Cholesterol Testing: Who Should Be Checked and How Often?

High cholesterol usually causes no obvious symptoms, yet it can gradually contribute to fatty deposits forming inside the arteries. Over time, this may restrict blood flow and increase the risk of heart attack, stroke and other cardiovascular conditions.

The only reliable way to know your cholesterol levels is through a blood test. At Hout Bay Family Medical Clinic, cholesterol testing may form part of a routine health check or a broader assessment of your cardiovascular risk.

What Is Cholesterol?

Cholesterol is a waxy, fat-like substance found in the blood. The body needs a certain amount to build healthy cells and produce hormones, but an unhealthy cholesterol pattern can increase the risk of cardiovascular disease.

Cholesterol travels through the blood in particles called lipoproteins. A standard cholesterol test commonly measures:

• Total cholesterol
• LDL cholesterol
• HDL cholesterol
• Triglycerides

These results should be interpreted together rather than focusing on only one number.

What Is LDL Cholesterol?

Low-density lipoprotein cholesterol is commonly known as LDL or “bad” cholesterol. Higher LDL levels can contribute to plaque building up inside the arteries.

This process, called atherosclerosis, may gradually narrow the arteries and increase the likelihood of a heart attack or stroke. LDL is therefore an important consideration when doctors assess cardiovascular risk.

What Is HDL Cholesterol?

High-density lipoprotein cholesterol is commonly called HDL or “good” cholesterol because it helps transport cholesterol away from the arteries.

However, a high HDL result does not automatically cancel out a high LDL level or other risk factors. Your cholesterol results still need to be interpreted alongside your blood pressure, blood sugar, smoking history, age and general health.

What Are Triglycerides?

Triglycerides are another type of fat found in the blood. The body stores excess energy as triglycerides, and high levels may be associated with an increased risk of cardiovascular disease.

Raised triglycerides may occur with:

• Excess weight
• Diabetes or insulin resistance
• High alcohol intake
• Certain dietary patterns
• Low physical activity
• Some medications
• Thyroid, liver or kidney conditions
• Inherited lipid disorders

Very high triglyceride levels may also increase the risk of inflammation of the pancreas.

Why Is Cholesterol Testing Important?

High cholesterol often has no warning signs. A person may feel healthy while cholesterol-related changes are gradually affecting the arteries.

Testing allows your doctor to:

• Identify raised cholesterol
• Assess your broader heart and stroke risk
• Recommend lifestyle changes
• Determine whether medication may be appropriate
• Monitor the response to treatment
• Investigate a possible inherited cholesterol disorder

High blood cholesterol is one of several important risk factors for cardiovascular disease, together with high blood pressure, raised blood sugar, smoking, physical inactivity and other health factors.

Who Should Have Their Cholesterol Checked?

Cholesterol screening is appropriate for most adults, even when they feel well. Current guidance from the American Heart Association recommends that adults aged 19 and older have a cholesterol blood-test panel, with the testing interval adapted according to individual risk.

Testing is particularly important for people who:

• Are aged 40 or older
• Have high blood pressure
• Have diabetes or prediabetes
• Smoke or previously smoked
• Are overweight
• Have a family history of high cholesterol
• Have a family history of early heart disease or stroke
• Have kidney disease
• Have an existing heart or blood-vessel condition
• Have previously recorded abnormal cholesterol levels
• Take medication that may affect cholesterol
• Have a diet high in saturated fat
• Are physically inactive

Age alone does not determine risk. Younger adults may also require testing, especially when there is a strong family history or another recognised risk factor.

How Often Should Healthy Adults Be Tested?

For adults at relatively low cardiovascular risk with previously normal results, cholesterol testing is commonly recommended approximately every four to six years. The American Heart Association’s current guidance suggests testing around every five years for most adults, while the CDC recommends every four to six years for healthy adults.

This is only a general guideline. Your doctor may recommend a different interval based on your age, health history and previous test results.

