What is the recommended frequency of lipid testing for adults with and without risk factors for cardiovascular disease?

Frequency of Lipid Testing in Adults

For adults without cardiovascular risk factors, lipid screening should be performed every 5 years starting at age 40, while those with risk factors should begin screening at age 20 and may require more frequent testing based on their risk profile. 1, 2

Age-Based Screening Recommendations

Adults Age 40-75 Years

• All adults in this age group should undergo lipid testing every 5 years, including measurement of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides 1, 2
• This represents the core screening population where benefits of detection and treatment clearly outweigh harms 3

Young Adults Age 20-39 Years

• Men age 20-35 years and women age 20-45 years should only be screened if they have cardiovascular risk factors 1, 2
• Risk factors warranting earlier screening include:
  • Diabetes 1, 2
  • Family history of premature cardiovascular disease (male relatives <55 years, female relatives <65 years) 3
  • Hypertension 3
  • Current cigarette smoking 3
  • Low HDL cholesterol (<40 mg/dL in men, <50 mg/dL in women) 3
• For young adults with risk factors, screening should occur every 5 years 1, 2

Adults Over Age 75 Years

• Routine lipid testing can be discontinued in adults over 75 years unless they are on statin therapy or have specific ongoing cardiovascular risk factors 1
• Continue monitoring in those already on statin therapy to assess adherence and efficacy 1
• The predictive value of cholesterol levels for cardiovascular risk diminishes significantly after age 75 1

Modified Screening Intervals Based on Risk

More Frequent Testing (Shorter Than 5 Years)

• Patients with multiple cardiovascular risk factors require more frequent monitoring 3
• Those with lipid levels close to treatment thresholds should be tested more frequently 1, 2
• Patients with diabetes, especially youth-onset type 1 diabetes, warrant more frequent testing 1
• Patients whose LDL level is only slightly below goal require closer monitoring 3

Less Frequent Testing (Longer Than 5 Years)

• Patients with repeatedly normal lipid levels and no cardiovascular disease may have longer intervals between tests 2
• This is particularly applicable to older adults over 75 years with consistently normal levels and no cardiovascular disease 1

Testing Methodology

Recommended Components

• Total cholesterol and HDL cholesterol are the essential components of routine lipid screening 3, 4
• These can be measured on non-fasting samples 3, 2
• Abnormal results should be confirmed by a repeated sample on a separate occasion, with the average of both results used for risk assessment 3, 2

Additional Testing Considerations

• LDL cholesterol and triglycerides provide additional information but require fasting samples 4
• In patients with elevated risk on screening, lipoprotein analysis including fasting triglyceride levels may be useful for choosing optimal treatments 2

Common Pitfalls to Avoid

Over-Testing

• Avoid routine lipid testing in young adults (men <35 years, women <45 years) without cardiovascular risk factors 3, 2
• Research demonstrates substantial over-testing occurs in low-risk populations, with 35.8% of low-risk males and 61.5% of low-risk females receiving unnecessary testing 5
• Do not rely on a single lipid measurement for diagnosis or treatment decisions 2

Under-Testing

• Between 21-25% of moderate and high-risk individuals not on statins receive no screening over 5 years, representing significant under-testing 5
• Ensure screening occurs in all adults 40-75 years regardless of perceived risk 1, 2

Testing Frequency Errors

• Questionable high-frequency testing (more often than annually) is common but not associated with improved goal attainment for most lipid parameters 6
• Base testing frequency on overall risk assessment rather than arbitrary intervals 6