What Is Lipid Testing? Your Cholesterol Panel Explained

A lipid test measures the amount of cholesterol and other fats in your blood. Elevated levels of LDL (bad) cholesterol—called dyslipidemia—can cause plaque to build up in your blood vessels, putting you at risk for heart disease and stroke.  

Cholesterol testing can guide you and your doctor in identifying whether you’re at risk for heart disease, and in taking steps to prevent it before you have symptoms.

Heart disease is the leading cause of death in adults worldwide. About 80% of heart disease can be prevented with healthy lifestyle or medication, said C. Noel Bairey Merz, MD,  director of the Barbra Streisand Women’s Heart Center, Preventive and Rehabilitative Cardiac Center, Linda Joy Pollin Women's Heart Health Program.

“Dyslipidemia is one of the few conditions we can prevent, which can really move the needle on your lifelong cardiovascular risk,” said Myriam Almeida-Jones, MD, director of Inpatient Pediatric Cardiology Services at the Smidt Heart Institute and Cedars-Sinai Guerin Children’s. “Lipid testing is an amazing opportunity to make sure we're preventing heart attacks in people who would otherwise have one by the time they're 30 to 50 years old. And we have more treatment options than ever before, meaning we can help people live longer, healthier lives.”

What Are Healthy Cholesterol Levels?

Lipid panels measure LDL and HDL (good) cholesterol and triglycerides, another type of fat. Healthy people should be screened with a blood test every four years. People who have heart disease, diabetes or familial hypercholesterolemia (an inherited risk of elevated LDL levels) should be screened more frequently.

Doctors agree lower LDL levels are better. Cardiologists focus on detecting and treating elevated cholesterol as early as possible to prevent heart disease before it begins.

Healthy people without heart disease should aim for:

• Total cholesterol below 150 mg/dL
• LDL below 100 mg/dL
• HDL at least 40 mg/dL in men and 50 mg/dL in women
• Triglycerides below 150 mg/dL

According to new guidelines from the American Heart Association, people at higher risk of heart attack or stroke may be around 70 mg/dL, and for people with established heart disease, doctors recommend LDL levels below 55 mg/dL.

What Causes High Cholesterol?

In some people, genetics determine cholesterol levels. Cholesterol levels also are influenced by lifestyle—mainly nutrition. Factors that can lead to higher cholesterol include:

• Diet high in saturated fats such as dairy, red meat and processed food
• Sedentary habits
• Smoking
• Heavy alcohol consumption
• Type 2 diabetes
• High blood pressure

What Is Familial Hypercholesterolemia?

About 20% of people have familial hypercholesterolemia, which causes high cholesterol levels from birth. About half of people who have heart attacks have familial hypercholesterolemia, so it’s important doctors recognize and treat it early, said Bairey Merz.

Doctors recommend adults with LDL over 190 mg/dL and kids with LDL over 160 mg/dL undergo genetic screening, by either a blood or saliva test. When someone tests positive for familial hypercholesterolemia, they should be seen by a cardiologist, who can help guide treatment to lower LDL. First-degree relatives (parents and children) also should be screened so they can be treated, if necessary.

How Is High Cholesterol Treated in Adults?

For patients with high LDL that isn’t improved with lifestyle changes, physicians can prescribe statin drugs.

For people with advanced heart disease, combination therapy—a statin plus an additional lipid-lowering drug, such as a weekly or biannual injection—can block disease progression and help you achieve a normal lifespan, said Bairey Merz.

Some patients are wary of adding another medication to their routine—but a weekly or biannual injection can be less burdensome than a pill, she said.

“Combination therapy can safely and effectively help you achieve an LDL below 55, and can save you from needing bypass surgery and stents or having strokes and heart failure,” said Bairey Merz.

How Is High Cholesterol Treated in Kids?

Guidelines suggest doctors screen kids with a lipid panel between ages 9 and 11, and again between 17 to 21. Kids with a family history of premature cardiovascular disease or hypercholesterolemia should be screened even sooner and tested for lipoprotein(a), or LP(a) another type of cholesterol, said Almeida-Jones.

“Pediatric care is a lifetime prevention strategy,” she said. “It’s really important to start screening early and broadly to capture patients who might be at risk, because sometimes, patients don’t present with typical signs and symptoms.”

For kids with elevated cholesterol levels, doctors first recommend lifestyle changes, including exercise and a balanced pediatric diet with healthy fats and whole foods. At Cedars-Sinai, registered dietitians provide nutrition counseling, which is essential for the whole family, Almeida-Jones said.

“A balanced, heart-healthy pediatric diet is really important, not just for cardiovascular risk, but for normal growth and development,” she said. “These dietary changes are not about restriction—its about choosing what we put into our bodies in a way that is sustainable and supports long-term health.”

Following an elevated cholesterol test, doctors retest lipids in six months. If levels haven’t improved despite lifestyle interventions, families can consider statin therapy in kids as young as 8, especially when they have a family history or genetic predisposition.

Parents are often concerned about putting a child on medication, Almeida-Jones said, but statins have been proven safe and effective in kids.

“We have 15 years of data showing that kids who take statins have normal development and cognition and good results in reducing cholesterol levels,” she said.

Kids with familial hypercholesterolemia will likely take medication long-term. But if high cholesterol levels are related to diet or metabolic syndrome, kids can come off the medication under the guidance of their physician, said Almeida-Jones.

Lipid Testing Helps Guide Health Improvement

Lipid testing can reveal health risks you might not otherwise know you had. Whether your cholesterol levels are out of balance because of genetic predisposition or lifestyle reasons, a cardiologist can help you improve them.

“Lower LDL cholesterol is better and it's safe,” said Bairey Merz. “Find a physician to help you with a regimen so you can get your health under control.”