Cholesterol Testing: First Checks, Treatment Response, and Follow-Up

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• The first cholesterol check
• Repeat testing in adulthood
• Changes that may affect cholesterol
• Checking the response to medication
• Follow-up during stable treatment
• Full Transcript

The first cholesterol check

Cholesterol testing serves different purposes at different stages of life. Asked by Dr. Anton Titov, MD, how often a person should be tested, cardiologist Dr. Paul D. Thompson, MD, begins with the importance of identifying a high level early.

He recommends a first check during the teenage years, around puberty. His concern is an inherited tendency to high cholesterol that might otherwise go unnoticed. He connects this with cumulative exposure: how many years a person spends with a high cholesterol level.

Repeat testing in adulthood

Repeat cholesterol testing does not necessarily mean annual testing for every untreated adult, in Dr. Thompson's account. He says levels often remain fairly stable after an initial measurement. He recommends another check in adulthood and keeping an eye on the result, rather than automatically repeating the test every year regardless of context.

Changes that may affect cholesterol

Changes in diet and life stage are part of that context. Dr. Thompson notes that a radical dietary change can affect the result. He also points out that women can experience changes in cholesterol levels during menopause. His explanation separates a stable result from circumstances in which the earlier measurement may no longer describe the current situation.

Checking the response to medication

Starting cholesterol medication changes the purpose of follow-up. Dr. Thompson says that a statin's effect begins quickly and that the cholesterol reduction is close to its maximum within two weeks. In his own practice, he generally measures cholesterol about three weeks after starting a patient on medication.

He also describes this early follow-up as roughly three weeks to a month after treatment starts. The point is to assess the response soon after the medication is introduced, rather than waiting for the next routine annual test.

Follow-up during stable treatment

Stable treatment involves a different testing interval. Once the medication dose and cholesterol result are where he wants them, Dr. Thompson says he generally checks patients yearly, rather than monthly or every six months. He qualifies that approach by referring to patients who remain on the same medications.

These intervals describe the approach he explains in this interview. His central distinction is between detecting an overlooked high level, assessing a new treatment, and monitoring an established treatment regimen.

Full Transcript

Dr. Anton Titov, MD: How often should I get my cholesterol checked?

Dr. Paul D. Thompson, MD: How often you get your cholesterol checked depends. First of all, you ought to get it checked sometime during your teens or so to figure out if you have a problem. We talked a little bit about pack years of cholesterol.

Dr. Paul D. Thompson, MD: In other words, how many years you have a high cholesterol level. If somebody inherited the wrong genes, it is nice to know that in childhood, so you ought to get it checked sometime about puberty at least. Once you get your cholesterol level checked, it does not change that much unless you make a radical change in your diet or a radical change in something else.

Dr. Paul D. Thompson, MD: Women, when they go through menopause, can often have changes in their cholesterol levels. You need to get it checked when you are an adult. You do not need to have it repeated every year and all that sort of stuff, but you should keep an eye on it.

Dr. Paul D. Thompson, MD: The most important thing is: how often should you get it checked when you get treated with medicines? Believe it or not, when you start a cholesterol medicine like a statin, the effect is almost immediate. Within two weeks, you have got about the maximum reduction in cholesterol level.

Dr. Paul D. Thompson, MD: I usually wait about three weeks after I start a patient on a medication, and then I measure the cholesterol level. Then I check them, not monthly, not every six months. I check people generally every year once I get them on a decent drug level and have that cholesterol level where I want it.

Dr. Paul D. Thompson, MD: What are the rules? Get it checked sometime around puberty to make sure that you do not have a high level that is being missed. Then get it checked when you are an adult, when you have your physical.

Dr. Paul D. Thompson, MD: If you get put on a medicine, have it checked soon after you go on that medicine, like three weeks to a month. Then have it checked every year or so, as long as you are on the same medications.