Lipid Screening for a 21-Year-Old
For a 21-year-old without cardiovascular risk factors, routine lipid screening is not recommended, as the evidence is insufficient to support universal screening in this age group. 1
Evidence-Based Approach to Lipid Screening in Young Adults
Risk-Based Screening for Ages 20-39
- The USPSTF found insufficient evidence that screening for dyslipidemia before age 40 has an effect on short- or longer-term cardiovascular outcomes 1
- For young adults aged 20-35 (men) or 20-45 (women), screening is only recommended if they have other risk factors for coronary heart disease 1
Risk Factors That Would Warrant Screening at Age 21
If any of these risk factors are present, lipid screening would be indicated:
- Diabetes
- Current cigarette smoking
- Hypertension (BP ≥140/90 mmHg or on antihypertensive medication)
- Family history of premature CHD (male first-degree relative <55 years; female first-degree relative <65 years)
- BMI ≥85th percentile (overweight or obesity) 1, 2
Screening Protocol When Indicated
If risk factors are present and screening is warranted:
- Measure total cholesterol and HDL-C (can be done on non-fasting samples)
- If abnormal, confirm with a repeat sample on a separate occasion 1
- The average of both results should be used for risk assessment
- Consider a full fasting lipid panel for more comprehensive evaluation if initial screening is abnormal 1
Special Considerations for Young Adults
Universal Screening at Specific Ages
- According to the Expert Panel on Integrated Guidelines for Cardiovascular Health, there is a Grade B recommendation for universal lipid screening once between ages 17-21 1
- For ages 17-19: If non-HDL cholesterol ≥145 mg/dL or HDL cholesterol <40 mg/dL, a follow-up fasting lipid panel is recommended
- For ages 20-21: If non-HDL cholesterol ≥190 mg/dL or HDL cholesterol <40 mg/dL, a follow-up fasting lipid panel is recommended 1
Impact on Long-Term Cardiovascular Health
- While lipid measurement in low-risk young adults can detect some persons at increased long-term risk of heart disease, the absolute risk reduction from treating dyslipidemia in most persons is small before middle age 1
- The benefits of screening and treating high-risk young adults outweigh the harms, but the net benefits for low-risk young persons are not sufficient to make a general recommendation 1
Clinical Implications
The high prevalence of abnormal lipid levels among overweight and obese youth (42.9% in obese individuals) makes BMI an important consideration when deciding about lipid screening 2. If the 21-year-old has normal weight and no risk factors, the current evidence does not support routine screening at this time.
Clinicians should be aware that early identification of lipid disorders in young adults with risk factors can lead to earlier intervention and potentially reduce long-term cardiovascular risk, but universal screening in this age group without risk factors has not been proven beneficial for mortality and morbidity outcomes.