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Lipid profile

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Why is the test needed?

The lipid profile test is done to evaluate the risk of cardiovascular disease (CVD) and to monitor the treatment taken for abnormal lipid levels.

When is it done?

Screening:

• Adults without risk factors: Even if the person is healthy and has no risk factors, he should get himself checked every 4 to 6 years.

• Children and youngsters without risk factors: till the age of 21 years, this test should be done between 9 and 11 years, and again between 17 and 21 years of age.

• People with risk factors: such as obesity or overweight, and previous positive test results, then this test should be done on a regular basis.

Monitoring:

• This test is also done to monitor the effectiveness of the treatment.

What sample is needed, and how is it collected?

lipid-profile-blood-test
• The sample is taken from the veins present in the arm, especially from the elbow fold.

• The blood sample can also be taken in the form of drops from the tip of a finger by pricking it by a needle. The fingertip sample is usually taken when the test is being done on a portable testing device.

What are the preparations needed before the test?

• Generally, a person is asked not to eat anything for 9 to 12 hours before giving the blood sample, but the sample can be collected in a non-fasting state as well.

• Children and youngsters between the ages of 2 to 24 years can give the blood sample without fasting.

• Follow the instructions and advice given by the doctor or the laboratory technician.

• It is important to tell the person who is taking your blood sample about your fasting condition.

What is tested?

The test measures the level of lipids or the fatty substance in your blood, which are called as blood lipids. The two main blood lipids are cholesterol and triglycerides. These fat molecules are only able to travel in your blood in the form of lipoproteins which are formed when they combine with protein molecules.

The lipid panel measures these lipids and classify these lipoproteins on the basis of their density into high-density lipoproteins (HDL), low-density lipoproteins (LDL), very-low-density lipoproteins (VLDL) and others.

A typical lipid profile consists of the following:

• Total cholesterol: calculates all the cholesterol found in the lipoprotein particles.

• High-density lipoprotein cholesterol (HDLC): calculates cholesterol found in the HDL particles. It is called good cholesterol, as it carries the extra cholesterol from the blood to the liver for its removal.

• Low-density lipoprotein cholesterol (LDLC): measures the cholesterol found in LDL particles. It is called bad cholesterol, as it results in deposition of the extra cholesterol in the blood vessel walls, leading to atherosclerosis. Typically, the LDLC is calculated considering the results of the total cholesterol, HDLC, and triglycerides results.

• Triglycerides: calculate triglycerides found in the lipoprotein particles, which is mostly present in the very low-density lipoproteins (VLDL).

Sometimes, a lipid profile may consist of following additional information.

• Very low-density lipoprotein cholesterol (VLDLC): measured from triglycerides/5, which is based on the composition of VLDL particles.

• Non-HDLC: measured from total cholesterol barring HDLC.

• Cholesterol/ HDL ratio: the ratio of total cholesterol to HDLC.

Why maintaining healthy blood lipids levels are important

Maintaining healthy levels of lipids is critically important for keeping good health. Although your body itself generates the required cholesterol, however, you get the other source of cholesterol from the food that you eat.
Eating food containing a high amount of saturated and trans-fat can result in an increased level of cholesterol in the blood. This excess cholesterol gets accumulated in the plaques along the inner walls of the blood vessel, causing the narrowing of the vessel and leading to cardiovascular issues such as high blood pressure, heart attack, stroke, and others. A high amount of triglycerides in the blood also increases the risk of developing cardiovascular disease (CVD).

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What does the test result mean?

The result of this test can be categorized for the two separate age groups:

Results (for adults)

Healthy levels of the blood lipids allow you to maintain good cardiovascular health and reduce the chances of having heart attacks, hypertension, stroke, and other conditions.

Lipid profile, when used along with your cardiovascular risk factors, allows your doctor
• To estimate your risk of developing cardiovascular issues.
• To find out whether you would need any treatment
• And, if yes, what would be the treatment that would suit you the most

Different health organizations have set different recommendations for the treatment based on the calculated cardiovascular disease risk.

