High cholesterol is a concern primarily because it increases the risk of heart attack and stroke. While not the only risk factor (about one half the people who have heart attacks have normal cholesterol), it is a significant one. Other risk factors include family history, smoking, overweight, high blood pressure, physical inactivity, diabetes, stress, and elevated C-reactive protein (CRP is a blood test for inflammation). To reduce risk, it is important to address all of these risk factors. The focus of this article, however, is on cholesterol screening.
While cholesterol and heart disease are primary thought of as concerns for adults, the National Heart, Lung, and Blood Institute (NHLBI) recently recommended that children as young as 9 years old begin cholesterol screening. While children at this age are unlikely to have actual heart disease, the risk factors that lead to disease as an adult often begin in childhood.
Cholesterol is a term that applies to a number of different substances in the blood, some of which increase the risk of heart disease and some which lower the risk. Total cholesterol is a more specific term that applies to all the various types of cholesterol. When cholesterol is tested a lipid profile is usually run in addition to the total cholesterol. A lipid profile includes the total cholesterol and its primary constituents, HDL, LDL, and triglycerides. HDL is the good cholesterol which lowers the risk of heart disease. It carries cholesterol away from the blood vessels and back to the liver to be metabolized. LDL is the bad cholesterol. It carries cholesterol to the arteries where it forms cholesterol plaques that cause heart disease. Triglycerides are fats in the blood and they also increase the risk of heart disease.
As with other screening tests, different groups have different recommendations for cholesterol screening. The following screening schedule is based on the guidelines from the National Cholesterol Education Program for adults and from the NHLBI for children:
Children: test once age 9-11 and again age 17-21.
Adults: all adults age 20 or older should be tested every five years. Those with high cholesterol should be tested every 1-2 years.
Another helpful tool that can be used to determine your risk of heart attack is the Framingham risk calculation. Based on the findings from the landmark Framingham Heart Study, you can calculate your 10 year risk of heart attack by entering a few things about yourself including age, smoking status, cholesterol, and blood pressure. You can find the calculator online at http://hp2010.nhlbihin.net/atpiii/calculator.asp.
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