---
title: "High Cholesterol: Which Blood Tests Do You Need?"
type: condition
url: "https://www.test-well.com/conditions/high-cholesterol"
date_published: 2026-11-03
reviewed_at: 2026-11-03
---

# High Cholesterol: Which Blood Tests Do You Need?

*High cholesterol has no symptoms, so the test is the diagnosis. A standard lipid panel answers most of the question; ApoB, lipoprotein(a) and hs-CRP answer the rest for people whose risk the basic numbers understate. Here is what each test measures, what the LDL categories mean, the secondary causes to exclude, and how often to retest.*

> A Lipid Panel ($19.99) — total, LDL, HDL, triglycerides and non-HDL cholesterol — is the test, fasting or not, every 4–6 years from age 20 and more often with risk. LDL under 100 mg/dL is optimal, 160–189 high, and 190 or more very high (familial hypercholesterolemia is considered). The Heart Health Panel ($99.99) adds ApoB, lipoprotein(a), hs-CRP and A1c — the markers that catch risk the basic panel misses. Check TSH, glucose and kidney and liver function once before treating.

## Recommended tests

| Recommended | Type | Price | Why |
| --- | --- | --- | --- |
| [Lipid Panel](https://www.test-well.com/tests/lipid-panel) | Test | $19.99 | Total, LDL, HDL, triglycerides and non-HDL — $19.99; the screening and monitoring test |
| [Heart Health Panel](https://www.test-well.com/tests/heart-health-panel) | Panel (5 tests) | $99.99 | Lipid panel + ApoB + Lp(a) + hs-CRP + A1c — $99.99; the complete cardiovascular risk workup |
| [ApoB — Heart Attack Risk Predictor](https://www.test-well.com/tests/apolipoprotein-b) | Test | $29.99 | The count of atherogenic particles — $29.99; 130 mg/dL or more is a risk enhancer, and the better number when triglycerides are high |
| [Lp(a) Hereditary Heart Risk Test](https://www.test-well.com/tests/lipoprotein-a) | Test | $32.99 | Lipoprotein(a), inherited and measured once in a lifetime — $32.99; 50 mg/dL (125 nmol/L) or more is high |
| [Advanced Cholesterol Particle Test (NMR)](https://www.test-well.com/tests/nmr-lipoprofile) | Test | $63.99 | LDL particle number and size by NMR — $63.99; for discordant results and insulin resistance |
| [Heart & Body Inflammation Test (hs-CRP)](https://www.test-well.com/tests/hs-crp) | Test | $26.99 | Inflammation; 2 mg/L or more is a risk enhancer in the AHA/ACC guideline |
| [Hemoglobin A1c](https://www.test-well.com/tests/hemoglobin-a1c) | Test | $18.99 | Diabetes changes the LDL target and is itself a secondary cause of high triglycerides |
| [TSH (Thyroid Stimulating Hormone)](https://www.test-well.com/tests/tsh) | Test | $20.99 | Hypothyroidism raises LDL — the most common reversible secondary cause — $20.99 |
| [Comprehensive Metabolic Panel](https://www.test-well.com/tests/comprehensive-metabolic-panel) | Test | $21.49 | Liver enzymes and kidney function before and during therapy; nephrotic syndrome and cholestasis raise cholesterol |

All prices are cash-pay plus one $6 lab processing fee per order; physician authorization is included.

## What high cholesterol is, and why there are no symptoms to wait for

Cholesterol travels in the blood inside lipoprotein particles. The ones that carry it into artery walls — LDL and the triglyceride-rich remnants — are the problem; HDL carries it away. "High cholesterol" (hypercholesterolemia, or dyslipidemia when triglycerides and HDL are involved) means too many of those atherogenic particles, which over decades build the plaques behind heart attacks and strokes. The exposure is cumulative, which is why a high LDL at 30 matters as much as a higher one at 60, and why screening starts at 20.

There are no symptoms. Cholesterol deposits visible on the skin (xanthomas on tendons, knuckles or eyelids) and a gray ring around the cornea before 45 occur only in the severe inherited forms. For everyone else the first "symptom" of untreated high cholesterol is the event it causes, which is the argument for the test. The 2018 AHA/ACC guideline recommends a lipid panel every four to six years in adults aged 20–39, and more frequently from 40, when it feeds the ten-year risk calculation that decides treatment, and any time risk changes.

## The core tests and what each one shows

**Lipid panel.** Total cholesterol, HDL, triglycerides and LDL (calculated from the others, or measured directly when triglycerides are high). The guideline categories for LDL are: below 100 mg/dL optimal, 100–129 near optimal, 130–159 borderline high, 160–189 high, and **190 or more very high** — a level at which familial hypercholesterolemia is considered and statin therapy is recommended regardless of calculated risk. Total cholesterol under 200 is desirable, 200–239 borderline, 240 or more high. HDL below 40 in men and 50 in women is low. Triglycerides below 150 are normal (175 non-fasting). **Non-HDL cholesterol** (total minus HDL) counts every atherogenic particle's cholesterol and is the better single number when triglycerides are raised; 130 or more corresponds to an LDL of 100.

