Recommendations for Screening in Children and Adults

• Initiate lipid profile screening in adults at age 19 years and repeat it at least every 5 years to identify treatable atherosclerotic cardiovascular disease (ASCVD) risk. Increase screening frequency in individuals with additional ASCVD risk factors.
• Screen children aged 9 to 11 years who have not been previously tested using a lipid profile to identify familial hypercholesterolemia (FH) and other significant lipid disorders.
• Perform screening with a single lipid profile, including cascade screening, starting at age ≥2 years in individuals with first- or second-degree relatives with premature ASCVD, severe hypercholesterolemia, or FH to enable early identification of FH.

Recommendations for Measurement of TC, LDL-C, HDL-C, TG, and Non-HDL-C

• Use a standard nonfasting or fasting lipid profile in adults and children to document baseline lipid levels, estimate ASCVD risk, and guide initiation of lipid-lowering therapy (LLT).
• Perform a fasting lipid profile in adults and children with a family history of dyslipidemia or premature ASCVD, a personally known or suspected disorder in triglyceride metabolism, or when a nonfasting lipid profile shows triglyceride levels ≥400 mg/dL (≥4.5 mmol/L), to more accurately estimate low-density lipoprotein cholesterol (LDL-C).
• Use either the Martin/Hopkins equation or the Sampson/National Institutes of Health (NIH) equation in preference to the Friedewald equation to estimate LDL-C in adults and children who have undergone a standard lipid profile.
• Use either the Martin/Hopkins equation or the Sampson/NIH equation in preference to direct LDL-C measurement, except when using beta-quantification, to estimate LDL-C in adults and children who have undergone a standard lipid profile.
• Report non-high-density lipoprotein cholesterol (non-HDL-C) in adults and children following a standard lipid profile to support ASCVD risk assessment and guide initiation and monitoring of LLT.
• Avoid routine use of advanced lipoprotein testing methods, including gradient gel electrophoresis, density gradient ultracentrifugation, nuclear magnetic resonance spectroscopy, and ion mobility analysis, to assess lipoprotein subclasses or parameters such as LDL particle size for estimating ASCVD risk or guiding initiation of LLT, as these do not provide additional benefit.

Recommendations for Measurement of Apolipoprotein B (ApoB)

• Measure apolipoprotein B (apoB) in adults receiving LLT, particularly in those with ASCVD, cardiometabolic kidney (CKM) syndrome, type 2 diabetes mellitus (T2DM), and/or elevated triglycerides (TG), to guide decisions on further therapeutic intensification after achieving LDL-C and/or non-high-density lipoprotein cholesterol (non-HDL-C) goals.
• Consider measuring apoB in adults not receiving LLT to enhance ASCVD risk assessment, guide decisions regarding initiation of lipid-lowering therapy, and help characterize inherited lipid disorders.

Recommendation for Monitoring and Follow-Up

• Perform a lipid profile 4 to 12 weeks after initiation or dose adjustment of LLT and repeat every 6 to 12 months thereafter to assess treatment efficacy and adherence to therapy.