Labs in Dyslipedemia
Labs in Dyslipedemia
Labs in Dyslipedemia
INTRODUCTION
• Lipids, such as cholesterol and triglyceride, are insoluble in
plasma.
• chylomicrons;
• very low-density lipoprotein (VLDL);
• intermediate-density lipoprotein (IDL);
• low-density lipoprotein (LDL); and
• high-density lipoprotein (HDL).
Term used is for lipid values that are associated with disease or increased
risk of disease and for which lipid-altering therapy might be of value.
Disorders of lipoproteins
Secondary causes
• Hypothyroidism
• Dysgammaglobulinemia (systemic lupus erythematosus, multiple myeloma)
• Cholostatic diseases of the liver due to abnormal lipoproteins, as in primary biliary cirrhosis
• Chronic renal failure
• T2DM
• Obesity
• Excessive alcohol intake
• Metabolic syndrome
• Antihypertensive medications (thiazide diuretics and b-adrenergic blocking agents)
• Corticosteroid therapy (or severe stress that increases endogenous corticosteroids)
• Orally administered estrogens, oral contraceptives, pregnancy
• Protease inhibitors for treatment of HIV infection
• Sedentary life
Indications for measurement
The lipid profile and its components are some of the most
commonly ordered laboratory tests in clinical practice.
• Identifying patients who are at high risk for a lipid abnormality due
to a family history of genetic disorder, such as familial
hypercholesterolemia.
• Identifying the cause of another clinical problem such as
pancreatitis.
• Managing patients with established atherosclerotic CVD.
• Evaluating the efficacy of and/or adherence with lipid-lowering
therapy and lifestyle modification.
WHO SHOULD BE SCREENED —
HDL:
• Low (undesirable) < 40 mg/dL
• High (desirable) ≥ 60 mg/dL
Total cholesterol to HDL cholesterol ratio
Cholesterol/HDL ratio:
• Optimal < 4
• Borderline 4-5
• High risk > 5
LDL/HDL ratio: risk factor if ≥ 3.33
LDL cholesterol
• Non-HDLc fraction may be a better tool for risk assessment than LDL
cholesterol.
ASCVD Risk Categories and LDL-C Treatment Goals
Treatment goals
Risk category Risk factors/10-year risk LDL-C Non-HDL-C Apo B
(mg/dL) (mg/dL) (mg/dL)
– Progressive ASCVD including unstable angina in individuals after
achieving an LDL-C <70 mg/dL
– Established clinical cardiovascular disease in individuals with
Extreme risk DM, stage 3 or 4 CKD, or HeFH <55 <80 <70
– History of premature ASCVD (<55 male, <65 female)
Moderate risk ≤2 risk factors and 10-year risk <10% <100 <130 <90
Low risk 0 risk factors <130 <160 NR
Abbreviations: ACS, acute coronary syndrome; apo, apolipoprotein; ASCVD, atherosclerotic cardiovascular disease; CKD, chronic kidney disease;
DM, diabetes mellitus; HeFH, heterozygous familial hypercholesterolemia; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density
lipoprotein cholesterol; NR, not recommended.
Triglycerides
Normal <150
The most common indications for measuring triglyceride levels, either as a standalone test or as part of a lipid
profile, include:
●Establishing the etiology of acute pancreatitis
●Monitoring treatment of hypertriglyceridemia
●Screening family members for familial hypertriglyceridemia
Lipoprotein (a) or Lp(a)
• Lp(a)- LDL like particle with a molecule of apolipoprotein B-100 linked by a disulfide bridge
to apolipoprotein (a).
• Apo(a) component has homology with plasminogen in terms of structure and competes
with plasminogen for binding sites resulting in reduced fibrinolysis and the formation of
blood clots (thrombosis).
• Lp(a) is also thought to speed up atherosclerosis by binding LDL, Ca and other components
into an atherosclerotic plaque on the blood vessel wall.
• This dual action of Lp(a) explains its role in the promotion of cardiovascular disease.
Nonfasting lipid profiles may be used to calculate "remnant"
cholesterol.
• Fall in LDLc and HDLc and rise in triglycerides after 24 to 48 hours after
an acute MI (and also surgical trauma or infection) with a maximal
effect at seven days, and these changes persisted for approximately
two months. And 96 hours after a non-ST elevation MI.
Secondary causes of dyslipidemia must be excluded with a: