What should I ask for as a baseline cholesterol screening?

The short version: a standard fasting lipid panel (total cholesterol, triglycerides, HDL, calculated LDL) is the baseline to ask for, but the numbers that matter most for real risk are triglycerides, HDL, and the ratios that follow from them.

The standard screening test is a fasting lipid panel that gives you total cholesterol, triglycerides, HDL cholesterol, and a calculated LDL. Most guidelines recommend this starting around age 20 and repeating every 4-6 years if results are normal [39]. The evidence that matters for your actual risk, though, is not the LDL number the drug companies push. A 2013 population study of adults over 50 without prior heart disease found that higher total cholesterol and LDL were actually associated with lower all-cause mortality, not higher [24]. What did predict worse outcomes were high triglycerides in women and low HDL in both sexes [24]. A 2012 meta-analysis of over 62,000 statin-treated patients found that non-HDL cholesterol (total minus HDL) was more strongly tied to cardiovascular risk than LDL was [28]. And a 2026 study showed that elevated non-HDL cholesterol (≥160 mg/dL) more than doubled the odds of high cardiovascular risk even in people already on statins [26].

So the practical ask is this: request a standard fasting lipid panel. But when you get the results, pay closest attention to triglycerides (under 150 mg/dL is desirable, and a 2014 consensus review suggests under 175 mg/dL as a reasonable cutoff [16]), HDL (above 40 mg/dL for men, above 50 for women), and the ratio of triglycerides to HDL (the atherogenic index of plasma, calculated as log of triglycerides divided by HDL, which a 2026 study found to be a strong independent risk marker [26]). Non-HDL cholesterol (total minus HDL) is a better single number than LDL for predicting risk [28]. The LDL number itself, which drives most drug prescribing, is the weakest predictor of the bunch in people over 50 [24].

My call: a standard fasting lipid panel is worth doing, but interpret it by triglycerides, HDL, and non-HDL cholesterol, not by the LDL number that drives statin prescriptions. Confidence: moderate — the evidence for the standard panel is solid, but the evidence that LDL is the wrong target in older adults is also solid and widely ignored.