From the Guidelines
Adults should be screened for hyperlipidemia starting at age 20, with LDL-C as the primary lipid analysis for screening, risk estimation, diagnosis, and management.
Key Recommendations
- LDL-C should be used as the primary target for treatment, with goals of < 1.8 mmol/L (70 mg/dL) for very high CV risk patients, and < 2.6 mmol/L (100 mg/dL) for high CV risk patients 1.
- Screening should begin at age 20, with routine cholesterol testing recommended for young adults 1.
- Statin use is recommended for primary prevention of cardiovascular disease in adults, with the USPSTF recommending screening and statin use in adults aged 40-75 years with no history of CVD, and a calculated 10-year CVD risk of 10% or greater 1.
Important Considerations
- Familial hypercholesterolemia should be suspected in patients with severely elevated LDL-C, and treated accordingly 1.
- Lipoprotein(a) levels should be measured in patients at high risk of cardiovascular disease, with a target level below 50 mg/dL 1.
- The USPSTF recommends neither for nor against screening for dyslipidemia in adults aged 21-39 years, due to insufficient evidence 1.
From the Research
Adult Hyperlipidemia Screening
The recommended approach for adult hyperlipidemia screening involves systematic assessment of LDL-C levels as part of global cardiovascular risk assessment in all adults 2. This approach is considered a cornerstone of ASCVD risk prevention.
- Routine random screening of all adults for hypercholesterolemia is recommended, with reduced intake of saturated fat and cholesterol and medication as potential interventions 3.
- Current guidelines suggest screening for dyslipidemia in early adulthood, with a total cholesterol level potentially used as a screening test due to cost considerations 4.
- The National Cholesterol Education Program (NCEP) recommends measuring total serum cholesterol (TC) and high density lipoprotein-cholesterol (HDL-C) in adults at 5-year intervals beginning at age 20 5.
Screening Tests and Intervals
The choice of screening tests and intervals may vary depending on individual risk factors and guidelines.
- Total serum cholesterol (TC) and HDL-C are recommended as initial screening tests for dyslipidemia in the general population 5.
- Lipoprotein analysis, including TC, HDL-C, triglyceride, and estimated LDL-C, may be recommended for adults with elevated TC levels or other risk factors 5.
- Screening intervals may be every 5 years for adults, with more frequent screening potentially recommended for individuals with elevated risk factors 5.
Special Considerations
Certain populations may require special consideration when it comes to hyperlipidemia screening.
- Selective lipid profile screening may be useful in young adults, adolescents, and children with specific conditions, such as family history of early ASCVD or multiple concomitant cardiovascular risk factors 2.
- Cascade screening for family members of individuals diagnosed with familial hypercholesterolemia (FH) may be of great clinical impact 2.
- Pediatricians may be more likely to routinely offer screening for hyperlipidemia to children according to guidelines, compared to family practitioners 6.