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Lipid Profile

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Description

Lab Testing Includes:

Cholesterol, total; High-Density Lipoprotein (HDL) cholesterol; Low-Density Lipoprotein (LDL) cholesterol (calculation); Triglycerides; Very Low-Density Lipoprotein (VLDL) cholesterol (calculation)

Use: Blood test to evaluate hyperlipidemia as an index to coronary artery disease. Fasting sample recommended.

Additional Information: It is recommended that one fasts for a minimum of 8 hours prior to getting their sample collected. Investigation of serum lipids is indicated in those with coronary and other arterial disease, especially when it is premature, and in those with family history of atherosclerosis or of hyperlipidemia. In this sense, the expression "premature" is mostly used to include those younger than 40 years of age. Patients with xanthomas should be worked up with lipid panels but not those with xanthelasmas or xanthofibromas in the sense of dermatofibromas. Those whose fasting serum is lipemic should have a lipid panel, but the serum of a subject with high cholesterol (but normal triglyceride) is not milky in appearance. The patient with high cholesterol (>240 mg/dL) should have a lipid panel. Patients with cholesterol levels between 200-240 mg/dL plus two other coronary heart disease risk factors should also have a lipid panel. In addition to application in screening programs for evaluation of risk factors for coronary arterial disease, lipid profiling may lead to detection of some cases of hypothyroidism. Primary hyperlipoproteinemia includes hypercholesterolemia, a direct risk factor for coronary heart disease. Secondary hyperlipoproteinemia includes increases of lipoproteins secondary to hypothyroidism, nephrosis, renal failure, obesity, diabetes mellitus, alcoholism, primary biliary cirrhosis, and other types of cholestasis. Decreased lipids are found with some cases of malabsorption, malnutrition, and advanced liver disease. In abetalipoproteinemia, cholesterol is <70 mg/dL. Through online blood testing, your lipid profile results can be turned around very rapidly.

ATP-III GUIDELINES

(NIH Publication No. 01-3305, May 2001 with July 2004 revisions)

Step 1: Determine lipoprotein levels - complete lipoprotein profile (total cholesterol, LDL and HDL cholesterol, triglycerides) after 9- to 12-hour fast.

ATP-III Classification of LDL, Total, and HDL Cholesterol

LDL Cholesterol

Primary Target of Therapy

Total Cholesterol

Primary Target of Therapy

<100 mg/dL

Optimal

<200 mg/dL

Desirable

100-129 mg/dL

Near optimal/above optimal

200-239 mg/dL

Borderline high

130-159 mg/dL

Borderline high

=240 mg/dL

High

160-189 mg/dL

High

HDL Cholesterol

 

=190 mg/dL

Very high

<40 mg/dL

Low

   

=60 mg/dL

High

Step 2: Identify atherosclerotic disease, which confers high risk for CHD events (CHD risk equivalent): Clinical CHD, symptomatic carotid artery disease, peripheral arterial disease, and abdominal aortic aneurysm.

Step 3: Blood test Determines presence of non-LDL major risk factors:

  • Cigarette smoking

  • BP =140/90 mm Hg

  • HDL <40 mg/dL (HDL >59 mg/dL is a negative risk factor and removes one risk factor from the total)

  • Males >44 years; females >54 years

  • CHD in male first-degree relative <55 years of age, in female first-degree relative <65 years of age

  • Diabetes

Step 4: Assess short-term CHD risk if two or more risk factors other than LDL are present without CHD or CHD risk equivalent. See following Framingham tables. There are three levels of 10-year risk:

>20% - CHD risk equivalent; 10% to 20%; <10%

Step 5: Determine risk category to establish LDL goal of therapy, to determine need for therapeutic lifestyle changes (TLC), and to determine level for drug consideration.

LDL Goals and Cutpoints for TLC and Drug Therapy inDifferent Risk Categories

Risk Category

LDL Goal

(mg/dL)

Initiate TLC

(mg/dL)

Consider Drug Therapy

Very high (CHD plus diabetes, eg)

<70 (optional)

=100

=100 mg/dL

(<100 mg/dL: drug optional)

High (CHD or risk equivalents)

(10-year risk >20%)

<100

=100

=130 mg/dL

(100-129 mg/dL: drug optional)

Moderately high (2+ risk factors)

<130

<100 (optional)

=130

10-year risk 10%-20%: =130 mg/dL

Moderate (2+ risk factors)

<130

=130

10-year risk <10%: =160 mg/dL

Low (0-1 risk factor

<160

=160

=190 mg/dL

(160-189 mg/dL: drug optional)

Step 6: Initiate therapeutic lifestyle changes if LDL is above goal. Diet, weight management, increased physical activity.

