How often should cholesterol levels be rechecked in adults with normal levels and no history of cardiovascular disease?

Cholesterol Screening Frequency for Adults with Normal Levels

For adults with normal cholesterol levels and no history of cardiovascular disease, cholesterol should be rechecked every 5 years. 1, 2

Age-Based Screening Recommendations

• For adults aged 20-39 years with normal levels and no risk factors, cholesterol screening is not routinely recommended until age 40 1, 2
• For adults aged 40-75 years with normal levels, cholesterol should be rechecked every 5 years 1, 2
• For adults over 75 years with consistently normal levels, routine screening can be discontinued unless on statin therapy or with specific cardiovascular risk factors 3

Risk Factors That Modify Screening Frequency

• Adults with lipid levels close to treatment thresholds should be screened at shorter intervals than 5 years 1, 2
• Adults with repeatedly normal lipid levels may be appropriate for longer screening intervals 1
• Adults with any of the following risk factors should be screened more frequently (every 2 years): 1
  • Family history of premature coronary artery disease (before age 50 in male relatives or age 60 in female relatives) 2
  • Diabetes 1, 2
  • Hypertension 1
  • Tobacco use 2
  • Obesity (BMI ≥25 kg/m²) 2

Components of Cholesterol Screening

• A complete lipid panel should include: 1
  • Total cholesterol 1
  • LDL cholesterol 1
  • HDL cholesterol 1
  • Triglycerides 1
• Non-fasting samples can be used to measure total cholesterol and HDL levels 2
• Abnormal results should be confirmed with a repeat sample on a separate occasion 2

Risk Assessment Considerations

• All adults aged 40 years or older should know their absolute risk of developing coronary heart disease 1
• For adults aged 40-75 years, the pooled cohort equations should be used to provide a 10-year atherosclerotic cardiovascular disease risk assessment 4
• Risk assessment should be repeated every 5 years (or more frequently if risk factors change) 1

Common Pitfalls to Avoid

• Relying on a single lipid measurement for diagnosis or treatment decisions 2
• Screening all young adults regardless of risk factors, which may lead to unnecessary testing 2
• Failing to recognize that early elevated non-HDL-C levels often persist throughout life and are associated with increased cardiovascular risk 5
• Not considering that adults with normal cholesterol levels in young adulthood are likely to maintain these levels over time 5

Special Considerations

• Early lipid monitoring before 40 years of age would identify those with a high likelihood for lifetime elevated lipid levels who also have increased long-term risk for cardiovascular disease 5
• Despite improved LDL-C levels in the general population, many adults with cardiovascular disease or related comorbidities are not at recommended levels for all lipids 6