Lipid profile

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LIPP

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Lipids are fat-like substances which are important parts of cells and are a source of energy. A lipid panel measures the level of specific lipids in blood to help assess your risk of cardiovascular disease (CVD). It includes the determination of total cholesterol (CHOL), high-density lipoprotein cholesterol (HDL), and triglycerides (TRIG).


Screening when no risk factors present: for adults, every four to six years; for youths, once between the ages of 9 and 11 and again between ages 17 and 21.


Monitoring: at regular intervals when risk factors are present, when prior results showed high-risk levels, and/or to monitor the effectiveness of treatment.


Note: includes indirect measurement of VLDL and two additional parameters: Non-HDL Cholesterol (nHDLc) and Ratio of total cholesterol to HDL cholesterol (TC/H).

About

Lipids are a group of fats and fat-like substances that are important constituents of cells and sources of energy. A lipid panel measures the level of specific lipids in the blood.


Two important lipids, cholesterol and triglycerides, are transported in the blood by lipoprotein particles. Each particle contains a combination of protein, cholesterol, triglyceride, and phospholipid molecules. The particles measured with a lipid profile are classified by their density into high-density lipoproteins (HDL), low-density lipoproteins (LDL), and very-low-density lipoproteins (VLDL).


Monitoring and maintaining healthy levels of these lipids is important in staying healthy. While the body produces the cholesterol needed to function properly, the source for some cholesterol is the diet. Eating too much of foods that are high in saturated fats and trans unsaturated fats (trans fats) or having an inherited predisposition can result in a high level of cholesterol in the blood. The extra cholesterol may be deposited in plaques on the walls of blood vessels. Plaques can narrow or eventually block the opening of blood vessels, leading to hardening of the arteries (atherosclerosis) and increasing the risk of numerous health problems, including heart disease and stroke. A high level of triglycerides in the blood is also associated with an increased risk of developing cardiovascular disease (CVD), although the reason for this is not well understood.

Preparation

Typically, fasting for 9-12 hours (water only) before having your blood drawn is required, but some labs offer non-fasting lipid testing. Follow any instructions you are given and tell the person drawing your blood whether or not you have fasted. For youths without risk factors, testing may be done without fasting.

Methodology

The Abaxis LIPID panel assay, an enzymatic end-point method.

Indications

Adults It is recommended that healthy adults with no other risk factors for heart disease be tested with a fasting lipid panel once every four to six years. Initial screening may involve only a single test for total cholesterol and not a full lipid profile. However, if the screening cholesterol test result is high, it will likely be followed by testing with a lipid panel.


If other risk factors are present or if the previous testing revealed a high cholesterol level in the past, more frequent testing with a full lipid profile is recommended.


Risk factors other than high low-density lipoprotein cholesterol (LDL-C) include:

  • Cigarette smoking
  • Being overweight or obese
  • Unhealthy diet
  • Being physically inactive—not getting enough exercise
  • Age (if you are a male 45 years or older or a female 50-55 years or older)
  • Hypertension (blood pressure of 140/90 or higher or taking high blood pressure medications)
  • Family history of premature heart disease (heart disease in a first-degree male relative under age 55 or a first-degree female relative under age 65)
  • Pre-existing heart disease or already having had a heart attack
  • Diabetes or prediabetes
Note: High HDL (60 mg/dL or above) is considered a "negative risk factor" and its presence allows the removal of one risk factor from the total.


Youths


For children and adolescents, routine lipid testing is recommended by the American Academy of Pediatrics (AAP) in all children once between the ages of 9 and 11 and again between 17 and 21. Earlier and more frequent screening with a lipid panel is recommended for children and youths who are at an increased risk of developing heart disease as adults. Some of the risk factors are similar to those in adults and include a family history of heart disease or health problems such as diabetes, high blood pressure, or being overweight. High-risk children should be tested between 2 and 8 years old with a fasting lipid profile, according to the AAP.


Children younger than 2 years old are too young to be tested.


Monitoring


A lipid panel may also be ordered at regular intervals to evaluate the success of lipid-lowering lifestyle changes such as diet and exercise or to determine the effectiveness of drug therapy such as statins.

Interpretation

Adults In general, healthy lipid levels help to maintain a healthy heart and lower the risk of heart attack or stroke. A health practitioner will take into consideration the results of each component of a lipid panel plus other risk factors to help determine a person's overall risk of coronary heart disease, whether treatment is necessary and, if so, which treatment will best help to lower the person's risk of heart disease.


In 2002, the National Cholesterol Education Program (NCEP) Adult Treatment Panel III provided the guidelines for evaluating lipid levels and determining treatment. However, in 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) published new guidelines on the treatment of cholesterol to reduce cardiovascular disease risk in adults. These guidelines recommend a treatment strategy different than those from NCEP. Decisions about cholesterol-lowering therapies are no longer focused on LDL-C or non-HDL-C targets but are based on the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) and other factors.