**Apolipoprotein B (ApoB).** One ApoB molecule sits on every LDL, VLDL, IDL and Lp(a) particle, so ApoB is a direct count of the particles that cause disease. It outperforms LDL cholesterol when the two disagree — in insulin resistance, diabetes, obesity and high triglycerides, where the LDL cholesterol can look fine while the particle count is high. The AHA/ACC guideline treats an ApoB of 130 mg/dL or more as a risk enhancer; many lipid specialists treat to an ApoB target.

**Lipoprotein(a).** An LDL-like particle whose level is about 90% inherited, unchanged by diet or statins, and an independent cause of heart attack, stroke and aortic stenosis. The National Lipid Association and the European Atherosclerosis Society recommend measuring it **once in every adult's lifetime**; 50 mg/dL (125 nmol/L) or more is high and raises the urgency of treating everything else. About one person in five carries a high level without knowing it.

**hs-CRP.** Low-grade inflammation; 2 mg/L or more is a risk enhancer that tips borderline statin decisions. **Hemoglobin A1c and fasting glucose** find the diabetes that changes the LDL target and raises triglycerides. **TSH** finds hypothyroidism, the most common reversible cause of a high LDL. **The comprehensive metabolic panel** gives the baseline liver enzymes and kidney function before therapy and catches nephrotic syndrome and cholestasis, both of which raise cholesterol. **NMR lipoprofile** measures LDL particle number and size directly and is used when LDL cholesterol and ApoB disagree or in insulin resistance.

## Who should be tested, and when

- **Every adult from age 20** — a lipid panel every four to six years when risk is low; from 40, often enough to keep the ten-year risk estimate current.
- **Anyone with a family history** of early heart disease (a man under 55 or a woman under 65), of very high cholesterol, or of a known familial hypercholesterolemia or high Lp(a) — test now, and test children in those families from age 2 (the 2018 guideline supports screening all children once between 9 and 11).
- **Diabetes, prediabetes, high blood pressure, chronic kidney disease, obesity, smoking, an inflammatory condition (rheumatoid arthritis, psoriasis, lupus, HIV), a history of preeclampsia or early menopause** — all risk enhancers; a panel plus ApoB and Lp(a) is reasonable.
- **Anyone already on cholesterol medication** — a panel 4–12 weeks after starting or changing a dose, then every 3–12 months to confirm the response and adherence.
- **Anyone with xanthomas, a corneal arcus under 45, or an LDL of 190 or more on a previous test** — the familial hypercholesterolemia work-up, including testing first-degree relatives.

**Fasting or not?** A non-fasting lipid panel is acceptable for screening and for most follow-up; the guideline allows it. Fast 9–12 hours when triglycerides were 400 mg/dL or more, when a diagnosis of a triglyceride disorder is being made, or when a precise LDL is needed. Avoid alcohol for 72 hours, test when you are well (acute illness and surgery lower cholesterol for weeks), and keep your usual diet in the weeks before — a result after a crash diet does not reflect your baseline.

## Reading the numbers together

**LDL 190 or more**: very high, statin therapy regardless of calculated risk, and familial hypercholesterolemia is likely when there is a family history or physical signs; relatives are tested. **LDL 160–189**: high; with a risk enhancer (family history, metabolic syndrome, inflammatory disease, high Lp(a), ApoB of 130 or more, hs-CRP of 2 or more) treatment is favored. **LDL 70–189 with diabetes**: statin therapy, intensity set by age and risk. **LDL 70–189 without diabetes**: the ten-year ASCVD risk estimate decides — below 5% lifestyle, 5–7.5% a discussion, 7.5–20% a statin is reasonable (a coronary calcium score can settle an uncertain case), above 20% treat. **High triglycerides with a normal LDL**: look at non-HDL and ApoB, which are often high, and at glucose, alcohol, weight and the medication list.

Before treating, exclude the secondary causes once: hypothyroidism (TSH), uncontrolled diabetes (A1c), nephrotic syndrome (urine albumin, albumin), cholestatic liver disease (alkaline phosphatase, bilirubin), and medications — thiazides, beta-blockers, oral estrogens, glucocorticoids, anabolic steroids, isotretinoin, some HIV drugs and antipsychotics. Correcting a hypothyroid state can lower LDL by 20–30% without a lipid drug.

Two discordant patterns are worth knowing. **A normal LDL with a high ApoB** — common in insulin resistance — means many small particles and a risk the LDL understates; ApoB or non-HDL becomes the target. **A very high HDL (above about 90–100 mg/dL)** is not extra protection and in some people reflects dysfunctional particles; it does not offset a high LDL.

