Cholesterol test by age: when to start, how often
For healthy adults, a cholesterol test every 5 years as a younger adult, every 1 to 2 years for men 45 to 65 and women 55 to 65, and every year after 65, with a first check at 9 to 11. That is the general guide from the National Heart, Lung, and Blood Institute. (NHLBI) The bodies differ: the USPSTF sets no testing interval (USPSTF, 2022), Medicare pays for screening once every 5 years (Medicare.gov), and on a cholesterol medicine tests come more often (AHA/ACC, 2018). Your doctor decides.
How often to get a cholesterol test, by age
NHLBI says how often you need a lipid panel "depends on your age, risk factors, and family history of high blood cholesterol or cardiovascular diseases." Its general guide for healthy people: (NHLBI)
| Age | How often | Note |
|---|---|---|
| 9 to 11 | First screening for children. NHLBI: repeat every 5 years. MedlinePlus: at least once at 9 to 11, and again once at 17 to 21. | Can start as early as age 2 if there is a family history of high cholesterol, heart attack or stroke. |
| 20 to 44 (men), 20 to 54 (women) | Every 5 years. | NHLBI writes "ages 20 to 65"; MedlinePlus writes "ages 21 to 65". |
| 45 to 65 (men), 55 to 65 (women) | Every 1 to 2 years. | |
| Older than 65 | Every year. |
MedlinePlus, from the National Library of Medicine, gives the same schedule. (MedlinePlus) These are intervals for people without known heart disease. If a result comes back high, or you start a cholesterol medicine, your doctor will set a different schedule.
How often, by source
| Source | What it says about how often |
|---|---|
| NHLBI and MedlinePlus (NIH) | Every 5 years for younger adults, every 1 to 2 years for men 45 to 65 and women 55 to 65, every year after 65 (NHLBI) (MedlinePlus) |
| USPSTF (2022) | No testing interval; adults 40 to 75 need a current risk estimate, which uses cholesterol, to decide on a statin (USPSTF, 2022) |
| AHA/ACC guideline (2018) | Screening can use fasting or nonfasting lipids; on a statin, a repeat test 4 to 12 weeks after starting or changing the dose, then every 3 to 12 months as needed (AHA/ACC, 2018) |
| Medicare Part B | Cardiovascular screening blood tests once every 5 years (Medicare.gov) |
When to get your first cholesterol test
Both NIH sources start screening in childhood, at ages 9 to 11. Testing "may be performed as early as age 2 if there is a family history of high blood cholesterol, heart attack, or stroke." (NHLBI)
The U.S. Preventive Services Task Force looked at the same question and did not take a side: for children and teens 20 and younger it says "the current evidence is insufficient to assess the balance of benefits and harms of screening for lipid disorders" (an I statement). (USPSTF, 2023) An I statement is not advice against testing. It means the decision is left to the family and the child's doctor.
If you are an adult and do not remember ever having a lipid panel, the age table above says you are due. Ask for one at your next checkup.
What a cholesterol test measures
The usual test is a blood test called a lipid panel (also lipoprotein panel or lipid profile). NHLBI lists what it reports: (NHLBI)
- Total cholesterol
- LDL ("bad") cholesterol, "the main source of cholesterol buildup and blockages in the arteries"
- HDL ("good") cholesterol, which "helps decrease cholesterol blockages in the arteries"
- Triglycerides, another type of fat in the blood
- Often non-HDL cholesterol too: total cholesterol minus HDL
NHLBI's goal for a healthy profile is non-HDL below 130 mg/dL, with HDL of at least 40 mg/dL for men and 50 mg/dL for women. (NHLBI) The full table of healthy levels for adults is on Know your numbers, with a wallet card to write yours on.
Do you need to fast?
Sometimes. NHLBI says your provider "may ask you to fast for 8 to 12 hours" before the panel. (NHLBI) MedlinePlus says you may need to have nothing "but water" for 9 to 12 hours, and to "follow the instructions your health care provider gives you." (MedlinePlus) The 2018 AHA/ACC cholesterol guideline says screening "can be performed with fasting or nonfasting measurement of lipids." (AHA/ACC, 2018) If nobody told you, call the office or lab before you eat.
Tests your doctor may add
- Lipoprotein(a), or Lp(a). Not usually part of a routine panel. Your level is set by the genes you inherit and "is unlikely to change much from childhood to old age." A provider may order it if you have a family history of stroke or early heart disease, or do not know your family history. (NHLBI) MedlinePlus mentions an Lp(a) test "once as an adult." (MedlinePlus) More on who needs an Lp(a) test and how to read it.
