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Screening Tests for Young Adults (Ages 19-29)

High cholesterol

Beginning in childhood, the waxy substance called cholesterol and other fatty substances known as lipids start to build up in the arteries. Slowly, over many years , these build-ups harden into plaques that narrow the passageway. During adulthood, plaque buildup and resulting health problems occur not only in 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 United States, 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.

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

  • Every 5 years, all adults 20 years of age and older should have a complete, fasting lipoprotein profile. If your lipid levels are low or repeatedly normal, you can go longer between tests. If your lipid levels are borderline, more frequent testing is advised.

If you fast for 9 to 12 hours before taking this blood test, the test provides 4 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, and 4) triglycerides, which are 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, American Academy of Family Physicians, and American College of Preventive Medicine approve of a less rigorous approach. They say you can start with the non-fasting 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:

  • All men 35 years of age and older and all women 45 years of age and older should be routinely screened for lipid disorders.
  • Younger adults—starting at 20 years of age—should be routinely screened for lipid disorders if they have other risk factors for coronary heart disease.

You also are more vulnerable and would want more frequent testing if you have any known risk factors, such as smoking, high blood pressure (hypertension; 140/90 mm Hg or higher or you take antihypertensive medications), diabetes, 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. With just 2 risk factors, you fit into a category that benefits from closer monitoring.

Links
University of Maryland Heart Center: Heart Disease Risk Calculator
National Heart, Lung, and Blood Institute: What is high blood cholesterol?
American Academy of Family Physicians: Heart disease & Stroke
To sign up for a personal cholesterol test scheduling reminder, click here.

Sources

Haney EM, et al. 1 Jul 2007. Screening and treatment for lipid disorders in children and adolescents: systematic evidence review for the US Preventive Services Task Force. Pediatrics 120(1):e189-e214. Available on the Internet through http://pediatrics.aappublications.org. Accessed 9 Jan 2008.

American Academy of Family Physicians. Summary of policy recommendations for clinical preventive services. Aug 2007. Available on the Internet through http://www.guideline.gov. Accessed 11 Feb 2008.

American Academy of Pediatrics, Committee on Nutrition. Cholesterol in childhood (policy statement). Jan 1998 (retired 1 May 2006). Pediatrics 101:1;141-147. Available on the Internet through http://aappolicy.aappublications.org. Accessed 10 Aug 2004.

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

American Heart Association. Get your cholesterol checked. Update of 27 Aug 2007. Available on the Internet at http://www.americanheart.org/presenter.jhtml?identifier=541 through http://www.americanheart.org. Accessed 16 Jul 2004 and 11 Feb 2008.

Grundy SM, 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. 13 Jul 2004. Circulation 110:227-239. Available on the Internet through http://www.circ.ahajournals.org. Accessed 5 Aug 2004 and 11 Feb 2008.

American Academy of Family Physicians. Heart disease and heart attacks: what women need to know. Sep 2000, updated Nov 2006. Available on the Internet at http://familydoctor.org/online/famdocen/home/common/heartdisease/risk/287.html through http://familydoctor.org. Accessed 4 Aug 2004 and 11 Feb 2008.

American Academy of Family Physicians. Heart disease: assessing your risk. Sep 2000, updated Nov 2006. Available on the Internet at http://familydoctor.org/online/famdocen/home/common/heartdisease/risk/292.html through http://familydoctor.org. Accessed 16 Jul 2004 and 11 Feb 2008.

National Heart, Lung, and Blood Institute of the National Institutes of Health. High blood cholesterol: what you need to know. Available on the Internet at http://www.nhlbi.nih.gov/health/public/heart/chol/hbc_what.htm through http://www.nhlbi.nih.gov. Accessed 16 Jul 2004; 2005 rev accessed 11 Feb 2008.

American College of Preventive Medicine. Screening for lipid disorders. Available on the Internet at http://www.acpm.org/cpslipiddisorders.htm through http://www.acpm.org. Accessed 5 Aug 2004 and 11 Feb 2008.

American Academy of Family Physicians. Summary of policy recommendations for periodic health examinations. Aug 2003. Available on the Internet through http://www.guideline.gov. Accessed 19 Jul 2004.

National Heart, Lung, and Blood Institute of the National Institutes of Health. 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) (NIH pub. 01-3670). May 2001. Available on the Internet at http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3_rpt.htm through http://www.nhlbi.nih.gov. Accessed 15 Jul 2004 and 11 Feb 2008.

National Heart, Lung, and Blood Institute of the National Institutes of Health. Update on cholesterol guidelines: more-intensive treatment options for higher risk patients (press release). 12 Jul 2004. Available on the Internet at http://www.nhlbi.nih.gov/new/press/04-07-12.htm through http://www.nhlbi.nih.gov. Accessed 4 Aug 2004 and 11 Feb 2008.