 

I. NCEP Adult Treatment Panel III guidelines (2002)

is an old guideline that is still widely used by many doctors to assess lipid levels and cardiovascular risk. This is as follows:

 

TestDesirableAbove desirableBorderline HighHighVery High
LDL CholesterolLess than 100 mg/dL; with CVD or diabetes: less than 70 mg/dL100-129 mg/dL130-159 mg/dL160-189 mg/dLGreater than 190 mg/dL
Total CholesterolLess than 200 mg/dL200-239 mg/dL240 mg/dL or higher
Fasting TriglyceridesLess than 150 mg/dL150-199 mg/dL200-499 mg/dLGreater than 500 mg/dL
Non-HDL CholesterolLess than 130 mg/dL130-159 mg/dL;160-189 mg/dL190-219 mg/dLGreater than 220 mg/dL

 

HDL CholesterolLow Level (Increased Risk)Average Level (Average Risk)High Level (Less than Average Risk)
WomenLess than 50 mg/dL50-59 mg/dl60 mg/dL
MenLess than 40 mg/dL40-50 mg/dL60 mg/dL or higher

According to the NCEP Adult Treatment Panel III guidelines, if the person’s LDL cholesterol is above the following values and has risk factors such as family history, cigarette smoking, diabetes, high blood pressure, then he requires treatment for the same.

The target value of LDL cholesterol is:

• Below 100 mg/dL, if the person is suffering from heart disease or diabetes (idea value below 70 mg/dL).

• Below 130 mg/dL, if the person has two or more risk factors.

• Below 160 mg/dL, if the person has none or 1 risk factor.

 

II. According the American College of Cardiology (ACC) and the American Heart Association (AHA)

According to ACC and AHH, a risk calculator should be used, in people with no heart disease aged between 40 to 75 years, to calculate the risk of developing any cardiovascular disease in the next 10 years.
For calculation conditions like total cholesterol, LDL cholesterol, HDL cholesterol, gender, age, race, blood pressure (BP), diabetes and smoking, and food habit should be considered.
With the first test, an initial risk should be calculated, which is then tracked over a period of time with subsequent risk calculations.

The Ten-year cardiovascular risk is classified as:

 

Calculated risk of 10 yearsCategory denoted for cardiovascular risk
Below 5%Low
Between 5% to 7.4%Borderline
Between 7.5% to 19.9%Intermediate
Above 20%High

American College of Cardiology (ACC) and the American Heart Association (AHA) has recommended the use of statins for the treatment in the following conditions:

• Heart disease: which is confirmed by medical history, physical examination, and imaging scans.

• High LDL cholesterol: above 190mg/dL

• Adults with diabetes: diabetics between the age of 40 to 75 years with LDL cholesterol of 70-189mg/dL, but with no heart disease.

• Adults without diabetes and heart disease but with higher risk category: people aged between 40 to 75 years with no diabetes or heart problem, but with LDL cholesterol between 70-189mg/dL, and immediate to high risk (more than 7%) of developing heart disease in 10 years.

The use of the risk calculator and ACC/AHA guidelines are controversial. Some doctors believe the current risk calculator overestimates the risk.

 

III. The U.S. Preventive Services Task Force (USPSTF)

The UPSTF has recommended the use of statins in the treatment, for adults between the age of 40 to 75 years with no history of heart disease, no symptoms of coronary artery disease or stroke, on the basis of risk factors such as

• LDL cholesterol above 130mg/dL
• HDL cholesterol below 40mg/dL
• Diabetes
• High blood pressure,
• Smoking, and
• Use of the risk calculator

 

Risk factors10 year Risk in %Recommendation
1 or more10% or moreShould use a low-to-moderate dose statin.
1 or more7.5% to 10%May or may not use a low-to-moderate dose statin.

 

Results for children

American Academy of Pediatrics recommends a fasting lipid panel to screen children and teenagers who have cardiovascular disease risk factors. No fasting is required in the absence of risk factors.

For non-fasting lipid screening, a non HDL cholesterol test is recommended. The cut-off values are as follows:

 

Age groupTestDesired valueBorderline valueHigh
Children/ Teenagers (Between the age of 2 to 18 years)Total CholesterolBelow 170170 to 199Equal or above 200
Non-HDL CholesterolBelow 120120 to 144Equal or above 145
Youngsters (between the age of 19 to 24 years)Total CholesterolBelow 190190 to 224Equal or above 225
Non-HDL CholesterolBelow 150150 to 189Equal or above 190

Source: Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents- Pediatrics 2011; 128.

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