Step 7: Consider adding drug therapy if LDL exceeds levels in Step 5.

Step 8: Identify metabolic syndrome and treat, if present, after three months of TLC.

Step 9: Treat elevated triglycerides.

ATP-III Classification of Serum Triglycerides

<150 mg/dL

Normal

150-199 mg/dL

Borderline-high

200-499 mg/dL

High

=500 mg/dL

Very high

Reference: Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) - National Cholesterol Education Program; NIH Publication No. 01-3305, 2001,JAMA, 285:2486-97.

Table 1. Total Serum Cholesterol Levels in Milligrams per Deciliter for Persons 20 Years of Age and Older by Race / Ethnicity, Sex, and Age - United States, 1988-91

Race / Ethnicity, Sex, and Age

Number of Examined Persons

Mean

Selected Percentile

5th

10th

15th

25th

50th

75th

85th

90th

95th

Male

20 years and older

3953

205

143

153

162

176

201

231

247

260

276

20-34 years

1186

189

134

145

151

162

186

211

225

236

260

35-44 years

653

207

144

155

167

182

205

231

245

258

269

45-54 years

508

218

152

170

180

191

215

242

257

268

283

55-64 years

535

221

154

169

180

195

221

245

264

274

285

65-74 years

557

218

157

173

179

190

214

241

256

270

286

75 years and older

514

205

145

156

164

175

202

232

248

257

275

Female

20 years and older

3885

207

143

154

162

175

202

233

252

269

287

20-34 years

1177

185

134

143

150

160

182

204

218

229

254

35-44 years

709

195

142

152

159

170

193

215

232

242

254

45-54 years

464

217

158

165

171

187

212

240

264

279

297

55-64 years

503

237

168

184

191

204

228

264

280

291

323

65-74 years

493

234

168

180

186

205

232

261

278

290

308

75 years and older

539

230

163

175

184

198

227

263

279

287

316

Mexican Americans

Male

1092

202

140

151

159

172

199

225

245

257

277

Female

1046

200

139

149

158

169

195

224

241

258

279

Non-Hispanic Black

Male

922

199

136

149

156

170

195

224

242

252

276

Female

985

203

137

150

159

172

200

227

248

262

286

Non-Hispanic White

Male

1816

206

144

154

163

177

203

232

247

260

276

Female

1734

208

144

155

163

176

202

234

254

271

288

Table 2. High Density Lipoprotein Cholesterol in Milligrams per Deciliter for Persons 20 Years of Age and Older by Race / Ethnicity, Sex, and Age - United States, 1988-91

Race / Ethnicity, Sex, and Age

Number of Examined Persons

Mean

Selected Percentile

5th

10th

15th

25th

50th

75th

85th

90th

95th

From the Second Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II) - National Cholesterol Education Program; NIH Publication No. 93-3095, September 1993, JAMA, 269:3015, 1993.