Who May Need More Frequent Testing?

Cholesterol may need to be checked more often when you:

• Have previously had a high result
• Take cholesterol-lowering medication
• Have diabetes
• Have high blood pressure
• Have heart disease or have experienced a stroke
• Have chronic kidney disease
• Have several cardiovascular risk factors
• Have a strong family history of premature heart disease
• Have an inherited cholesterol condition
• Have recently made significant treatment or lifestyle changes

The CDC specifically advises more frequent testing for people with heart disease, diabetes or a family history of high cholesterol.

Your doctor may recommend repeat testing after several weeks or months when treatment has been started or adjusted.

Should Cholesterol Only Be Tested After 40?

No. High cholesterol can begin earlier in life and may be influenced by genetics, diet, weight, diabetes and other factors.

Current American Heart Association guidance recommends cholesterol screening for all adults from age 19, rather than waiting until middle age.

Testing earlier may be particularly important when a parent, sibling or close relative developed heart disease at a young age or has very high cholesterol.

What Is Familial Hypercholesterolaemia?

Familial hypercholesterolaemia is an inherited condition that causes unusually high LDL cholesterol from a young age. It can substantially increase the risk of premature heart disease when it is not identified and treated.

Possible warning signs include:

• Very high LDL cholesterol
• A close relative with very high cholesterol
• Heart attack or heart disease at a young age in the family
• Several relatives with early cardiovascular disease
• Cholesterol deposits around the eyes or tendons in some cases

A normal lifestyle does not rule out an inherited cholesterol problem. Anyone with a strong family history should discuss earlier testing with a doctor.

Do Children Need Cholesterol Testing?

Children do not usually require the same routine testing schedule as adults, but screening may be appropriate where there is:

• A strong family history of high cholesterol
• A family history of early heart disease
• Obesity
• Diabetes
• High blood pressure
• Kidney disease
• Another condition associated with abnormal cholesterol

Current international guidance also supports at least one cholesterol check during later childhood or adolescence, although the precise approach may vary between healthcare systems.

Parents should discuss testing with their family doctor rather than arranging adult-style screening without medical advice.

Do You Need to Fast Before a Cholesterol Test?

Many routine cholesterol tests can now be performed without fasting. A non-fasting result is often suitable for an initial cardiovascular-risk assessment.

However, fasting may still be requested when:

• Triglycerides were previously very high
• A previous result was difficult to interpret
• The doctor needs a fasting glucose test at the same time
• A particular medical condition is being investigated
• The laboratory or doctor gives specific instructions

Follow the clinic’s instructions before your test. Do not assume that fasting is necessary, and do not stop medication unless your doctor specifically advises it.

What Happens During the Test?

A cholesterol test requires a small blood sample, usually taken from a vein in the arm. The laboratory then measures the different fats in the blood.

A standard lipid panel usually reports total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides.

The blood draw itself generally takes only a few minutes. Results are then interpreted in the context of your overall cardiovascular risk.

What Is a Healthy Cholesterol Level?

There is no single ideal cholesterol result that applies to everyone. A level considered acceptable for a young, otherwise healthy person may not be low enough for someone who already has heart disease, diabetes or several risk factors.

Doctors consider:

• LDL level
• HDL level
• Triglycerides
• Total cholesterol
• Blood pressure
• Blood sugar
• Age
• Smoking status
• Family history
• Kidney function
• Existing cardiovascular disease

Treatment decisions should therefore not be based on comparing one result with a generic online chart.

What Happens If Your Cholesterol Is High?

A raised result does not automatically mean medication is required. Your doctor will first consider the degree of elevation and your overall risk of heart attack or stroke.

Management may include:

• Improving dietary habits
• Increasing physical activity
• Losing excess weight where appropriate
• Stopping smoking
• Reducing harmful alcohol intake
• Improving diabetes or blood-pressure control
• Starting cholesterol-lowering medication
• Investigating an underlying medical cause
• Arranging follow-up testing

People at higher cardiovascular risk may benefit from medication even when their cholesterol result is only moderately raised.

