Lipid panel (total cholesterol, HDL, LDL, triglycerides)

Pick Ordered or Not ordered to see the note.

Indicated when

• —Screening men and women over 40 (fasting or non-fasting), or at any age with a specific risk condition (e.g. diabetes, hypertension, CKD, smoking, obesity, family history of premature CVD). Consider earlier screening in groups at increased risk, such as South Asian or Indigenous individuals [12]
• —Cardiovascular risk assessment in adults, particularly those with diabetes, hypertension, obesity, a family history of premature cardiovascular disease, chronic kidney disease, or known cardiovascular disease, where a standard lipid panel is the first-line test [8]
• —Once-in-a-lifetime measurement of lipoprotein(a), recommended as part of initial lipid screening to assess cardiovascular risk ([9]; see the lpa record)
• —Triglycerides above 1.5 mmol/L, or diabetes, obesity, or metabolic syndrome, where this panel is the starting point for calculating non-HDL-C or adding ApoB, both preferred over LDL-C alone in this situation ([8]; see the apob record)

Not indicated when

• —Including a full lipid panel in every annual 'wellness' bundle regardless of age or cardiovascular risk [10]
• —Repeating a lipid panel more often than needed once cardiovascular risk and any treatment targets are already established [11]

Why not

Repeating lipid testing at an interval not supported by evidence adds cost without changing management, and an isolated, mildly abnormal result in a genuinely low cardiovascular risk adult can prompt a work-up disproportionate to its clinical significance [11].

Better first step

Base ordering and repeat interval on cardiovascular risk rather than the calendar: use the standard panel (total cholesterol, HDL-C, triglycerides, and calculated or measured LDL-C) as the first-line test for at-risk adults, adding ApoB or Lp(a) as indicated (see those entries).

Typical ND rationale

An ND may order a lipid panel as part of a wellness check, reasoning that cardiovascular risk is worth knowing about and cholesterol is one of the most established, modifiable risk markers available, so checking it broadly seems like reasonable preventive care.

Ontario coverage & CONO orderability

OHIP status

insured

Total cholesterol (L055), HDL cholesterol (L117), and triglycerides (L243) are each listed by name in the 2026 Schedule of Benefits for Laboratory Services, along with a bundled 'Lipid (total)' code (L151). Each is insured when ordered by a physician, midwife, or NP who has clinically assessed the patient. No separate LDL-cholesterol line item was found in the Schedule; the CONO list's own description of the equivalent panel item describes LDL/VLDL as a 'calculated estimate' rather than a separately measured analyte, consistent with LDL-C ordinarily being calculated from the other three values rather than billed as its own test, though the Schedule text itself does not state this. ND-ordered testing is not insured and is billed privately (Reg. 552 s.22(1); SOB-LS 2026 preamble).

CONO orderable

Yes — CONO list #121

CONO list item 121, blood: 'Total Cholesterol panel – HDL / LDL / lipoprotein phenotyping (includes sample appearance, cholesterol, triglycerides, Lipopro VLDL cholesterol [calculated estimate]).'

Linked conditions

• dyslipidemia ↗
• diabetes ↗

Counselling script

“Given your risk factors, checking your cholesterol panel is a genuinely useful part of understanding your heart disease risk, so let's do that today, and I'll include a one-time Lp(a) as part of it if it hasn't been checked before. If your risk and cholesterol are already well understood and stable, I don't repeat this test every single year without a reason, since that adds cost without giving us new information. I'll re-check it whenever your risk picture changes or as recommended.”

Revisit if

• —New diagnosis of diabetes, hypertension, or cardiovascular disease
• —New family history of premature cardiovascular disease comes to light
• —Significant weight change or new metabolic risk factor

References

1. [1]Ontario Ministry of Health (2026). Ontario Health Insurance Plan: Schedule of Benefits for Laboratory Services (effective April 1, 2026). linkTotal cholesterol (L055) is listed by name in the 2026 OHIP Schedule of Benefits for Laboratory Services
2. [2]Ontario Ministry of Health (2026). Ontario Health Insurance Plan: Schedule of Benefits for Laboratory Services (effective April 1, 2026). linkHDL cholesterol (L117) is listed by name in the 2026 OHIP Schedule
3. [3]Ontario Ministry of Health (2026). Ontario Health Insurance Plan: Schedule of Benefits for Laboratory Services (effective April 1, 2026). linkTriglycerides (L243) is listed by name in the 2026 OHIP Schedule
4. [4]Ontario Ministry of Health (2026). Ontario Health Insurance Plan: Schedule of Benefits for Laboratory Services (effective April 1, 2026). linkA bundled 'Lipid (total)' code (L151) is listed in the 2026 OHIP Schedule
5. [5]Ontario Ministry of Health (2026). Ontario Health Insurance Plan: Schedule of Benefits for Laboratory Services (effective April 1, 2026). linkCommunity lab tests are insured only when ordered under the Schedule by an authorized prescriber
6. [6]Government of Ontario (e-Laws) (2026). Health Insurance Act, R.R.O. 1990, Reg. 552: General, s. 22 (insured laboratory services). linkA lab test is insured only when ordered by a physician, midwife, or NP who has clinically assessed the patient
7. [7]Ontario Ministry of Health (2026). Ontario Health Insurance Plan: Schedule of Benefits for Laboratory Services (effective April 1, 2026). linkTests ordered by anyone other than an authorized provider, including NDs, are not insured services
8. [8]Canadian Cardiovascular Society (2021). 2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in Adults. linkFor patients with triglycerides above 1.5 mmol/L, diabetes, or obesity, ApoB or non-HDL-C is the preferred lipid parameter for screening
9. [9]Canadian Cardiovascular Society (2021). 2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in Adults. linkLipoprotein(a) is recommended once in a patient's lifetime as part of initial lipid screening
10. [10]College of Family Physicians of Canada / Choosing Wisely Canada (2026). Family Medicine: Fifteen Tests and Treatments to Question. linkDon't do annual screening blood tests unless directly indicated by the patient's risk profile
11. [11]Canadian Society for Medical Laboratory Science / Choosing Wisely Canada (2025). Medical Laboratory Science: Fourteen Tests and Treatments to Question. linkDon't support repeat test ordering at a frequency not backed by evidence
12. [12]Canadian Cardiovascular Society (2021). 2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in Adults. linkCCS 2021: lipid screening for men and women over 40, or at any age with a listed risk condition; non-fasting acceptable