On the top 10 list of things to do, getting your cholesterol level checked probably isn’t low—but regardless of your age, knowing your numbers can be a critical factor in overall health.
People in their 20s may never consider getting their cholesterol checked, but they should because it can uncover a genetic predisposition to high cholesterol that they didn’t know existed. The sooner it’s treated, the more damage you can prevent.”
Dr. Michael Farbaniec, cardiologist, Penn State Health Milton S. Hershey Medical Center
In fact, the National Heart, Blood and Lung Institute recommends basic screening between ages 9 and 11 and every five years thereafter.
People over age 40 should get a lipid panel annually, and if their primary care doctor doesn’t order it, they should ask to have it added to annual blood work — because it can be easily overlooked with the maintenance of a host of other problems, Farbanic said. . .
What is a healthy cholesterol level?
Cholesterol, a waxy substance made in the liver and found in the blood and in all cells of the body, is needed to make cell walls, make hormones, serve as guards for cells, and more. For muscle and cell energy, cholesterol is transported as low-density lipoprotein (LDL), commonly known as “bad cholesterol,” and high-density lipoprotein (HDL), or “good cholesterol.”
In addition to total cholesterol, a lipid panel measures these lipoproteins as well as triglycerides, fatty acids in the blood that the body uses for energy. Directly affected by exercise and diet, high levels of triglycerides combined with low HDL cholesterol or high LDL cholesterol levels can increase your risk for plaque formation, fatty liver disease, heart attack and stroke.
While most people can quote their total cholesterol number and be happy if it’s under the recommended limit of 200 mg/dL, the most important value to know is what’s called non-HDL cholesterol. This number comes from subtracting your HDL from your total cholesterol.
“We’ve shifted our thinking away from that absolute value because we know we’re underestimating people’s risk, and they’re dying of heart disease,” Farbanik said. “If your total cholesterol is under 200, but your HDL is 25 and your LDL is 170, that’s not good.”
Treat risk, not numbers
Ideally, non-HDL cholesterol should be less than 130 mg/dL for people without risk factors. For those with an increased risk of heart disease due to cardiovascular disease, other health problems, or familial hypercholesterolemia—a family or personal history of inherited high cholesterol that is not affected by diet or exercise changes—the LDL should be lower than that. 70 mg/dL, Farbaniec said. Triglyceride values should be less than 150 mg/dL. A value above 200 is considered high.
That said, it’s important to consider cardiovascular disease risk factors individually rather than relying on numbers.
“I had a patient with normal cholesterol, but she had a family history of heart disease at a very young age, and she was very concerned,” Farbanik said. “I did a coronary artery calcium scan, and it showed calcified plaque build-up. That told me she was at risk, even though she had good numbers, but we could do something now to prevent further plaque build-up.”
Other risk factors for high cholesterol include high blood pressure, obesity, diabetes, premature heart disease, vascular disease and familial hypercholesterolemia, he said. Certain medications can also cause elevated levels.
The American College of Cardiology offers a risk calculator where users can enter age, lipid values, and other factors to estimate their risk of developing atherosclerotic heart disease.
Take the first step
Making a lipid panel is not difficult. All it takes is a lab order from your doctor.
These days, most doctors don’t require fasting for routine screening because fasting doesn’t change non-HDL cholesterol levels. Some patients, especially those already receiving treatment, may still wonder how long they need to fast for a lipid panel, and the answer is about 10 hours, Farbanik said.
Statins, prescription drugs used to lower cholesterol levels, are the main treatment for high cholesterol, but there are many other options, Farbanic said.
“The most important thing is to build a lipid panel,” he said. “No one knows if they have high cholesterol, but the results of a test can help us provide preventative treatment for a healthier future.”
Studies have shown that statins can reduce or stabilize plaque build-up, providing another reason why knowing your cholesterol status is important for overall health.
Penn State Health Milton S. Hershey Medical Center