How do lipid screening recommendations vary among guidelines?

Updated: Nov 30, 2018
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Answer

Answer

The majority of screening guidelines recommend a full fasting lipid profile including total cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides, although some guidelines allow for a non-fasting lipid panel. The age at which to begin screening varies among the guidelines and may differ for men and women. A comparison of the recommendations can be found in Tables 2 and 3, below.

Table 2. Guidelines for Lipid Screening in Adults. (Open Table in a new window)

Issuing Organization

Year

Populations to be Screened

Screening Measurement

Screening Interval

USPSTF [23]

2008 (update in progress)

Men ≥35 years: Universal screening

Men 20-34 years: if at increased risk for coronary heart disease (CHD)

Women ≥20 years: if at increased risk for CHD

Fasting or non-fasting lipid panel

Uncertain; every 5 years, with shorter intervals for individuals with elevated lipid levels and longer intervals for those not at increased risk with normal lipid levels

ACC/AHA [24]

2013

Adults 20-78 years

None given

Every 4-6 years if free of ASCVD

NHLBI (ATP-III) [2]

2002

Adults ≥20 years: Universal Screening

Fasting lipid panel; Calculation of non-HDL-C when TG>200mg/dL

Every 5 years

AACE [25]

2012

Men 20-44 years and Women 20-54 years: Universal screening as part of global risk assessment for CHD

Fasting lipid panel;

Calculation of non-HDL-C more accurate if TG >200 and < 500 mg/dL, diabetes, insulin resistance, or established CAD

Every 5 years; more frequent assessment for patients with family history of CHD before age 55 for father or first-degree male relatives or age 65 for mother or first-degree female relatives

Annually for adults with diabetes

NLA [26]

2014

Adults ≥20 years: Universal Screening

Fasting or non-fasting lipid panel

Every 5 years

VA/DOD [27]

2014

Men >35 years and women >45 years: Universal Screening

Fasting or non-fasting Non-fasting lipid panel

Every 5 years for low CVD risk

Every 2 years for intermediate risk or the appearance of a new CVD risk factor

ESC/EAS [28]

2011

Adults with any of the following risk factors:

  • Type 2 diabetes
  • Obesity
  • Hypertension
  • Smoker
  • Chronic inflammatory disease
  • Chronic kidney disease
  • Family history of premature cardiovascular disease (CVD) or familial dyslipidemia

Men ≥40 years and Women ≥50 years or post-menopausal: Consider screening

Fasting lipid panel with calculation of non-HDL-C  and TC/HDL-C ratio;

apoB or apoB/apoA1 ratio considered alternate risk factors

None given

CAD = Coronary artery disease; CHD = Coronary heart disease; CVD = Cardiovascular disease; HDL-C = High-density lipoprotein cholesterol; TC = Total cholesterol; TG = Triglycerides

Table 3. Guidelines for Lipid Screening in Children and Adolescents (Open Table in a new window)

Issuing Organization

Year

Populations to be Screened

Screening Measurement

Screening Interval

USPSTF [29]

2007 (update in progress)

Insufficient evidence for or against screening for ages < 20 years

N/A

N/A

NHLBI (endorsed by American Academy of Pediatrics) [30]

2011

< 1 year: No screening

 

 

1-8 years: if family history of heart disease or high cholesterol or child has other risk factor or high-risk medical condition

 

9-11 years: Universal screening

 

 

 

12-16 years: if family history of heart disease or high cholesterol or child has other risk factor or high-risk medical condition

 

≥17 to < 20 years: Universal screening

 

≥20 to < 21 years: Universal screening

N/A

 

 

 

Fasting lipid panel

 

 

Nonfasting non-HDL-C; abnormal results followed up with fasting lipid panel

 

 

 

Fasting lipid panel

 

 

Nonfasting non-HDL-C or fasting lipid panel

 

Nonfasting non-HDL-C or fasting lipid panel

N/A

 

 

As indicated

 

 

 

Once

 

 

 

 

As indicated

 

 

 

Once 

 

 

Once


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