February 25, 2011
Dear Mayo Clinic:
I'm a fit woman, age 64, with no health problems except arthritis. I get an annual physical but I don't know my cholesterol level because my doctor states that I only need to be checked every four to five years. Should I be more assertive in requesting this test?
For most healthy people, an annual cholesterol check isn't necessary. But for a woman in her 60s, five years between cholesterol tests is a long wait. Having it checked about once every three years is probably a better fit for you.
A cholesterol test — also called a lipid panel — is a blood test. Typically, the cost is around $200. The test measures four categories: total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides.
LDL is sometimes called bad cholesterol because too much of it in your blood causes a buildup of fatty deposits (plaques) in the lining of your arteries. Sometimes these plaques can rupture, and a blood clot forms at the site of the rupture, closing off the artery. This blockage can cause a heart attack if the artery leads to the heart, or it may cause a stroke if the artery leads to the brain. HDL is referred to as good cholesterol because it helps carry away LDL cholesterol, keeping arteries open. Triglycerides are a type of fat in the blood.
Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood. Generally, to be at healthy levels your total cholesterol should be less than 200 mg/dL, triglycerides less than 150 mg/dL, and LDL less than about 130 mg/dL. But those numbers can vary. If you're at risk for heart disease due to diabetes or a family history of heart problems, then LDL cholesterol should be below 100 mg/dL. If you've already been diagnosed with heart disease, LDL should be less than 70 mg/dL. For HDL, healthy levels are different for men and women. For men, HDL should be more than 40 mg/dL. For women, it should be more than 50 mg/dL.
When considering how often to test cholesterol, doctors usually break it down into three categories. First are the people who have heart disease, high cholesterol or those who are at high risk of developing heart disease. For this group, an annual cholesterol test is appropriate. Second are those at intermediate risk. Their cholesterol levels may be on the borderline between healthy and unhealthy levels. They may be at increased risk due to a family history of heart disease or an underlying medical condition. A cholesterol test once every two years is generally recommended for people in this category.
The third group includes those at low risk for heart disease. They don't have an underlying medical condition or a family history that puts them at higher risk. They don't have symptoms of heart problems, and results of previous tests have shown healthy cholesterol levels. Typically, they don't need to be checked as frequently as the other two groups and can go three to five years between cholesterol tests.
It sounds like you fall into the third category. But I'd put you on the lower end of the timeframe between tests due to your age and gender. Post-menopausal women have an increased risk of developing high cholesterol, even when their cholesterol levels have been normal in the past. It's not uncommon for a woman's LDL cholesterol to rise in the years following menopause. With that in mind, having your cholesterol checked once every three years seems appropriate.
It's important to have your cholesterol checked on a regular basis because heart disease can progress rapidly. Monitoring your cholesterol can be a valuable way for your doctor to assess your ongoing risk of heart disease.
— Stephen Kopecky, M.D., Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.