Should I test my cholesterol at home?

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Q I recently saw an ad for a cholesterol test kit for home use. It seems like a good way to keep track of my cholesterol. Is there any reason not to use something like this?

A There's practically no good reason to use such cholesterol-testing kits, because they won't give you reliable or helpful information about your cholesterol.

High cholesterol is a major risk factor for heart disease and stroke, but knowing only your total cholesterol level isn't enough. You also need to know the levels of several blood lipids (fats found in the blood): high-density lipoprotein (HDL) cholesterol, or "good" cholesterol; low-density lipoprotein (LDL) cholesterol, or "bad" cholesterol; and triglycerides. All of these make up a full lipid profile, and all affect your cardiovascular risk and help determine whether you need treatment.

Most cholesterol-testing kits simply measure total cholesterol, a number that's hard to interpret. Even with elevated total cholesterol, you need to know how much of the total is HDL or LDL cholesterol to judge your risk for cardiovascular disease. Some home-testing kits measure total cholesterol and HDL, and at least one also measures LDL. But experts doubt their accuracy, because HDL and LDL measurements can vary widely even among clinical laboratories.

If you're being treated for high cholesterol with a statin (such as fluvastatin, atorvastatin, lovastatin, pravastatin, or simvastatin), you may want to use a home-testing kit to monitor your cholesterol levels. But it won't save you a trip to the lab. If you take any of these drugs, you need regular liver function tests anyway, and a complete cholesterol assessment can be done at that time.

If you rarely see your doctor, at-home tests could be useful, provided they motivate you to follow up with an office visit and appropriate testing.

The National Cholesterol Education Project (NCEP) recommends that everyone age 20 and older have a full, or fasting, lipid profile done every five years. A fasting lipid profile is performed after 12 hours without food or liquids other than water.

If you'd like to know more about cholesterol levels and your risk for cardiovascular disease, see the April 2002 issue of the Harvard Women's Health Watch.

Good cholesterol targets

Total cholesterol: 200 mg/dL or less

HDL cholesterol: 40 mg/dL or more

LDL cholesterol: 130 mg/dL or less

Having other cardiovascular risk factors modifes these target levels.

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By Celeste Robb-Nicholson, M.D.

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