Cholesterol Testing Guidelines

According to guidelines from the National Cholesterol Education Program (NCEP), all adults over the age of 20 should be tested for HDL and total cholesterol at least once every five years. Some people should be retested more frequently.

  • If your total cholesterol is in the desirable range and your HDL is above 35 mg/dl, you can wait up to five years to have them rechecked. If your total cholesterol is borderline-high and your HDL is above 35 mg/dl, you should be rechecked in a year or two.
  • If your total cholesterol is borderline-high or high and/or your HDL is below 35 mg/dl, especially if you have two or more risk factors for coronary artery disease (CAD), you should have a complete lipid profile (which requires fasting overnight) to determine LDL. Then, if your LDL is in the desirable range, you can wait up to five years to be retested. But if your LDL is borderline-high or high, and depending on your other risk factors, you’ll need to be retested annually as well as modifying your diet and take other steps to reduce your risk of CAD.

Note: Calculating LDL isn’t simply a matter of subtracting your HDL from your total cholesterol. The blood fats known as triglycerides figure into the equation for arriving at total cholesterol and are used in deriving LDL.

Risk Factors for High Cholesterol

The recommendations for testing are more stringent if you have other risk factors for CAD besides high cholesterol and/or low HDL. These risk factors are age, family history of premature CAD (a heart attack in your father before age 55, in your mother before age 65), smoking, high blood pressure, and diabetes. The guidelines are even stricter for those who already have CAD: for instance, your LDL should be below 100, rather than 130.

Men and Women and High Cholesterol

Women need to be monitored as carefully as men. But women tend to develop CAD about a decade later than men do, so while age is considered a risk factor for men starting at age 45, for women it’s at age 55. Women over 55 who have high cholesterol should make as great an effort as men to reduce it.

The Elderly and High Cholesterol

People in their 70s or even older should be treated just like people in their 50s or 60s, according to the NCEP guidelines. It is true that blood cholesterol levels naturally start to decline after age 75. But a recent report from the National Cholesterol Education Program found that nearly three-fourths of older people have substantial cholesterol build-up in their arteries. To reduce heart attack risk, therefore, it is important to have your blood cholesterol checked every five years even if you’re over 70. If your cholesterol is high, you and your physician should discuss your other risk factors, lifestyle changes to lower cholesterol levels, and whether to consider taking cholesterol-lowering medication.

Children and High Cholesterol

According to the NCEP, only children who have a family history of very high cholesterol levels and/or heart disease—particularly those with a parent who suffered a heart attack before age 50—should be tested. That includes as many as one-quarter of the nation’s children. Many authorities have concluded that screening all youngsters is unnecessary, since high blood cholesterol levels in childhood do not necessarily predict high levels later in life. But all children, whatever their family history, can benefit from a low-fat, heart-healthy diet after age two.

What If You Do Nothing?

A high total cholesterol level isn't likely to decrease significantly unless you make some or all of the recommended lifestyle changes, particularly those regarding weight control and diet. Some individuals may also require cholesterol-lowering medication to control their cholesterol levels.


The Complete Home Wellness Handbook

John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter

Updated by Remedy Health Media

Publication Review By: the Editorial Staff at

Published: 16 Nov 2011

Last Modified: 24 Mar 2014