Lipid Panel

From Anvita Health Wiki

Contents 1 More Specific Terms 2 Indications 3 Clinical-significance 4 More General Terms 5 Additional Terms 6 References

More Specific Terms

• cholesterol HDL in serum
• cholesterol in serum/plasma
• cholesterol LDL in serum
• triglyceride in serum

Indications

• screening for dyslipidemia

• cardiovascular risk assessment

Clinical-significance

• Screening for dyslipidemia with a lipid panel is recommended annually for high-risk patients & every 5 years for patients at low risk with normal lipid profiles. [6]
  
• Generally consists of total cholesterol, HDL cholesterol & triglycerides in serum after an overnight fast. LDL cholesterol is generally calculated from the total & HDL cholesterol & triglycerides using the equation:
  
• ( LDL-cholesterol = Total Cholesterol - HDL-cholesterol - TG/5)*
  
• ( non-HDL cholesterol = Total Cholesterol - HDL-cholesterol) [3]
  
• * TG = triglycerides in serum ( mg/dL) Cholesterol = cholesterol in serum ( mg/dL)
  
• When triglycerides are > 200 mg/dL, non HDL-cholesterol is the target for lipid-lowering therapy. Add 30 mg/dL to the LDL-cholesterol goal. [3] Even when triglycerides are < 200 mg/dL, non HDL-cholesterol may be target for lipid-lowering therapy. [7]
  
• Measuring only total cholesterol & HDL cholesterol give equivalent to fasting lipid panel for cardiovascular risk assessment:

• does not require fasting
• risks for coronary disease & ischemic stroke are not associated with serum triglyceride levels
  

• Concentrations of cholesterol, HDL cholesterol & triglycerides obtained within 24 hours of acute myocardial infarction reflect preinfarct levels. After 24 hours, cholesterol levels decline, triglycerides may markedly increase & HDL cholesterol levels are unpredictable. Serum cholesterol drops with any acute injury or illness. 4 weeks should be allowed after recovery before obtaining a fasting lipid panel.

</pre>

• NCEP* Adult treatment goals for LDL-cholesterol & non-HDL cholesterol#
  
• Risk Factor@ Treatment goals
• Absent ............................ 160 190
• Present ........................... 130 160
• Coronary Artery Disease ........... 100 130
• high risk ......................... 70 100

</pre>

• * National Cholesterol Education Program
• # all values in mg/dL
• @ Risk Factor - 2 or more of the following:

• male sex
• family history of CAD < 55 years of age
• hypertension
• smoking
• obesity
• diabetes mellitus
• HDL-cholesterol < 40 mg/dL
• non- coronary artery atherosclerosis
  

• For moderately-high or high risk patients, lipid-lowering drug therapy ( statin, niacin) should achieve a least 30-40% reduction in LDL cholesterol levels. [3]
  
• Mortality in patients> 65 years of age not associated any lipid measurement. HDL inversely associated with myocardial infarction (hazard ratio = 0.85) in this age group.

More General Terms

• chemistry panel

Additional Terms

• LDL cholesterol direct (LDL direct) in serum

References

1. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
2. Prescriber's Letter 11(10): 2004 Detail-Document#: [1] (subscription needed) [2]
3. Grundy SM, Cleeman JI, Merz CN, Brewer HB Jr, Clark LT, Hunninghake DB, Pasternak RC, Smith SC Jr, Stone NJ; Coordinating Committee of the National Cholesterol Education Program. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. J Am Coll Cardiol. 2004 Aug 4;44(3):720-32. Review. PMID: [3]
4. Journal Watch 24(23):176-77, 2004 Psaty BM, Anderson M, Kronmal RA, Tracy RP, Orchard T, Fried LP, Lumley T, Robbins J, Burke G, Newman AB, Furberg CD. The association between lipid levels and the risks of incident myocardial infarction, stroke, and total mortality: The Cardiovascular Health Study. J Am Geriatr Soc. 2004 Oct;52(10):1639-47. PMID: [4]
5. Journal Watch 25(8):62, 2005 LaRosa JC, Grundy SM, Waters DD, Shear C, Barter P, Fruchart JC, Gotto AM, Greten H, Kastelein JJ, Shepherd J, Wenger NK; Treating to New Targets (TNT) Investigators. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med. 2005 Apr 7;352(14):1425-35. Epub 2005 Mar 8. PMID: [5]
6. Di Angelantonio E et al. for the Emerging Risk Factors Collaboration. Major lipids, apolipoproteins, and risk of vascular disease. JAMA 2009 Nov 11; 302:1993. PMID: [6]
7. Boekholdt SM et al Association of LDL Cholesterol, Non-HDL Cholesterol, and Apolipoprotein B Levels With Risk of Cardiovascular Events Among Patients Treated With Statins JAMA. 2012;307(12):1302-1309 <PubMed> PMID: [7] <Internet> [8]
8. NATIONAL GUIDELINE CLEARINGHOUSE (NGC) GUIDELINE SYNTHESIS LIPID SCREENING IN THE PRIMARY PREVENTION OF CORONARY HEART DISEASE AND ATHEROSCLEROTIC CARDIOVASCULAR DISEASE IN ADULTS [9]
   - Screening and management of hyperlipidemia University of Michigan ngc-guideline: [10] ngc-guideline: [11]

lipid panel (fasting lipid panel, FLP)