The Cholesterol Check - Wes Bailey, MD, CAQSM
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The Cholesterol Check

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The Cholesterol Check

By Westly Bailey, MD, CAQSM


What is the Cholesterol Panel?

The “cholesterol panel” is a blood test that measures fats (lipids) in your blood vessels. It is a Lipid Panel that measures Total Cholesterol (TC), Triglycerides (TG), High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL), and Very Low Density Lipoprotein (VLDL).


Why Do I Need to Have it Checked?

Certain fat types are linked to disease of the heart, eyes, brain, and other organs. High levels are linked to deadly problems like heart attack and stroke.


When Should I Start Checking it?

The American Heart Association currently recommends starting at 21 years of age. The American Academy of Pediatrics recommends screening earlier. Society recommendations may periodically change.


How Often Should I Check it?

Usually anywhere from 1 to 4 times yearly depending on age, family history, symptoms, medical problems, medications, and physical exam findings. The American Heart Association currently recommends cholesterol checks at least once every five years. These recommendations may periodically change.


Should My Kids Get Checked Too?

Depends on age, family history, symptoms, medical problems, medications, and physical exam findings. For example, kids who are notably overweight should have cholesterol checked before adulthood. Ask your child’s Pediatrician or Family Physician about cholesterol screening.


Do I Have to Fast for this Test?

Fasting is usually preferred. Triglycerides can be increased by food and certain fluids. Your doctor’s office will give specific instructions.


What Do the Numbers Tell Me?

Triglycerides – After you eat, the body stores unused calories (energy) from food in the form of triglycerides. Triglycerides are stored in fat cells. They are released when the body needs energy again, for example, in between meals. They can also be processed into LDL and VLDL based on the body’s metabolic state. Too much sugar, carbohydrates, fats, and alcohol can raise TG. Thus folks with a “sweet tooth”, “carb munchers”, and heavy alcohol drinkers can have TG- and other elevations.

LDL – The “bad” cholesterol that contributes to fat buildup in blood vessels. Carries cholesterol in the bloodstream. High levels are linked to circulation issues, heart attack, and stroke. Cutting back on saturated fats and simple carbohydrates  (e.g., sugars, white bread) can lower LDL. Aerobic exercise helps as well.

VLDL – Another “bad” cholesterol which is actually the main TG carrier in the blood. Carries TG from the liver to either fatty tissue (for storage) or to muscle (to supply muscle energy).  VLDL is not included on all lipid panels. When included, this number is often calculated as a percentage of your TG value. VLDL can be processed into LDL based on the body’s metabolic state. High VLDL is associated with vessel disease.

HDL – The “good” cholesterol. Studies have linked low HDL with heart disease. Expert consensus is that  “protective” effect is via more than one function: 1) Carrying some excess LDL away from arteries and back to the liver for reprocessing, and 2) Contributing to repair of damaged blood vessel walls. Aerobic exercise and quitting habits such as smoking can raise HDL.

TC – Cholesterol is used to build cells and certain hormones in your body. Sources include food and the liver. Cholesterol is carried in the blood by lipoproteins, mainly LDL.


Do I Have to Start Medication if My Panel is Abnormal?

Fats are necessary for your growth, development, and health maintenance. It is important to assess your lipid numbers in context of your overall health picture. A physical exam and additional labs can provide other information which can optimize your panel assessment. For example, high blood pressure or high blood sugar might increase your risk of heart attack or stroke, so your doctor might want you to achieve specific number goals on your lipid panel. The plan might involve medication. Talk to your doctor about your lipid panel results and explore your management options in detail.