Cholesterol: Knowing When to Check it

High cholesterol can lead to heart disease if left unchecked

/ Author:  / Reviewed by: Joseph V. Madia, MD

High cholesterol can have deadly consequences for the heart. However simple check ups and monitoring of cholesterol can make it manageable and controllable.

Most patients are more than willing to get their cholesterol checked when it is suggested by their physician. But for individuals who do not get regular check ups, it may be a simple test that they could seek out on their own.

Unlike certain hereditary conditions, cholesterol is inherently manageable, and keeping it in check significantly lowers the risk of heart disease, including heart attack and stroke.

"We don't have any problems getting people to take that test,"said Carol Wolin-Riklin, a registered dietitian at The University of Texas Health Science Center at Houston." That's the one test that people want to have done. They know it's a killer."

When to check

For most, cholesterol check ups should begin at the age of 20 with subsequent screenings every five years if cholesterol is in the desirable range.

Total cholesterol should remain under 200 mg/dL, while cholesterol between 200 and 239 is considered borderline and cholesterol above that is classified as high. Though cholesterol is naturally produced by the human body to keep it healthy, having too much can lead to clogged arteries.

"Some family practices do it as part of an annual screening," Wolin-Riklin noted. "Now so many Americans are overweight or obese, which is a risk factor, that it just has to be done."

In 2001, the National Cholesterol Education Panel issued major changes in clinical guidelines, which increased the number of Americans requiring high cholesterol treatment from 52 million to 65 million. It also meant that 36 million would need to take medication as compared to the previous 13 million taking drugs to control their cholesterol.

Though the guidelines placed a larger percentage of Americans into a group requiring treatment for high cholesterol, the more aggressive guidelines that encouraged diet and lifestyle management, recognition of the risk of patients who also suffer from type 2 diabetes and a new focus on high triglycerides, the most common fat in the body, have helped improve treatment for high cholesterol.

There also have been changes in monitoring cholesterol in children. In 2008, guidelines brought forth by the American Academy of Pediatrics suggested a baseline cholesterol check for children and teenagers with a family history of high cholesterol or heart disease.

The agency also recommended a cholesterol screening for children with unknown family history or other risk factors such as obesity, high blood pressure or diabetes. The testing is suggested between the ages of 2 and 10. If cholesterol was found to be high, kids could be subject to regular monitoring. Repeat testing is suggested in three to five years if the cholesterol levels are found to fall within the desirable range.

The guidelines, which were published in the July 2008 edition of Pediatrics, went even a step further, asking that doctors consider cholesterol-lowering medications for children over 8 years old who have elevated levels of "bad" LDL cholesterol. In younger patients nutritional counseling is recommended along with promoting weight reduction and increased physical activity.

Physicians also were advised to suggest reduced-fat dairy products such as 2 percent milk for overweight children as young as 1-year-old.

How to check

When it comes to a cholesterol screening, it is done through a simple blood test called a fasting lipid profile, generally after a person has been fasting between nine to 12 hours.

The test is usually performed once every five years though it is often performed more often for those with high cholesterol, those with other risks of heart disease or patients over the age of 50.

Home testing devices are available, with some that measure only total cholesterol, while others measure HDL and LDL cholesterol, and triglycerides. The American Heart Association has not offered a position on use of such devices, but patients that use home devices should still ensure they also receive screenings from a physician to make sure that the results are interpreted correctly, and that the appropriate treatment is recommended.

Though not standard at every doctor's office or outpatient lab that tests cholesterol levels, some testing also may indicate a person's risk of heart disease. Wolin-Riklin noted that when her patients are checked, they are assigned a number that corresponds to their risk of developing coronary heart disease. The higher the number, the more at risk the patient is.

Unlike some tests, patients don't seem hesitant to comply with cholesterol screenings when it is suggested by their doctor.

"They want to find out if they need medication to make their heart healthier. It's the fear that gives them more motivation to work on it," Wolin-Riklin said.

Even patients without insurance or who have low-income can generally find public cholesterol screenings that may be available free or for a reduced fee. It's important not to skip the test but because most of the time there are no symptoms associated with high cholesterol, and left unchecked patients may find out only after they exhibit symptoms of heart disease.

What the test really means

With all those numbers, most find the concept of total cholesterol versus LDL or HDL cholesterol and triglycerides a tricky topic.

The American Heart Association considers triglycerides under 150 mg/dL within the normal range, while less than 200 is borderline high and over 200 falls within the high range.

LDL or "bad" cholesterol should remain under 100 mg/dL, while over 160 is considered high per American Heart Association guidelines. When it comes to HDL or "good" cholesterol, maintaining at least 60 mg/dL can provide protection from heart disease. HDL is considered too low at 40 mg/dL in men and 50 mg/dL in women.

"It is confusing," noted Wolin-Riklin. "Especially since HDL is good cholesterol and you want that number to be high."

Instead of doing the math to find out which numbers are too high or low, she suggested that patients instead pay attention to total cholesterol and triglycerides.

After looking at these numbers, for some patients it may be time to take action. Finding out your cholesterol is elevated, however, doesn't automatically mean prescription medication. Though that is one treatment available, many patients are able to successfully manage their cholesterol through lifestyle changes.

Maintaining a healthy weight through eating a balanced diet full of fresh fruits, vegetables, whole grains and lean meats while avoiding trans fats may be one of the simplest methods for making major changes in your cholesterol.

Physical activity for at least half an hour to an hour on most days and quitting smoking also can significantly reduce cholesterol and lower your risk of heart disease.

But since genetics play a part in cholesterol, lifestyle changes may not be enough for some patients, though they can aid in reducing the number of medications needed. Cholesterol-lowering statins, cholesterol absorption inhibitors, fibrates or bile-acid binding drugs may help in those cases -- either alone or in combination.

"The more active you are in lowering your cholesterol levels, the more proactive you are in reducing your risk of heart disease," said Wolin-Riklin.

Reviewed by: 
Review Date: 
October 6, 2011