Male

20 years and older

3920

46.5

28.0

31.0

34.0

37.0

44.1

53.1

59.1

64.0

73.0

20-34 years

1178

47.1

30.0

34.0

35.1

38.0

46.0

54.0

60.1

64.0

71.0

35-44 years

642

46.3

28.0

30.0

33.0

37.0

44.0

53.0

58.1

63.0

73.0

45-54 years

502

46.6

28.0

30.0

33.0

36.0

43.1

53.0

61.0

66.1

77.1

55-64 years

533

45.6

29.0

31.0

33.0

36.1

43.0

53.0

59.0

62.0

72.0

65-74 years

553

45.3

28.0

31.0

32.0

36.0

43.0

53.0

58.0

62.1

71.0

75 years and older

512

47.2

28.0

32.0

34.0

38.0

45.0

54.0

62.0

67.0

75.1

Female

20 years and older

3855

55.7

34.0

38.0

41.0

44.1

54.0

65.0

71.0

76.1

83.0

20-34 years

1167

55.7

34.0

38.0

41.0

44.1

54.0

64.1

70.1

75.1

83.1

35-44 years

701

54.3

33.0

37.0

40.0

44.0

53.0

64.1

69.1

72.1

79.0

45-54 years

459

56.7

37.0

38.1

41.0

46.0

56.0

65.0

72.1

77.1

84.1

55-64 years

500

56.1

33.0

37.0

40.0

44.0

53.0

66.0

73.0

79.0

87.1

65-74 years

492

55.7

34.0

37.0

40.0

44.1

54.0

65.1

73.0

78.0

83.1

75 years and older

536

57.1

33.0

39.0

41.0

44.1

56.0

66.1

73.1

78.1

87.0

Mexican Americans

Male

1077

46.9

30.0

33.0

34.1

38.0

45.0

54.0

59.0

64.0

69.0

Female

1040

53.3

34.0

37.0

40.0

44.0

52.0

61.0

68.0

72.1

78.0

Non-Hispanic Black

Male

918

53.3

30.0

35.0

38.0

42.0

51.0

62.0

69.1

75.1

86.1

Female

978

57.8

37.0

40.0

43.0

47.0

55.1

67.1

74.0

78.1

86.0

Non-Hispanic White

Male

1803

45.5

28.0

30.0

33.1

36.1

44.0

52.1

58.0

62.0

71.1

Female

1717

55.7

33.1

37.0

40.0

44.0

54.0

65.1

71.1

77.0

83.1

Table 3. Low Density Lipoprotein Cholesterol in Milligrams per Deciliter for Persons 20 Years of Age and Older by Race / Ethnicity, Sex, and Age - United States, 1988-91

Race / Ethnicity, Sex, and Age

Number of Examined Persons

Mean

Selected Percentile

5th

10th

15th

25th

50th

75th

85th

90th

95th

Male

20 years and older

1669

131

75

87

95

106

129

154

167

179

194

20-34 years

487

120

67

78

86

97

121

139

152

165

186

35-44 years

274

134

85

92

98

111

131

156

166

176

192

45-54 years

224

138

78

91

100

118

136

163

174

187

195

55-64 years

228

142

78

90

104

117

143

165

175

194

205

65-74 years

259

141

93

104

109

119

134

163

177

185

199

75 years and older

197

132

83

88

93

106

130

154

170

186

196

Female

20 years and older

1673

126

69

81

88

99

122

150

165

175

191

20-34 years

525

110

59

70

75

88

108

129

142

155

173

35-44 years

316

117

67

85

88

97

116

138

146

155

165

45-54 years

214

132

70

87

93

107

130

157

173

182

198

55-64 years

213

145

79

90

101

122

145

170

184

189

209

65-74 years

202

147

92

97

109

119

148

169

185

192

206

75 years and older

203

147

90

102

109

121

143

168

189

197

209

Mexican Americans

Male

448

124

70

77

85

96

120

148

161

172

188

Female

471

122

67

80

86

95

118

144

158

166

189

Non-Hispanic Black

Male

393

126

69

76

82

96

123

146

168

186

206

Female

422

126

67

76

86

100

124

147

162

174

192

Non-Hispanic White

Male

773

132

76

88

97

108

129

154

168

179

194

Female

729

126

69

82

89

99

122

151

166

176

192

Lipid Reference Intervals and Coronary Heart Disease (CHD) Cut-Points
 

Adults (>19 y)

Children and Adolescents

*Other factors affect CHD risk such as hypertension, smoking, diabetes, severe obesity, and family history of premature CHD.

1 The Expert Panel. Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, Arch Intern Med, 1988, 36:36-69.

2 Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) - National Cholesterol Education Program; NIH Publication No. 01-3305, 2001, JAMA, 285:2486-97.

3 Friedewald WT, Levy RI, Fredrickson DS, "Estimation of the Concentration of Low-Density Lipoprotein Cholesterol in Plasma Without Use of the Ultracentrifuge," Clin Chem, 1972, 18:449-552.

LDL cholesterol calculated by Friedewald formula: "LDL cholesterol" = "total cholesterol" - "triglycerides/5" - "HDL cholesterol"; where "triglycerides/5" = "VLDL cholesterol"

4 Kannel WB, Castelli WP, Gordon T, Ann Int Med, 1979, 90:85.

5 Grinstead GF, "Lipoprotein(s): Review and Update," AACC Lipids and Lipoproteins Division Newsletter: The Fats of Life, 1990, 4(1):1, 3-8.

