About the Test
Purpose of the test
Cholesterol testing is often used as part of a cardiac risk assessment. Too much cholesterol in the blood can damage arteries and blood vessels and elevate the risk for stroke, heart attack, and heart disease.
Total cholesterol may be measured as part of cholesterol screening, which is looking for signs of risks to cardiovascular health in people who have not shown any symptoms. When used for screening, total cholesterol is typically one component of the lipid panel, which also determines levels of high-density lipoprotein (HDL or “good”) cholesterol, low-density lipoprotein (LDL or “bad”) cholesterol, and triglycerides.
Depending on the results from initial screening, future tests may involve only total and HDL cholesterol.
Total cholesterol and lipid panel tests may also be used to:
- Monitor people with a high risk of cardiovascular disease
- Diagnose certain medical conditions
- Monitor how well treatment is working to reduce cardiovascular disease risk
What does the test measure?
The total cholesterol test measures the combined sum of all cholesterol molecules found in the blood. This test alone does not specify the breakdown of different types of cholesterol; however, it is often combined with other tests that include measurements of HDL, LDL, and triglycerides.
When should I get a cholesterol test?
There are no consensus guidelines for when to do cholesterol screening. Based on different views of the benefits and downsides of screening, expert groups have varying recommendations for when to start screening and how frequently to do repeat tests.
As a general guideline, diagnostic testing typically begins with routine blood testing as an adult, usually around 35 years old. However, it is a good idea to consult with your doctor to determine whether or not you are at greater risk of high cholesterol. But there are certain factors that may put you at high risk, including:
- Being over 45 years old for men and over 50-55 for women
- High cholesterol on a previous test
- Prior cardiovascular problems
- Being overweight or obese
- Cigarette smoking
- Unhealthy diet
- Lack of regular physical activity
- High blood pressure (hypertension)
- Having a first-degree relative who had heart disease at an early age (under 55 in men and under 65 in women)
- Diabetes or prediabetes
There are no telltale symptoms of high cholesterol which present themselves prior to a catastrophic health event such as a heart attack or stroke, which makes getting tested incredibly important. Depending on your risk factors and ongoing test results, you may have cholesterol tests every year or less.
For people who have already had cardiovascular problems, cholesterol tests can be used to monitor their heart health and see how well treatment is working to lower their cholesterol.
A summary reviewing general approaches to cholesterol screening is listed below. In the majority of cases, screening is done with a lipid test that measures total cholesterol as well as HDL, LDL, and triglycerides.
| Demographic Group | Risk Factors | Screening Frequency |
|---|---|---|
| Children | None | Once between ages 7-11; again between 17-21 |
| Children | 1 or more | Every 1-3 years starting when risk factor is identified |
| Children | High risk of familial hypercholesterolemia | Age 3, between 9-11, and age 18 |
| Adolescents and adults | 1 or more | At least every 5 years; often annually |
| Men age 20-45 Women age 20-55 |
None | Every 5 years |
| Men age 45-65 Women age 55-65 |
None | Every 1-2 years |
| Men and women over 65 | None or risk factors present | Annually |
Finding a Cholesterol Test
How can I get a cholesterol test?
Cholesterol tests are usually done using blood that is drawn from a vein in your arm. This procedure is typically done in a doctor’s office, clinic, or medical lab. When the laboratory analyzes your blood, total cholesterol is frequently measured along with other types of cholesterol in a lipid panel test ordered by your doctor.
Total cholesterol can also be measured with rapid, point-of-care testing. This kind of test requires putting a drop of blood from your finger on a special test strip that is inserted into a small device, giving results within minutes. Point-of-care testing is used in some medical offices and clinics and may also be found at health fairs.
Though having your cholesterol checked by a doctor is highly recommended, there are at-home tests available.
Can I take the test at home?
Two main types of at-home cholesterol tests are available:
- Test kits that have you take a blood sample from your finger and send it by mail to a lab.
- Test kits that include an at-home method for analyzing the blood sample from your finger. This may be a small electronic device or a test strip that changes color to indicate cholesterol levels.
At-home tests for total cholesterol may include other cholesterol measurements, such as HDL and LDL, that are part of a typical lipid panel.
While at-home testing may be convenient, there are a few downsides. Mistakes can be made in the sample collection process, leading to inaccurate results. Additionally, most kits only measure total cholesterol and aren’t able to distinguish between LDLs and HDLs.