Can Diet Help Lower Cholesterol?

Diet can influence cholesterol, although genetics and medical conditions may also play an important role.

Helpful changes may include:

• Eating more vegetables, fruit and whole grains
• Choosing beans, lentils and other fibre-rich foods
• Including nuts and seeds in suitable portions
• Choosing fish and lean protein sources
• Replacing saturated fats with unsaturated fats
• Limiting processed meats
• Reducing foods high in saturated and trans fats
• Limiting heavily processed foods

Current heart-health guidance recommends reducing saturated and trans fats while placing greater emphasis on vegetables, legumes, whole grains, fibre and lean sources of protein.

Extreme diets are not necessary and may be difficult to sustain. A realistic, balanced approach is generally more useful over the long term.

Does Exercise Improve Cholesterol?

Regular physical activity can support heart health, weight management, blood-pressure control and healthy blood-sugar levels. It may also help improve triglyceride and HDL patterns.

Aim to build activity gradually, particularly when you have been inactive or have an existing medical condition. Walking, swimming, cycling and other activities can all be useful when suited to your health and fitness.

People experiencing chest pain, unexplained breathlessness or exercise-related dizziness should speak to a doctor before beginning an intensive training programme.

When Is Medication Needed?

Cholesterol-lowering medication may be recommended when:

• LDL cholesterol is very high
• There is established heart or blood-vessel disease
• The patient has experienced a heart attack or stroke
• Diabetes or kidney disease significantly increases risk
• Lifestyle changes have not lowered cholesterol sufficiently
• An inherited cholesterol disorder is suspected
• The calculated cardiovascular risk is high

Statins are among the most commonly prescribed cholesterol-lowering medicines. Other treatments may be considered when statins are unsuitable or do not reduce cholesterol enough.

Medication decisions should be personalised and reviewed regularly.

Can You Stop Medication When Cholesterol Improves?

A lower cholesterol result while taking treatment often means that the medication is working. It does not necessarily mean that the underlying risk has disappeared.

Do not stop cholesterol medication without discussing it with your doctor. Cholesterol may rise again after treatment is discontinued, particularly when genetics or an existing cardiovascular condition is involved.

Cholesterol and Other Health Checks

Cholesterol should rarely be considered in isolation. A cardiovascular health assessment may also include:

• Blood-pressure measurement
• Blood-sugar testing
• Weight and waist assessment
• Smoking history
• Exercise and dietary habits
• Family medical history
• Kidney-function testing
• Review of medication

Together, these factors provide a more accurate picture of cardiovascular risk than cholesterol alone.

When Should You Arrange a Cholesterol Test?

Consider booking a cholesterol assessment when:

• You have never had your cholesterol checked
• It has been several years since your previous test
• You are aged 40 or older
• You have high blood pressure
• You have diabetes or prediabetes
• You smoke
• You have gained significant weight
• A close relative has high cholesterol
• A family member developed heart disease or had a stroke at a young age
• You have started or changed cholesterol treatment
• Your doctor has recommended follow-up testing

Do not wait for symptoms, as high cholesterol usually does not cause noticeable warning signs.

Cholesterol Testing in Hout Bay

Hout Bay Family Medical Clinic provides cholesterol testing and cardiovascular-risk assessments for adults in Hout Bay and surrounding areas.

A consultation may include a review of your personal and family history, blood pressure, lifestyle, current medication and other risk factors. Where appropriate, your doctor can arrange a lipid profile, interpret the results and recommend suitable follow-up or treatment.

Book a Cholesterol Check

Unsure when your cholesterol was last tested or whether you may be at increased risk? Contact Hout Bay Family Medical Clinic to arrange a health check with one of our doctors.

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This article provides general health information and does not replace an individual medical consultation, examination, diagnosis or treatment plan.