How often should I have a fasting lipoprotein panel (total cholesterol, LDL‑C, HDL‑C, triglycerides) as an adult, considering my age, presence or absence of cardiovascular risk factors, and use of lipid‑lowering medication?

How Often Should I Check Lipoprotein Analysis?

For healthy adults without cardiovascular risk factors, obtain a fasting or nonfasting lipid profile every 5 years starting at age 40, with more frequent testing (annually or every 1-2 years) if you have 2 or more cardiac risk factors, borderline/high LDL-C levels, or are on lipid-lowering therapy. 1, 2

Screening Frequency by Age and Risk Status

Adults Age 40-75 Years

• All adults in this age range should have lipid testing performed, as this is the primary age group for cardiovascular risk assessment and prevention 1, 2
• For those without risk factors and with normal lipid levels, repeat testing every 5 years is appropriate 1, 3
• Shorter intervals (every 1-2 years) are warranted when lipid levels are close to treatment thresholds or borderline high 1, 3

Adults Under Age 40 Years

• Routine screening is not recommended for men under 35 or women under 45 unless specific risk factors are present 2, 3
• Begin screening at age 20 if you have any of the following risk factors: 1, 2
  • Diabetes mellitus
  • Family history of premature cardiovascular disease (male relative <55 years or female relative <65 years)
  • Current cigarette smoking
  • Hypertension (BP ≥140/90 mmHg or on antihypertensive medication)
  • Obesity
  • Multiple coronary heart disease risk factors
• When risk factors are present, obtain a lipid profile at initial evaluation and repeat every 5 years 1, 3

Adults Over Age 75 Years

• Routine lipid testing can be discontinued in adults over 75 years unless specific circumstances apply 3
• Continue monitoring if you are: 3
  • Already on statin therapy (to assess adherence and efficacy)
  • Have established atherosclerotic cardiovascular disease
  • Have diabetes with multiple cardiovascular risk factors
  • Recently had medication changes affecting lipid levels
• The predictive value of cholesterol for cardiovascular risk diminishes significantly after age 75 3

When to Increase Screening Frequency

More frequent testing (annually or every 1-2 years) is appropriate when: 1, 3

• You have 2 or more CHD risk factors (smoking, hypertension, HDL-C <40 mg/dL, family history of premature CHD, age >45 years for men or >65 years for women)
• Your LDL-C levels are borderline (130-159 mg/dL) or high (≥160 mg/dL)
• You have diabetes mellitus
• You are on lipid-lowering medication (to monitor treatment efficacy and adherence)
• Your lipid levels are close to treatment thresholds

Special Considerations for Lipoprotein(a) Testing

Lipoprotein(a) should only be measured once in your lifetime (or repeated at puberty in children), as levels are genetically determined and remain stable throughout adult life 4

Measure Lp(a) if you have: 4

• Family history of premature cardiovascular disease
• Unexplained early cardiovascular events in first-degree relatives
• Known elevated Lp(a) in family members
• Familial hypercholesterolemia
• Recurrent CVD despite optimal statin therapy
• Borderline cardiovascular risk (5-15% 10-year risk)

Do not routinely screen for Lp(a) unless these specific indications are present 1, 4

Practical Testing Considerations

Fasting vs. Nonfasting

• Either fasting or nonfasting lipid profiles are acceptable for initial screening and risk assessment 1
• Repeat in the fasting state if initial nonfasting triglycerides are ≥400 mg/dL (≥4.5 mmol/L) 1
• Maximal differences between fasting and nonfasting samples are clinically insignificant: triglycerides increase by ~26 mg/dL, while LDL-C decreases by only ~8 mg/dL 5

Confirming Abnormal Results

• Always confirm abnormal results with a repeat sample on a separate occasion 2
• Use the average of both results for risk assessment and treatment decisions 2
• This approach avoids treatment decisions based on a single potentially erroneous measurement 2

Common Pitfalls to Avoid

• Don't rely on a single lipid measurement for diagnosis or treatment decisions—always confirm with repeat testing 2
• Don't screen all young adults regardless of risk factors, as this leads to unnecessary testing 2
• Don't continue routine screening in adults over 75 with consistently normal levels and no cardiovascular disease 3
• Don't order advanced lipoprotein testing beyond a standard lipid profile for routine cardiovascular risk assessment—it provides no additional benefit 2
• Don't repeatedly measure Lp(a)—once is sufficient unless testing during childhood, in which case retest at puberty 4