The latest guidelines include a newly developed, evidence-based risk calculator for ASCVD used to identify individuals most likely to benefit from therapy. It is intended for people without heart disease between the ages of 40 and 79. Many factors are considered in the calculation, including age, gender, race, total cholesterol, HDL-C, blood pressure, presence of diabetes, and smoking habit. Additionally, the updated guidelines recommend evaluating therapeutic response compared to LDL-C baseline values, with reduction thresholds differing based on the intensity of the lipid-lowering drug therapy.


Use of the updated risk calculator and guidelines remains controversial. Many still use the older guidelines from the NCEP Adult Treatment Panel III to evaluate lipid levels and CVD risk:


LDL Cholesterol

Optimal: Less than 100 mg/dL (2.59 mmol/L); for those with known disease (ASCVD or diabetes), less than 70 mg/dL (1.81 mmol/L) is optimal

Near/above optimal: 100-129 mg/dL (2.59-3.34 mmol/L)

Borderline high: 130-159 mg/dL (3.37-4.12 mmol/L)

High: 160-189 mg/dL (4.15-4.90 mmol/L)

Very high: Greater than 190 mg/dL (4.90 mmol/L)


Total Cholesterol

Desirable: Less than 200 mg/dL (5.18 mmol/L)

Borderline high: 200-239 mg/dL (5.18 to 6.18 mmol/L)

High: 240 mg/dL (6.22 mmol/L) or higher


HDL Cholesterol

Low level, increased risk: Less than 40 mg/dL (1.0 mmol/L) for men and less than 50 mg/dL (1.3 mmol/L) for women

Average level, average risk: 40-50 mg/dL (1.0-1.3 mmol/L) for men and between 50-59 mg/dl (1.3-1.5 mmol/L) for women

High level, less than average risk: 60 mg/dL (1.55 mmol/L) or higher for both men and women


Fasting Triglycerides

Desirable: Less than 150 mg/dL (1.70 mmol/L)

Borderline high: 150-199 mg/dL(1.7-2.2 mmol/L)

High: 200-499 mg/dL (2.3-5.6 mmol/L)

Very high: Greater than 500 mg/dL (5.6 mmol/L)


Non-HDL Cholesterol

Optimal: Less than 130 mg/dL (3.37 mmol/L)

Near/above optimal: 130-159 mg/dL (3.37-4.12mmol/L)

Borderline high: 160-189 mg/dL (4.15-4.90 mmol/L)

High: 190-219 mg/dL (4.9-5.7 mmol/L)

Very high: Greater than 220 mg/dL (5.7 mmol/L)


Unhealthy lipid levels and/or the presence of other risk factors such as age, family history, cigarette smoking, diabetes and high blood pressure, may mean that the person tested requires treatment. The NCEP Adult Treatment Panel III guidelines use the results of lipid tests and these other major risk factors to define target LDL cholesterol levels. According to those guidelines, if individuals have LDL-C above the target values, they will be treated. The target LDL-C value is:

  • Less than 100 mg/dL (2.59 mmol/L) if the person has heart disease or diabetes [and ideally less than 70 mg/dL (1.81 mmol/L)]
  • Less than 130 mg/dL (3.37 mmol/L) if the person has 2 or more risk factors
  • Less than 160 mg/dL (4.14 mmol/L) if the person has 0 or 1 risk factor
Youths


A full, fasting lipid panel is recommended for screening youths with risk factors for developing heart disease, according to the American Academy of Pediatrics. Fasting prior to lipid screening in children without risk factors is unnecessary. Non-high-density lipoprotein cholesterol (non-HDL-C) is the recommended test for non-fasting lipid screening. Non-HDL-C-is calculated by testing for total cholesterol and HDL-C and taking the difference between the two levels. Recommended cut-off values include:



Test Acceptable (mg/dL) Borderline (mg/dL) High (mg/dL)
Children and Adolescents Total Cholesterol Less than 170 170-199 Greater than or equal to 200

Non-HDL Cholesterol Less than 120 120-144 Greater than or equal to 145
Young Adults Total Cholesterol Less than 190 190-224 Greater than or equal to 225

Non-HDL Cholesterol Less than 150 150-189 Greater than or equal to 190
*Adapted from "Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: Summary report." Pediatrics 2011; 128.

Disclaimer

The laboratory test results are NOT to be interpreted as results of a "stand-alone" test. The test results have to be interpreted after correlating with suitable clinical findings and additional supplemental tests/information. Your healthcare providers will explain the meaning of your tests results, based on the overall clinical scenario. Certain medications that you may be currently taking may influence the outcome of the test. Hence, it is important to inform your healthcare provider of the complete list of medications (including any herbal supplements) you are currently taking. This will help the healthcare provider interpret your test results more accurately and avoid unnecessary chances of a misdiagnosis.

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