6 Concentrations >30 mg/dL are associated with a two- to fivefold increase in risk. The significance of elevated Lp(a) in nonwhite populations is still under investigation.

 

CHD Cut-Points

 

Total cholesterol1

<200 mg/dL

Desirable blood cholesterol

<170 mg/dL

Acceptable

200-239 mg/dL

Borderline-high blood cholesterol

170-199 mg/dL

Borderline

=240 mg/dL

High blood cholesterol

=200 mg/dL

High

 

CHD Cut-Points

   

Triglycerides2

<150 mg/dL

Normal

 

Not established

150-199 mg/dL

Borderline-high

     

200-499 mg/dL

High

     

=500 mg/dL

Very high

     

HDL cholesterol2

<40 mg/dL as the cut-point for increased CHD risk

Not established

 

CHD Cut-Points

   

LDL cholesterol1-3

<100 mg/dL

Optimal

<110 mg/dL

Acceptable

100-129 mg/dL

Near optimal/above optimal

110-129 mg/dL

Borderline

130-159 mg/dL

Borderline-high

=130 mg/dL

High

160-189

High

     

=190

Very high

     
 

Risk of CHD

Male

Female

   

Total cholesterol/HDL ratio4*

1/2 average risk

3.4

3.3

Not established

Average risk

5.0

4.4

   

2 x average risk

9.6

7.1

   

3 x average risk

23.4

11.0

   
 

Risk of CHD

Male

Female

   

LDL/HDL ratio4*

1/2 average risk

1.0

1.5

Not established

Average risk

3.6

3.2

   

2 x average risk

6.3

5.0

   

3 x average risk

8.0

6.1

   

Apo A-1 level

Reference

132±20 (mg/dL)

 

Not established

Diagnosed CHD

98±15 (mg/dL)

     

Apo B level

Reference

83±13 (mg/dL)

 

Not established

Diagnosed CHD

114±23 (mg/dL)

     
 

Risk of CHD

Male

Female

   

Ratio of Apo A-1/Apo B

Average risk

1.4

1.6

Not established

2 x average risk

1.1

1.1

   

3 x average risk

1.0

1.0

   
 

Risk of CHD

Male

Female

   

Ratio of Apo B/Apo A-1

Average risk

0.7

0.6

Not established

2 x average risk

0.9

0.9

   

3 x average risk

1.0

1.0

   

Lipoprotein (a)5

<30 mg/dL (lowest risk groups)6

Not established

Lipoprotein Phenotyping by Electrophoresis (Fredrickson Classification)1,2

Electrophoretic Lipoprotein Phenotype (Prevalence)

Elevated Lipoproteins

Plasma Cholesterol

Plasma Triglycerides

Appearance of Chilled Plasma

Primary Disorders

Secondary Disorders

1 Adapted from Havel RJ, et al, "Lipoproteins and Lipid Transport," Metabolic Control and Disease, 8th ed, Bondy PK, Rosenberg LD, eds, Philadelphia, PA: WB Saunders Co, 1980:393-494.

2 Lipoprotein phenotyping results are based on Fredrickson et al classifications using the following lipid values in conjunction with the electrophoretic pattern:

Type I (rare)

Chylomicrons

Normal or slightly elevated

Markedly elevated

Creamy layer above clear or slightly turbid infranate

Familial lipoprotein lipase deficiency

SLE; not associated with atherosclerosis

Type IIa (moderately common)

LDL

Moderately elevated

Normal

Clear

Familial hypercholesterolemia; familial combined hyperlipidemia; polygenic hypercholesterolemia

Nephrotic syndrome; hypothyroidism

Type IIb (common)

LDL; VLDL

Moderately elevated

Slightly elevated

Slight to moderate turbidity

Familial combined hyperlipidemia; polygenic hypercholesterolemia (dietary excess)

Nephrotic syndrome; stress-induced

Type III (rare)

Broad ß lipoprotein

Moderately elevated

Moderately to markedly elevated

Turbid or opaque layer above turbid infranate

Familial dysbeta-lipoproteinemia (broad ß disease)

Hypothyroidism; monoclonal gammopathies

Type IV (common)

VLDL

Normal or slightly elevated

Moderately to markedly elevated

Turbid to frankly opaque

Familial (mild) Tangier disease

Diabetes mellitus; alcoholism; uremia; stress; oral contraceptives

Type V (fairly common)

Chylomicrons; VLDL

Moderately elevated

Markedly elevated

Creamy layer over turbid to opaque infranate

Familial combined hyperlipidemia

Alcoholism; oral contraceptives; diabetes mellitus

Age

(y)

Triglycerides

(mg/dL)

LDL

(mg/dL)

Reference: N Engl J Med, 176:1967.

