As of August 1st 2010 Merck will DISCONTINUE the Schering-Plough Cares Patient Assistance Program.
Patients who are already enrolled in the discontinued program need to enroll in the Merck Patient Assistance Program to receive assistance for their current medications.
Try: merckpap.com (Merck.com) for patient assistance or PPARX.org
The Comprehensive Metabolic Panel (CMP) is a frequently ordered panel of tests that gives your doctor important information about the current status of your kidneys, liver, and electrolyte and acid/base balance as well as of your blood sugar and blood proteins. Abnormal results, and especially combinations of abnormal results, can indicate a problem that needs to be addressed. The CMP is typically a group of 14 specific tests that have been approved, named, and assigned a CPT code (a Current Procedural Terminology number) as a panel by Medicare, although labs may adjust the number of tests up or down. Since the majority of insurance companies also use these names and CPT codes in their claim processing, this grouping of tests has become standardized throughout the United States.
The CMP includes:
Both increased and decreased levels can be significant.
Proteins
Albumin, a small protein produced in the liver, is the major protein in serum. Total protein measures albumin as well as all other proteins in serum. Both increases and decreases in these test results can be significant.
Electrolytes
The concentrations of sodium and potassium are tightly regulated by the body as is the balance between the four molecules. Electrolyte (and acid-base) imbalances can be present with a wide variety of acute and chronic illnesses. Chloride and CO2 tests are rarely ordered by themselves.
Kidney Tests
BUN and creatinine are waste products filtered out of the blood by the kidneys. Increased concentrations in the blood may indicate a temporary or chronic decrease in kidney function. When not ordered as part of the CMP, they are still usually ordered together.
Liver Tests
ALP, ALT, and AST are enzymes found in the liver and other tissues. Bilirubin is a waste product produced by the liver as it breaks down and recycles aged red blood cells. All can be found in elevated concentrations in the blood with liver disease or dysfunction.
How is the sample collected for testing?
The CMP uses a tube of blood collected by inserting a needle into a vein in your arm. Ask your doctor whether you should be fasting for 10 to 12 hours prior to the blood draw. Depending on the reason for ordering the CMP, it may be drawn after fasting or on a random basis.
How is it used?
The CMP is used as a broad screening tool to evaluate organ function and check for conditions such as diabetes, liver disease, and kidney disease. The CMP may also be ordered to monitor known conditions, such as hypertension, and to monitor patients taking specific medications for any kidney- or liver-related side effects. If your doctor is interested in following two or more individual CMP components, he may order the entire CMP because it offers more information.
When is it ordered?
The CMP is routinely ordered as part of a blood work-up for a medical exam or yearly physical. Although it may be performed on a random basis, the CMP sample is usually collected after a 10 to 12 hour fast (no food or liquids other than water). While the individual tests are sensitive, they do not usually tell your doctor specifically what is wrong. Abnormal test results or groups of test results are usually followed up with other specific tests to confirm or rule out a suspected diagnosis.
NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.
Sources Used in Current Review
Henry’s Clinical Diagnosis and Management by Laboratory Methods. 21st ed. McPherson R, Pincus M, eds. Philadelphia, PA: Saunders Elsevier: 2007, P. 147.
Quest Diagnostics. Chemistry Screen, Patient Health Library. Available online at http://www.questdiagnostics.com/kbase/topic/medtest/tu6207/descrip.htm through http://www.questdiagnostics.com. Accessed February 2009.
Sources Used in Previous Reviews
Thomas, Clayton L., Editor (1997). Taber’s Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].
Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby’s Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.
American Medical Association (2002). Current Procedural Terminology, cpt 2002, Standard Edition.
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Source Information:
"Comprehensive Metabolic Panel." Lab Tests Online: Welcome! American Association for Clinical Chemistry, 18 June 2010. Web. 06 July 2010. http://www.labtestsonline.org/understanding/analytes/cmp/glance-2.html.
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The lipid profile is a group of tests that are often ordered together to determine risk of coronary heart disease. They are tests that have been shown to be good indicators of whether someone is likely to have a heart attack or stroke caused by blockage of blood vessels or hardening of the arteries (atherosclerois). The lipid profile typically includes:
An extended profile may also include:
Sometimes the report will include additional calculated values such as the Cholesterol/HDL ratio or a risk score based on lipid profile results, age, sex, and other risk factors. Talk to your doctor about what these other reported values may mean for you.
How is the sample collected for testing?
