Hyperlipidemia Screening Recommendations
Begin lipid screening at age 40 for all adults, but start at age 20 for those with cardiovascular risk factors including diabetes, hypertension, smoking, family history of premature CHD, or obesity. 1, 2
Screening by Age and Risk Status
Adults Age 40-75 Years (Universal Screening)
- All adults in this age range should undergo lipid screening regardless of risk factors. 3, 1, 2
- The American College of Cardiology strongly recommends lipid testing for all adults 40-75 years, including total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. 2
- Screen every 5 years if no risk factors are present. 3, 1
- Screen every 2 years if risk factors are present. 3
Young Adults Age 20-39 Years (Risk-Based Screening)
Men age 20-35 years:
- Screen only if cardiovascular risk factors are present. 3, 1, 2
- Do not screen routinely in the absence of risk factors. 3, 1
Women age 20-45 years:
- Screen only if cardiovascular risk factors are present. 3, 2
- Do not screen routinely in the absence of risk factors. 3
Risk Factors That Warrant Earlier Screening at Age 20
The following risk factors justify beginning lipid screening at age 20 rather than waiting until age 40:
- Diabetes mellitus 1, 2
- Family history of premature cardiovascular disease (CHD in male first-degree relative <55 years; CHD in female first-degree relative <65 years) 3, 1
- Current cigarette smoking 3, 1
- Hypertension (untreated systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, or taking antihypertensive medication) 3, 1
- Obesity 1
- Chronic kidney disease 3
Approximately 59% of young adults have at least one of these risk factors, making them candidates for earlier screening. 4
Screening Components and Methodology
Recommended Tests
- Measure total cholesterol and HDL cholesterol as the primary screening components. 3, 1, 5
- Total cholesterol and HDL levels can be measured on non-fasting samples. 3, 1
- A complete fasting lipid profile (total cholesterol, LDL-C, HDL-C, and triglycerides) provides more comprehensive information but requires fasting. 3, 2
Confirmation of Results
- Abnormal results should be confirmed by a repeated sample on a separate occasion. 3, 1
- Use the average of both results for risk assessment and treatment decisions. 1
Screening Intervals
Standard intervals:
Adjust intervals based on individual circumstances:
- Shorter intervals are appropriate for persons with lipid levels close to treatment thresholds. 3, 1, 2
- Longer intervals may be appropriate for those with repeatedly normal lipid levels. 3, 1
Special Populations
Adults Over Age 75
- Routine lipid panel testing can be discontinued in adults over 75 years unless the patient is on statin therapy or has specific cardiovascular risk factors that warrant continued monitoring. 2
- Continue monitoring in patients already on statin therapy to assess medication adherence and efficacy. 2
High-Risk Young Adults
Although the evidence for screening young adults without risk factors is insufficient, cumulative exposure to even moderate hyperlipidemia in young adulthood increases subsequent CHD risk in a dose-dependent fashion. 6 This supports the rationale for risk-based screening starting at age 20 rather than universal screening in this age group.
Common Pitfalls to Avoid
- Do not rely on a single lipid measurement for diagnosis or treatment decisions—always confirm abnormal results. 1
- Do not screen all young adults regardless of risk factors—this leads to unnecessary testing and is not supported by guidelines. 3, 1
- Do not ignore risk factor assessment—approximately 65% of young adults with CHD or CHD equivalents have high LDL-C, yet screening rates remain below 50% even in high-risk young adults. 4
- Do not order lipoprotein(a) testing as part of routine screening—this is reserved for specific high-risk populations with premature CVD, familial hypercholesterolemia, or intermediate risk by standard calculators. 5