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
Additional Information: 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.
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
|
|