Beginning in childhood, the waxy substance called cholesterol and other fatty substances known as lipids begin to build up in the arteries, hardening into plaques that narrow the passageway. During adulthood, plaque buildup and resulting health problems occur not only in the arteries supplying blood to the heart muscle but in arteries throughout the body (a problem known as atherosclerosis). For both men and women in the U.S., the number one cause of death is heart disease, and the amount of cholesterol in your blood greatly affects your chances of suffering from it.

Because heart disease is America’s biggest health problem, you can expect health care providers to be interested in helping you avoid its effects (a heart attack, stroke, serious disability, or even early death) by routinely ordering a blood cholesterol screening test. Cholesterol-lowering is important for men and women of all ages. The experts even encourage reducing cholesterol intake in children and teens as a way to prevent heart disease in adulthood.

The National Cholesterol Education Program and the American Heart Association recommend the most rigorous screening approach, beginning in young adulthood:

If you do not eat for 9 to 12 hours before taking this blood test, the test provides four measurements: 1) total cholesterol, 2) LDL cholesterol, which you want to be low because it contributes to buildup and blockage, 3) HDL cholesterol, which you want to be high because it helps remove cholesterol, and 4) triglycerides (another form of fat in your blood). This “fasting” test is the preferred initial test, according to the National Cholesterol Education Program.

Without fasting, two useful measurements can be obtained: total cholesterol and HDL cholesterol. The U.S. Preventive Services Task Force, the American Academy of Family Physicians, and the American College of Preventive Medicine say you can start with the nonfasting test and, if you have no risk factors, begin monitoring your cholesterol later, in middle age. If these two measurements indicate a problem, you can have the more complete test done. Their recommendation:

You also are more vulnerable and would want more frequent testing if you have any known risk factors ? such as smoking, high blood pressure (140/90 or higher or you take antihypertensive medications), diabetes, obesity/overweight, a family history of early heart disease, a low level of the “good” HDL cholesterol (less than 40 mg/dL), or a high total and high LDL cholesterol.

A final note: with just two risk factors, you fit into a category that benefits from closer monitoring. The National Heart, Lung, and Blood Institute announced in July 2004 that if you fit the “high” or “moderately high” risk categories, you will reduce your risk of having a heart attack by keeping your LDL cholesterol at a lower level (under 100 mg/dL), by medication if necessary.

Links

Sources
American Academy of Family Physicians. Heart disease and heart attacks: what women need to know. Available on the Internet at http://www.familydoctor.org/x50-22.xml. Accessed August 4, 2004.

American Academy of Family Physicians. Heart disease: assessing your risk. Available on the Internet at http://www.familydoctor.org/x2756.xml. Accessed July 16, 2004.

American Academy of Family Physicians. Summary of policy recommendations for periodic health examinations. 2003 Aug. Available on the Internet from the National Guideline Clearinghouse at http://www.guidelines.gov/summary/summary.aspx?doc_id=4183&nbr=3208. Accessed July 19, 2004.

American Academy of Pediatrics, Committee on Nutrition. Cholesterol in childhood (policy statement). 1998 Jan. Pediatrics 101:1;141-147. Available on the Internet at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;101/1/141. Accessed August 10, 2004.

American College of Preventive Medicine. Screening for lipid disorders. Available on the Internet at http://www.acpm.org/cpslipiddisorders.htm. Accessed August 5, 2004.

American Heart Association. Get your cholesterol checked. Available on the Internet at http://www.americanheart.org/presenter.jhtml?identifier=541. Accessed July 16, 2004.

Berg AO, for the United States Preventive Services Task Force. Screening for lipid disorders: recommendations and rationale. Am J Prev Med 2001;20(3S):73-76.

A.D.A.M., Inc. Children can have high cholesterol, too. 2002 Jun 17. Available on the Internet from the University of Maryland Medicine web site at http://www.thoraciconcology.com/careguides/cholesterol. Accessed August 10, 2004.

Grundy SM, Cleeman JI, Bairey Merz CN, et al, for the Coordinating Committee of the National Cholesterol Education Program. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation. 2004 July 13;110:227-239. Available on the Internet at http://www.circ.ahajournals.org/content/vol110/issue2/index.shtml. Accessed August 5, 2004.

National Heart, Lung, and Blood Institute of the National Institutes of Health, United States Department of Health and Human Services. High blood cholesterol: what you need to know. Available on the Internet at http://www.nhlbi.nih.gov/health/public/chol/wyntk.htm. Accessed July 16, 2004.

National Heart, Lung, and Blood Institute of the National Institutes of Health, United States Department of Health and Human Services. Third report of the National Cholesterol Education Program (NCEP)Expert Panel on detection, evaluation, and treatment of high blood pressure in adults (Adult Treatment Panel III). Bethesda, Md. 2001 May. NIH publication 01-3670. Available on the Internet at http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3_rpt.htm. Accessed July 15, 2004.

National Heart, Lung, and Blood Institute of the National Institutes of Health, United States Department of Health and Human Services. Update on cholesterol guidelines: more-intensive treatment options for higher risk patients (press release). 2004 July 12. Available on the Internet at http://www.nhlbi.nih.gov/new/press/04-07-12.htm. Accessed August 4, 2004.