How much does the test cost?
There is no standard price for a total cholesterol test. The cost depends on where you take the test as well as coverage that may be provided by your insurance.
Costs of testing can include the office visit, the fee for the technician to draw your blood, and the actual laboratory analysis. If your doctor recommends a cholesterol test, these costs are typically covered by insurance. However depending on your plan, you may be responsible for copays or a deductible. Your doctor and insurance plan can provide more specific information about your costs for cholesterol testing.
A point-of-care cholesterol test at pharmacies or health clinics may cost around $100 or less. This kind of test may be free at community health fairs or similar events.
There is a wide price range for at-home test kits. Many models include a small device to conduct the test and cost under $150, but more expensive options are available. Kits commonly come with extra test strips that allow you to check your cholesterol more than once.
Taking a Cholesterol Test
Cholesterol testing is performed on a sample of your blood. If your blood is going to be analyzed in a lab, the sample is normally drawn from a vein in your arm. In point-of-care and at-home tests, a drop of blood is taken from your fingertip.
Before the test
In many cases, it is important to fast for nine to 12 hours before a cholesterol test, which means avoiding all food and all beverages other than water.
If your total cholesterol is being measured as part of a lipid panel, fasting prior to the test ensures the validity of the results. If the laboratory is only going to measure your total cholesterol and HDL, fasting may not be necessary.
Because the need to fast depends on the exact type of cholesterol test you take, it is essential to talk with your doctor’s office beforehand so that you know all of the pretest instructions to follow.
During the test
For laboratory tests, a needle is used to take a sample of blood from a vein in your arm. An elastic band known as a tourniquet is tied around the upper part of your arm so that there is more blood in the vein. To prevent infection, your skin will be cleaned with an antiseptic in the area where your blood will be drawn.
There may be slight pain or a sting when the needle is inserted. After that, it usually takes less than a minute for enough blood to be drawn.
Point-of-care and at-home tests get a blood sample from a fingerstick. This is a small puncture on your fingertip that produces a drop of blood but generally causes little pain.
After the test
Once blood has been drawn from your vein, bleeding is stopped with a cotton swab and/or an adhesive bandage. You may need to keep pressure on the puncture site for an hour or more to prevent bleeding and allow it to heal quickly.
These types of blood draws are routine. They are an outpatient procedure, so you can drive or go to work or school afterward. You may need to avoid sports or intense activity for a few hours. If you were told to fast before testing, it may be helpful to bring a light snack to eat once the test is complete.
Tests that use a fingerstick do not usually have any post-test restrictions. An adhesive bandage can be used if bleeding continues after you’ve taken the blood sample.
Cholesterol Test Results
Receiving test results
If your cholesterol is being analyzed by a laboratory after a needle blood draw, you can expect to receive results within a few days. The doctor’s office may contact you with results or schedule an appointment to review them. You may also receive results through an online health portal or in the mail.
For point-of-care tests or at-home test kits with a device for analyzing cholesterol, results are available within minutes.
Interpreting test results
Cholesterol levels are measured in milligrams per deciliter of blood (mg/dL). General reference ranges for total cholesterol are listed below:
- Normal: under 200 mg/dL
- Borderline high: 200-239 mg/dL
- High: 240 mg/dL and above
Remember that total cholesterol alone does not offer a complete picture of your risk for cardiovascular problems. The amounts of good (HDL) and bad (LDL) cholesterol are important to consider, which is why these are evaluated as part of a complete lipid panel.
Cholesterol test results are also not the only factor determining your heart health. Your age, family history, and health habits are elements that affect your cardiovascular disease risk. Using a risk calculator, your doctor may analyze your test scores alongside these other factors.
Depending on your test scores and overall risk, treatment may be suggested to lower your cholesterol. Examples of treatment include lifestyle changes, such as increase to exercise, quitting smoking or changing your diet, as well as medications that help decrease cholesterol. Your doctor can best discuss the benefits and risks of these approaches in your situation, but be sure to ask follow-up questions, such as:
- What lifestyle changes do I need to make?
- How often should I check my cholesterol?
- Do cholesterol medications have any side effects?
- How do I know the medication is working?
- What happens if this treatment plan doesn’t improve my cholesterol—what’s next?
While the main focus of cholesterol testing is on identifying cases of high cholesterol, it is also possible to have very low levels. This is most often tied to an underlying health condition or malnutrition.
