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We hear it everyday-Eat more fiber to reduce your cholesterol!  Any modification of your cholesterol levels must begin with the laboratory testing.  The laboratory testing for cholesterol has become increasingly complicated and is now a veritable alphabet soup of different fat proteins. Collectively, they are known as lipids.  The lipid panel usually includes the following:

Additional tests may include:


Most methodes have derived this using the Friedewald formula wich depends upon the total cholesterol, HDL, and TG-use of this formula in postprandial samples may underestimate levels by as much as 20%-the reason is mobilization of cholesterol out of LDL and HDL and into chylomicrons and VLDL

Direct measurement should be able to measure non fasting samples

IDEAL TESTING STATE Nine hour fast but a 12-14 hour fast after a low-fat, low-calorie meal, with no intake of alcohol for 24 hours is preferable

JAMA 2001;285:2486-2497

Current Recommendations for Adults from the National Cholesterol Education Program (NCEP) Third Report

Total Cholesterol (TC)
>240 mg/dL
>6.2 mmol/L
Low Density Lipoprotein (LDL-C)

Optimal <100 mg/dL
Near or above optimal (100-129 mg/dL)
Borderline High (130-159 mg/dL)
High (160-189 mg/dL)
Very High (>/= 190 mg/dL)

High Density Lipoprotein (HDL)
>40 mg/dL
Triglyceride (TG)
>/=150 mg/dL borderline
>/=400 mg/dL (4.5 mmol/L) elevated
>/=1000 mg/dL (11.3 mmol/L) very elevated
Additional Points
Current guidelines raises those with diabetes to an equivalent risk level for heart attack as those with coronary heart disease
Recommends treatment for beyond LDL lowering for those with TG >/= 200 mg/dL
Encourages use of plant stanols/sterols and viscous soluble fiber as a therapeutic dietary option
Lipoprotein (a)

JAMA 1996;276:544-548
JAMA 1994;271:999-1003

Elevated levels associated with increased risk in many studies, but not all-independent from other lipoproteins

Composed of an LDL with an extra lipoprotein called apo(a) attached by a disulfide bond to apo B-100

Apo(a) is heterogenous in length because of a genetically variable repeating peptide sequence called kringles (MW varying from 185-650 kDa)

>75% homology to plasminogen suggesting that it interferes with plasminogen binding and disrupts the fibrinolytic cascade

Measurments are for apo(a) protein content which is then converted to total particle mass or for cholesterol concentration, similar to LDL or HDL

Assay uses the high degree of glycosylation by binding Lp(a) to lectin, eluting, then measuring cholesterol

Triglyceride rich lipoprotein remnants (TRL) Lipoproteins containing the greatest proportion of triglyceride including chylomicrons, chylomicron remnants, VLDL, VLDL remnants, and intermediate density lipoproteins (IDL)

N Engl J Med 1998;338:1009-1015

Addition of folate reduced levels leading to decreased risk of CVD

C-reactive protein

N Engl J Med 2000;342:836-843

Ultrasensitive measurment has revealed a very small rise may indicate higher levels of risk for CVD


Veterans Affairs HDL Intervention Trial (VA-HIT) showed utility in raising HDL levels

N Engl J Med 1999;341:410-418
2500 men with coronary artery disease and relatively normal baseline levels of LDL, cholesterol, TG, but low HDL levels

Significant reduction in both primary and secondary endpoints in men with CAD when HDL was raised using gemfibrozil therpay

Raising HLD lowers risk without a change in LDL
7.5% increase in HDL and 24.5% decrease in TG associated with 22% decrease in coronary events and a 25% decrease in stroke


Posture Ideally, patient should be sitting for at least 20 minutes before sample is taken
Standing vs. lying down TC 10% higher
TG 12% higher
HDL 7% higher


Postprandial levels HDL may be slightly lower

Clinical Diagnosis and Management by Laboratory Methods. 20th Edition. Henry JB. WB Saunders 2001.

Commonly Used Terms

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