On your list of top 10 things to do, checking your cholesterol level probably won’t help — but no matter your age, knowing your numbers can be crucial to overall health.
People in their 20s may never think to check their cholesterol, but they should because it can reveal a genetic predisposition to high cholesterol that they didn’t know existed. The sooner it’s treated, the more damage you can prevent.”
Dr. Michael Farbaniec, cardiologist, Penn State Health Milton S. Hershey Medical Center
In fact, the National Heart, Blood, and Lung Institute recommends an initial screening between ages 9 and 11 and every five years thereafter.
People over the age of 40 should get a lipid panel every year, and they should ask to have it added to their annual blood work if their primary care doctor doesn’t order it — because it’s easily overlooked with the multitude of other problems that persist, he said. Farbaniec.
What is a healthy cholesterol level?
Cholesterol, a waxy substance formed in the liver and found in the blood and all cells of the body, is needed to build cell walls, create hormones, serve as a cell protector, and more. In order for muscles and cells to get energy, cholesterol is transported in low-density lipoprotein (LDL), commonly called “bad cholesterol,” and high-density lipoprotein (HDL), or “good cholesterol.”
In addition to total cholesterol, the lipid panel measures these lipoproteins as well as triglycerides, fatty acids in the blood that the body uses for energy. Directly affected by exercise and diet, high triglyceride levels combined with low HDL cholesterol or high LDL cholesterol levels can increase the risk of plaque buildup, fatty liver disease, heart attack, and stroke.
While many people can quote their total cholesterol and are happy if it’s below the recommended threshold of 200 mg/dL, it turns out that the most important value to know is what’s called non-HDL cholesterol. This number is obtained by subtracting your HDL from your total cholesterol.
“We shifted our thinking away from that total because we know we were underestimating the risk to people and they were dying of heart disease,” Farbaniec said. “If your total cholesterol is below 200, but your HDL is 25 and your LDL is 170, that’s not good.”
Treat the risk, not the numbers
Ideally, non-HDL cholesterol would be below 130 mg/dL for people without risk factors. For those at increased risk of heart disease due to a family or personal history of heart disease, other health problems, or those with familial hypercholesterolemia—an inherited high cholesterol that is not affected by a change in diet or exercise—the LDL value should be below —as low as 70 mg/dL, Farbaniec said. Triglyceride levels should be below 150 mg/dL. A value above 200 is considered high.
However, it is important to consider heart disease risk factors on an individual basis rather than relying on the numbers.
“I had a patient with normal cholesterol, but she had a family history of heart disease at a very early age, and she was very concerned,” Farbaniec said. “I had a coronary artery calcium scan and it showed a lot of calcified plaque build-up. That told me she was at risk despite her good numbers, but we can do something now to prevent more plaque build-up.”
Others at risk for high cholesterol include those with high blood pressure, obesity, diabetes, premature heart disease, vascular disease and familial hypercholesterolemia, he said. Certain medications can also cause levels to rise.
The American College of Cardiology offers a risk calculator where users can enter factors such as age, lipid levels and other factors to estimate their risk of atherosclerotic cardiovascular disease.
Take the first step
Performing a lipid panel is not difficult. All it requires is a lab order from your doctor.
These days, most doctors do not require fasting for routine screening because non-HDL cholesterol levels are not changed by fasting. Some patients, especially those already on treatment, may still wonder how long to fast for a lipid panel, and the answer is about 10 hours, Farbaniec said.
Statins, prescription drugs used to lower cholesterol levels, are the main treatment for high cholesterol, but there are many other options, Farbaniec said.
“The most important thing is to do a lipid panel,” he said. “No one can feel if they have high cholesterol, but the test results can help us treat preventively for a healthier future.”
Studies show that statins can also reduce or stabilize plaque build-up, offering another reason why knowing your cholesterol status is important for overall health.
Penn State Health Milton S. Hershey Medical Center