- Apolipoprotein B (apo B). MedlinePlus lists it for people with certain health conditions. (MedlinePlus)
- Coronary calcium scan. An imaging test that "may be done to help determine if you need cholesterol medicines." (MedlinePlus)
What the USPSTF says for adults 40 to 75
The USPSTF has no separate cholesterol screening grade for adults. Its 2022 recommendation is about statins, and cholesterol is part of it: (USPSTF, 2022)
- Adults 40 to 75 with one or more risk factors ("dyslipidemia, diabetes, hypertension, or smoking") and an estimated 10-year risk of a heart attack or stroke of 10% or more: the USPSTF recommends a statin. Grade B.
- The same ages and risk factors with a 10-year risk of 7.5% to under 10%: a statin may be offered selectively, since "the likelihood of benefit is smaller." Grade C.
- Adults 76 and older: evidence is insufficient to judge starting a statin. I statement.
The 10-year risk is estimated with a calculator; the USPSTF names the ACC/AHA Pooled Cohort Equations as one that "may be used." (USPSTF, 2022) Because high cholesterol (dyslipidemia) is one of the four risk factors it names, a current lipid panel is part of that decision. This site does not calculate risk scores. Ask your doctor to run one with you.
Statins are a medicine, so they are outside this site's planner, which lists USPSTF grade A and B screenings only. See Method.
What insurance and Medicare pay for
Medicare Part B covers cardiovascular screening blood tests, which "includes blood tests for cholesterol, lipid, and triglycerides levels," once every 5 years. You pay nothing for the tests if your provider accepts assignment. (Medicare.gov) That is less often than the yearly NHLBI interval after 65; tests your doctor orders to manage a known condition are billed differently, so ask what you will owe. For private plans, see preventive screenings covered by insurance and Medicare.
Questions people ask
At what age should you get your first cholesterol test?
The NIH sources on this page say screening begins at ages 9 to 11. A child with a family history of high cholesterol, heart attack or stroke may be tested as early as age 2. An adult who was never tested should ask for a lipid panel at the next visit.
How often should an adult get a cholesterol test?
For healthy adults, NHLBI gives every 5 years for younger adults, every 1 to 2 years for men 45 to 65 and women 55 to 65, and every year after 65. Your doctor may test more often if a result is high, you take a cholesterol medicine, or you have other risk factors.
Do you need to fast before a cholesterol test?
Not always. The 2018 AHA/ACC cholesterol guideline says screening can use fasting or nonfasting lipids. NHLBI says a provider "may ask you to fast for 8 to 12 hours"; MedlinePlus says 9 to 12 hours. Follow the instructions you are given for your test.
How often is cholesterol checked if I take a statin?
More often than for screening. The 2018 AHA/ACC guideline advises a repeat lipid test 4 to 12 weeks after a statin is started or the dose is changed, then every 3 to 12 months as needed. Your doctor sets the schedule.
Does Medicare pay for cholesterol tests?
Medicare Part B covers cardiovascular screening blood tests (cholesterol, lipid and triglyceride levels) once every 5 years, with nothing to pay if the provider accepts assignment. Tests ordered more often to manage a condition are billed differently, so ask first.
Does the USPSTF recommend cholesterol screening?
Not as a separate screening for adults. Its 2022 statin recommendation for adults 40 to 75 relies on knowing cholesterol (dyslipidemia is one of the four risk factors it names) to estimate 10-year risk. For children and teens 20 and younger it found the evidence insufficient (an I statement).
Related
- Cholesterol test results: what total, LDL, HDL, non-HDL and triglyceride numbers mean
- Lipoprotein(a) test: who needs one, mg/dL vs nmol/L, and family testing
- Heart, diabetes, bone and AAA guidelines compared
- Heart screenings by age: blood pressure, statin risk, diabetes, aortic ultrasound, and heart tests not advised
- Know your numbers: cholesterol, blood pressure, A1c, BMI and waist ranges
- Blood pressure screening and prediabetes and diabetes screening, two of the other heart risk factors the USPSTF names
- Statins for prevention by age: who the USPSTF says should start one, using the cholesterol numbers from this test
- Healthy eating and activity counseling, recommended for adults with abnormal cholesterol
- What tests are in an annual physical?
- Build my screening plan
By age: 18, 21, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85.