety of problems including liver, kidney, electrolytes, cell counts, and of course, cholesterol. Who really needs to be screened for these things? Should we screen everyone at every age? Every year? Below are the basic recommendations for cholesterol screening.
Based on recommendations from the United States Preventative Services Task Force (USPSTF) increased risk of coronary heart disease (CHD) is defined as the presence of any one of the following risk factors: diabetes; a personal history of CHD or non-coronary atherosclerosis; a family history of cardiovascular disease before 50 years of age in male relatives or before 60 years of age in female relatives; tobacco use; hypertension; and obesity (BMI greater than or equal to 30 kg per m2).
Decisions to screen for lipid disorders should be based on the patient's age and sex, and the presence of CHD risk factors. Women older than 20 years who are at risk of CHD are likely to benefit from screening. The optimal interval for lipid screening is uncertain. The USPSTF recommends that all men 35 years and older receive screening for lipid disorders. However, in men 20 to 35 years of age and women 20 years and older who are not at risk of CHD, the benefits and harms of screening are closely balanced. Consequently, the USPSTF makes no recommendation for or against routine lipid screening in these groups.
According to the USPSTF recommendation, the preferred screening tests for dyslipidemia are total cholesterol and HDL cholesterol levels from fasting or nonfasting samples. There is insufficient evidence of the benefit of including triglycerides. Abnormal screening test results should be confirmed by a repeat sample on a separate occasion, and the average of the two results should be used for risk assessment. Treatment decisions should take into account a person's overall risk of heart disease rather than lipid levels alone.