## How to get tested and what happens next

Order online, walk into any Quest or Labcorp location with your requisition — no appointment or doctor's visit needed — and results post to your account, most within one to two business days. Non-fasting is fine for a screening panel; fast 9–12 hours if your triglycerides have been high before.

Take the results to your clinician with your family history, blood pressure and smoking status, which together produce the ten-year risk estimate that drives the treatment decision; statins, ezetimibe, bempedoic acid and PCSK9 inhibitors are prescription decisions, and the choice of intensity and target depends on your risk category. Lifestyle changes — saturated fat, fiber, weight, exercise, alcohol — move LDL by 10–20% and triglycerides by much more, and a repeat panel 8–12 weeks after a change shows the effect. An LDL of 190 or more, a lipoprotein(a) above 50 mg/dL, or a strong family history of early heart disease warrants a conversation sooner rather than at the next routine visit.

## Frequently asked questions

### What cholesterol level is considered high?

For LDL — the number that matters most — below 100 mg/dL is optimal, 130–159 borderline high, 160–189 high, and 190 or more very high, a level at which familial hypercholesterolemia is considered and treatment is recommended regardless of other risk. Total cholesterol of 240 or more is high. HDL below 40 in men and 50 in women is low. Triglycerides of 150 or more are raised. Non-HDL cholesterol of 130 or more corresponds to an LDL of 100.

### What are the symptoms of high cholesterol?

None. Cholesterol deposits on the tendons, knuckles or eyelids (xanthomas) and a gray ring around the cornea before age 45 occur only in the severe inherited forms. For everyone else the first sign is the heart attack or stroke it eventually causes, which is why a lipid panel is recommended every four to six years from age 20 and more often from 40.

### Do I need to fast for a cholesterol test?

Not for screening or most follow-up — the 2018 AHA/ACC guideline accepts non-fasting lipid panels, and non-fasting triglycerides up to 175 mg/dL are considered normal. Fast 9–12 hours if your triglycerides were 400 or more before, if a triglyceride disorder is being diagnosed, or if a precise LDL is needed. Avoid alcohol for 72 hours and test when you are well.

### Should I test ApoB or Lp(a) as well as a lipid panel?

ApoB is worth adding when triglycerides are high, in diabetes, prediabetes or obesity, or whenever the LDL seems too reassuring for the rest of the picture — it counts the particles directly and an ApoB of 130 mg/dL or more is a risk enhancer. Lipoprotein(a) should be measured once in every adult's lifetime: it is inherited, unaffected by diet or statins, and a level of 50 mg/dL or more independently raises heart attack and stroke risk.

### What causes high cholesterol besides diet?

Genetics first — familial hypercholesterolemia affects about 1 in 250 people and produces an LDL of 190 or more from childhood — then hypothyroidism, uncontrolled diabetes, nephrotic syndrome, cholestatic liver disease, obesity, pregnancy, menopause and medications including thiazides, beta-blockers, oral estrogens, glucocorticoids, anabolic steroids, isotretinoin and some HIV and antipsychotic drugs. TSH, A1c, a metabolic panel and a medication review exclude these before treatment.

### How often should cholesterol be rechecked?

Every four to six years in low-risk adults aged 20–39; often enough from 40 to keep the ten-year risk estimate current, typically every one to two years with any risk factor; 4–12 weeks after starting or changing a cholesterol medication, then every 3–12 months; and 8–12 weeks after a lifestyle change to see its effect. A lipoprotein(a) is measured once; it does not change.

## Sources

- [Grundy SM, Stone NJ, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol. Circulation. 2019;139(25):e1082–e1143](https://pubmed.ncbi.nlm.nih.gov/30586774/)
- [Lloyd-Jones DM, et al. 2022 ACC Expert Consensus Decision Pathway on the Role of Nonstatin Therapies for LDL-Cholesterol Lowering. J Am Coll Cardiol. 2022;80(14):1366–1418](https://pubmed.ncbi.nlm.nih.gov/36031461/)
- [Koschinsky ML, et al. A focused update to the 2019 NLA scientific statement on use of lipoprotein(a) in clinical practice. J Clin Lipidol. 2024;18(3):e308–e319](https://pubmed.ncbi.nlm.nih.gov/38565461/)
- [US Preventive Services Task Force. Statin Use for the Primary Prevention of Cardiovascular Disease in Adults (2022)](https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/statin-use-in-adults-preventive-medication)
- [MedlinePlus — Cholesterol levels: what you need to know](https://medlineplus.gov/cholesterollevelswhatyouneedtoknow.html)

---

Medically reviewed by Youmna DiStefano, MD (Medical Reviewer, TestWell); last reviewed 2026-11-03. Review policy: https://www.test-well.com/reviewers/youmna-distefano-md

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Prices are cash-pay, in USD, and include physician authorization; every order adds one flat $6 lab processing fee. Educational content is not a diagnosis — discuss results with a clinician.