How often should you check your cholesterol?
At least every 5 years from age 19, the 2026 US guideline says, and more often if you have risk factors. Children get one test at 9 to 11. After you start or change a cholesterol medicine, test again in 4 to 12 weeks.
What we’d do
Get a first panel at 19, or now if you’ve never had one, and ask for Lp(a) to be added once. Then test at least every 5 years. If you change what you eat, retest LDL 6 to 12 weeks after the change has settled in, and triglycerides after 4, at the same lab and fasted or not the same way as last time.
The schedule
| Who | When |
|---|---|
| Adults | from 19, at least every 5 years, more often with risk factors and with age |
| Children | once at 9 to 11 |
| Relatives of someone with FH or early heart disease | one panel from age 2 |
| Everyone, once | Lp(a), at least once as an adult |
| After starting or changing a cholesterol medicine | 4 to 12 weeks later, then every 6 to 12 months |
| After a change in food, drink or weight | LDL at 6 to 12 weeks, triglycerides at 4 or later |
Why 9 to 11, and not as a teenager
Cholesterol does something odd in puberty. Total and LDL fall 10 to 20% in mid to late puberty before they climb to adult levels, so a test at 15 can look better than it should. Signs of thickening in the neck arteries can show up in children as young as 8 to 10. About 1 in 250 US children has FH, and up to half of children with a high LDL don’t report any family history of it.
Why start at 19
LDL and non-HDL climb about 1 to 2 points a year through young adulthood, and FH affects 1 in 250 to 300 adults, most of whom don’t know. The guideline is open about the limit. No trial has shown that screening young adults prevents heart attacks. It recommends screening anyway because LDL is a proven cause of heart disease, the treatments help younger adults the most, and the test is cheap.
It’s like a car’s service schedule. You check the oil at set intervals, and sooner after you’ve had work done.
Don’t retest too soon
A retest 2 weeks after a change is mostly noise. Your own LDL swings about 9.5% between tests with nothing changed, and a certified lab can add up to 4% more. Together that means two LDL results can differ by about 19% by chance, and now and then by 29%. At an LDL of 130 that’s 24 points, or 37.
Did it really go down? puts your two results side by side and shows which changes are bigger than that noise.
4 sources
- Blumenthal RS, Morris PB, Gaudino M and others, 2026 ACC/AHA guideline on the management of dyslipidemia, JACC, 2026doi.org
- The same guideline, full text, Circulation, 2026api.iscpcardio.org
- Smith SJ, Cooper GR, Myers GL and Sampson EJ, Biological variability in concentrations of serum lipids, Clinical Chemistry, 1993pubmed.ncbi.nlm.nih.gov
- CDC Clinical Standardization Programs, certification criteria for cholesterol test manufacturerscdc.gov
