On a top 10 list of things to do, getting your cholesterol level checked likely doesn't make the cut – but no matter your age, knowing your numbers can be a crucial factor in overall health.
People in their 20s may never consider getting their cholesterol checked, but they should because it may uncover a genetic predisposition to high cholesterol that they didn't know about. 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 initial testing between ages of 9 and 11 and every five years after that.
People over age 40 should get a lipid panel annually, and they should ask to have it added to annual blood work if their primary care physician doesn't order it – since it is easily overlooked with the plethora of other issues being maintained, Farbaniec said.
What is a healthy level of cholesterol?
Cholesterol, a waxy substance made in the liver and found in the blood and all the body's cells, is needed for making cell walls, creating hormones, serving as protectants for cells and more. In order for muscles and cells to get energy, cholesterol is transported in the low-density lipoprotein (LDL), commonly called "bad cholesterol," and the high-density lipoprotein (HDL), or "good cholesterol."
In addition to total cholesterol, a 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 levels of triglycerides combined with low HDL cholesterol or high LDL cholesterol levels can increase your risk for plaque build-up, fatty liver disease, heart attack and stroke.
While many people can quote their total cholesterol number and are happy if it's under the recommended threshold of 200 mg/dL, it turns out the most important value to know is what's called non-HDL cholesterol. This number is arrived at by subtracting your HDL from your total cholesterol.
"We have shifted our thinking away from that total value because we know we were underestimating people's risk, and they were dying of heart disease," Farbaniec said. "If your total cholesterol is under 200, but your HDL is 25 and your LDL is 170, that's not good."
Treat to the risk, not the numbers
Ideally, non-HDL cholesterol will be less than 130 mg/dL for people without risk factors. For those with elevated heart disease risk due to a family or personal history of cardiovascular disease, other health problems or those with familial hypercholesterolemia – inherited high cholesterol that isn't impacted by a change in diet or exercise – the LDL value should be less than 70 mg/dL, Farbaniec said. Triglyceride values should be less than 150 mg/dL. A value above 200 is considered high.
That said, it's important to consider risk factors for cardiovascular disease on an individual basis rather than rely on the numbers.
"I had a patient with normal cholesterol, but she had a family history of heart disease at very early ages, and she was very concerned," Farbaniec said. "I did a coronary artery calcium scan, and it showed a lot of calcified plaque buildup. That told me she was someone at risk, despite her good numbers, but we could do something now to prevent more plaque buildup."
Others at risk for high cholesterol are those with high blood pressure, obesity, diabetes, premature heart disease, vascular disease and familial hypercholesterolemia, he said. Certain medications may also cause levels to rise.
The American College of Cardiology offers a risk calculator where users can input factor such as age, lipid values and other factors to estimate danger of atherosclerotic cardiovascular disease.
Take the first step
Getting a lipid panel done isn't hard. All it requires is a lab order from your doctor.
These days, most doctors don't require fasting for routine screening because the non HDL cholesterol levels are not altered by fasting. Some patients, particularly those already under treatment, may still wonder how long to fast for a lipid panel and the answer is about 10 hours, Farbaniec said.
Statins, prescription medicine drugs used to lower cholesterol levels, are the mainstay treatment for high cholesterol, but there are many other options, Farbaniec said.
"The most important thing is to get a lipid panel done," he said. "No one can feel if they have high cholesterol, but the results of a test can help us treat preventatively for a healthier future."
Studies have shown that statins may also shrink or stabilize plaque buildup, offering another reason why knowing the status of your cholesterol is important for overall health.
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