Routine cholesterol (lipid) testing identifies elevated LDL and other lipid abnormalities that increase risk of atherosclerotic cardiovascular disease. Most people begin screening in early adulthood; those at low risk may repeat testing every 4-6 years while people with risk factors need more frequent monitoring. Tests measure total cholesterol, LDL-C, HDL-C, and triglycerides; additional markers such as apoB or lipoprotein(a) can refine risk assessment. Lifestyle changes are first-line; statins are the primary medication when needed. Newer therapies (PCSK9 inhibitors, siRNA agents) exist for selected high-risk patients. Regular testing and follow-up allow clinicians to tailor prevention and reduce heart attack and stroke risk.
Why cholesterol testing still matters
High LDL cholesterol is a major, modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD), including heart attack and ischemic stroke. Routine cholesterol testing finds elevated levels before symptoms appear, so people and clinicians can reduce risk with lifestyle changes or medicines.What a cholesterol test measures
Most routine checks use a lipid panel that reports total cholesterol, LDL-C ("bad" cholesterol), HDL-C ("good" cholesterol), and triglycerides. Testing can be fasting or non-fasting for screening. Additional tests such as apolipoprotein B (apoB) or lipoprotein(a) may be ordered when a clinician needs more detail about risk.Who should be screened and how often
Many guideline groups recommend starting screening in early adulthood. For people at low risk, repeating a normal lipid panel every 4-6 years is common. People with risk factors - family history of early heart disease, diabetes, obesity, smoking, or very high initial cholesterol - should be tested more often and may start screening earlier.What raises cholesterol and what to do about it
Common contributors include diets high in saturated and trans fats, physical inactivity, excess weight, smoking, and some hereditary conditions (familial hypercholesterolemia). Clinicians typically first recommend lifestyle measures: a heart-healthy diet (more vegetables, whole grains, unsaturated fats), regular aerobic activity, weight management, and quitting smoking.If lifestyle change is insufficient, clinicians may prescribe medications. Statins remain the first-line therapy for lowering LDL and reducing ASCVD risk. For people who need additional lowering or who cannot tolerate statins, options include ezetimibe and PCSK9-targeting therapies; newer agents such as small interfering RNA therapies are also available for select patients. 1
How testing changes outcomes
Identifying high cholesterol creates an opportunity to lower long-term cardiovascular risk. For many people, a test result prompts lifestyle changes; for others, it starts a medication plan that has proven benefits in reducing heart attacks and strokes. Regular follow-up testing helps clinicians track response to treatment and adjust therapy.Bottom line
Cholesterol testing is a simple preventive tool. Talk to your clinician about when to start screening, how often to repeat it, and what targets and treatments fit your personal risk profile.- Confirm guideline recommendations for the age to start routine cholesterol screening and the advised screening interval (e.g., specific AHA/ACC/USPSTF/other guideline statements). [[CHECK]]
- Verify recommendations on measuring lipoprotein(a) and apoB (whether guidelines recommend one-time or selective measurement) and update wording to match current guideline language. [[CHECK]]
- Confirm the current status and approved indications of newer LDL-lowering therapies (inclisiran and other siRNA agents) in 2025 and reflect any label changes. [[CHECK]]