0-19

10-140

50-170

20-29

10-140

60-170

30-39

10-150

70-190

40-49

10-160

80-190

50-59

10-190

80-210

Properties of Lipoproteins Classified by Electrophoresis

Electrophoretic Migration

Density on Ultracentrifugation

Composition

Major Apoproteins

C = cholesterol; TG = triglyceride; PL = phospholipid; P = protein.

1 Do not migrate during electrophoresis.

a

High density (HDL)

15% C, 5% TG, 30% PL, 50% P

AI, AII, C, D

ß

Low density (LDL)

45% C, 10% TG, 20% PL, 25% P

B-100

Pre-ß

Very low density (VLDL)

15% C, 60% TG, 15% PL, 10% P

B-100, C, E

Chylomicrons1

Extremely low density

5% C, 85% TG, 5% PL, 2% P

B-48, C, E

FRAMINGHAM TABLES - Estimate of 10-Year Risk for Men

Adapted from "Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)," JAMA, 2001, 285(19):2486-97.

Age

(y)

Points

20-34

-9

35-39

-4

40-44

0

45-49

3

50-54

6

55-59

8

60-64

10

65-69

11

70-74

12

75-79

13

Total Cholesterol

(mg/dL)

Points

20-39

(y)

40-49

(y)

50-59

(y)

60-69

(y)

70-79

(y)

<160

0

0

0

0

0

160-199

4

3

2

1

0

200-239

7

5

3

1

0

240-279

9

6

4

2

1

=280

11

8

5

3

1

 

Points

20-39

(y)

40-49

(y)

50-59

(y)

60-69

(y)

70-79

(y)

Nonsmoker

0

0

0

0

0

Smoker

8

5

3

1

1

HDL

(mg/dL)

Points

=60

-1

50-59

0

40-49

1

<40

2

Systolic BP

(mm Hg)

Untreated

Treated

<120

0

0

120-129

0

1

130-139

1

2

140-159

1

2

=160

2

3

Point Total

10-Year Risk

(%)

<0

<1

0

1

1

1

2

1

3

1

4

1

5

2

6

2

7

3

8

4

9

5

10

6

11

8

12

10

13

12

14

16

15

20

16

25

=17

=30

FRAMINGHAM TABLES - Estimate of 10-Year Risk for Females

Adapted from "Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)," JAMA, 2001, 285(19):2486-97.

Age

(y)

Points

20-34

-7

35-39

-3

40-44

0

45-49

3

50-54

6

55-59

8

60-64

10

65-69

12

70-74

14

75-79

16

Total Cholesterol

(mg/dL)

Points

20-39

(y)

40-49

(y)

50-59

(y)

60-69

(y)

70-79

(y)

<160

0

0

0

0

0

160-199

4

3

2

1

1

200-239

8

6

4

2

1

240-279

11

8

5

3

2

=280

13

10

7

4

2

 

Points

20-39

(y)

40-49

(y)

50-59

(y)

60-69

(y)

70-79

(y)

Nonsmoker

0

0

0

0

0

Smoker

9

7

4

2

1

HDL

(mg/dL)

Points

=60

-1

50-59

0

40-49

1

<40

2

Systolic BP

(mm Hg)

Untreated

Treated

<120

0

0

120-129

1

3

130-139

2

4

140-159

3

5

=160

4

6

Point Total

10-Year Risk

(%)

<9

<1

9

1

10

1

11

1

12

1

13

2

14

2

15

3

16

4

17

5

18

6

19

8

20

11

21

14

22

17

23

22

24

27

=25

=30

 
 
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Lab Test FAQ's
With LabTestportal.com you can order a blood test or multiple blood tests to accommodate your lab testing needs at over 2,500 locations in the US. With an extensive menu of health wellness laboratory tests, you have the freedom to choose the desired blood tests and have your lab testing performed on your schedule. One of the most popular blood tests CBC (Complete Blood Count) is routinely ordered from the Labtestportal blood test catalogue of health wellness testing. When you find your lab testing profile, we provide you with the fasting blood test information need to prepare for the visit to lab testing facility you choose.