At what age should a lipid panel be ordered in individuals with a normal Body Mass Index (BMI)?

From the Guidelines

Lipid panel screening should begin at age 20 for adults with normal BMI and no additional risk factors. The screening typically includes measurements of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. For those with normal results and no risk factors, repeat testing every 5 years is generally sufficient 1. However, more frequent testing (every 1-3 years) is recommended for individuals with additional cardiovascular risk factors such as family history of premature heart disease, smoking, hypertension, or diabetes, regardless of BMI.

Key Considerations

• The American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures recommends fasting lipid profile measurement for patients with at least one risk factor for coronary heart disease (CHD) 1.
• Risk factors include diabetes, current cigarette smoking, hypertension, and family history of premature CHD.
• The rationale for beginning screening at age 20 is that early detection of abnormal lipid levels allows for lifestyle modifications or medical interventions that can prevent the development of atherosclerosis and reduce long-term cardiovascular risk.

Screening Frequency

• For individuals with normal results and no risk factors, repeat testing every 5 years is generally sufficient 1.
• More frequent testing (every 1-3 years) is recommended for individuals with additional cardiovascular risk factors.

Important Notes

• Even in individuals with normal BMI, genetic factors can contribute to dyslipidemia, making screening important regardless of weight status.
• Children and adolescents with family history of high cholesterol or early heart disease may warrant screening before age 20.

Recommendations

• Lipid panel screening should begin at age 20 for adults with normal BMI and no additional risk factors.
• Repeat testing every 5 years is generally sufficient for those with normal results and no risk factors.
• More frequent testing is recommended for individuals with additional cardiovascular risk factors.

From the Research

Lipid Panel Screening

• The provided study 2 does not specify an exact age to order a lipid panel for individuals with a normal BMI.
• However, it discusses the importance of lipid measurements in managing patients at risk for atherosclerotic coronary heart disease (CHD) and atherosclerotic cardiovascular disease (ASCVD).
• The study highlights the acceptability of screening with nonfasting lipids and the reliability of measuring non-high-density lipoprotein cholesterol (non-HDL-C) in either the fasting or nonfasting state.

Lipid Measurement Considerations

• The study 2 recommends considering obtaining fasting lipids when LDL-C or triglyceride screening results are abnormal.
• It also discusses the estimation of low-density lipoprotein cholesterol (LDL-C) from total cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglyceride measurements.
• Advanced lipoprotein tests, such as apolipoprotein B (apoB) or LDL Particle Number (LDL-P), may help guide therapeutic decisions in select patients, but data are limited for patients already on lipid-lowering therapy with low LDL-C levels.

Reporting and Follow-Up

• Lipid laboratory reports should denote desirable values and specifically identify extremely elevated LDL-C levels (≥190 mg/dL at any age or ≥160 mg/dL in children) as severe hypercholesterolemia, as stated in the study 2.
• Potentially actionable abnormal lipid test results, including fasting triglycerides (TG) ≥500 mg/dL, should be reported as hypertriglyceridemia.
• Lipid measurements are recommended 4-12 weeks after a change in lipid treatment, according to the study 2.