A blood sample is obtained by inserting a needle into a vein in the arm. Sometimes a drop of blood is collected by puncturing the skin on a fingertip. This fingerstick sample is typically used when a lipid profile is being measured on a portable testing device, for example, at a health fair. You need to fast for 9-12 hours before having your blood drawn; only water is permitted.
How is a lipid profile used?
The lipid profile is used to help determine your risk of heart disease and to help guide you and your health care provider in deciding what treatment may be best for you if you have borderline or high risk. The results of the lipid profile are considered along with other known risk factors of heart disease to develop a plan of treatment and follow-up. Depending on your results and other risk factors, treatment options may involve life-style changes such as diet and exercise or lipid-lowering medications such as statins.
If you have other risk factors or have had a high cholesterol level in the past, you should be tested more regularly and you should have a full lipid profile.
For children and adolescents at low risk, lipid testing is usually not ordered routinely. However, screening with a lipid profile 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 (hypertension), or being overweight. High-risk children should have their first lipid profile between 2 and 10 years old, according to the American Academy of Pediatrics. Children younger than 2 years old are too young to be tested.
A lipid profile 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.
Risk factors include:
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.
LDL Cholesterol
Optimal: Less than 100 mg/dL (2.59 mmol/L)
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)
The risk categories for children and adolescents are different than adults. Talk to your child's pediatrician about your child’s results.
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Source Information:
"Lipid Profile." Lab Tests Online: Welcome! American Association for Clinical Chemistry, 3 June 2010. Web. 08 June 2010. http://www.labtestsonline.org/understanding/analytes/lipid/glance-3.html.
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Your target LDL-C value is:
The first step in treating high LDL-C is targeted at changes in lifestyle - specifically, adopting diets low in cholesterol, saturated fat and trans unsaturated fats (trans fats) and participating in moderate exercise. You may be referred to a dietician for advice in making dietary changes.
If low-fat diets and exercise are not adequate to lower LDL cholesterol to the target value, drug therapy would be the next step. There are several classes of drugs that are effective in lowering LDL. You may be prescribed one of these. Your LDL will be checked at regular intervals to assure that the drug is working. If the drug does not result in reaching your target LDL-cholesterol, your doctor may increase the amount of drug or possibly add a second drug.
1. I had a screening test for cholesterol. It was less than 200 mg/dL (5.18 mmol/L). Do I need a lipid profile?
If your total cholesterol is below 200 (5.18 mmol/L) and you have no family history of heart disease or other risk factors, a full lipid profile is probably not necessary. However, an HDL-cholesterol measurement would be advisable to assure that you do not have a low HDL. Many screening programs now offer both cholesterol and HDL.
2. My lipid profile results came back with high triglycerides and no results for LDL-cholesterol. Why?
In most screening lipid profiles, LDL-cholesterol is calculated from the other lipid measurements. However, the calculation is not valid if triglycerides are over 400 mg/dL (4.52 mmol/L). To determine LDL-cholesterol when triglycerides are over 400 mg/dL (4.52 mmol/L) requires special testing techniques such as a direct LDL-C test or a lipid ultracentrifugation test (sometimes called a beta-quantification test).
3. What is VLDL?
Very Low Density Lipoprotein (VLDL) is one of three major lipoprotein particles. The other two are high density lipoprotein (HDL) and low density lipoprotein (LDL). Each one of these particles contains a mixture of cholesterol, protein, and triglyceride, but in varying amounts unique to each type of particle. LDL contains the highest amount of cholesterol. HDL contains the highest amount of protein. VLDL contains the highest amount of triglyceride. Since VLDL contains most of the circulating triglyceride and since the composition of the different particles is relatively constant, it is possible to estimate the amount of VLDL cholesterol by dividing the triglyceride value (in mg/dL) by 5. At present, there is no simple, direct way of measuring VLDL-cholesterol, so the estimate calculated from triglyceride is used in most settings. This calculation is not valid when the triglyceride is greater than 400 mg/dl (see question 2 above). Increased levels of VLDL-cholesterol have been found to be associated with increased risk of heart disease and stroke.
4. What is non-HDL-cholesterol?
Non-HDL-cholesterol (non-HDL-C) is calculated by subtracting your HDL-C result from your total cholesterol result. It represents the “atherogenic” cholesterol — the cholesterol that can build up in the arteries, form plaques, and cause narrowing of the vessels and blockages. Unlike calculation of VLDL-C (see question 3 above), this calculation is not affected by high levels of triglycerides. Your non-HDL-C result may be used to assess your risk for CVD, especially if you have high triglycerides since high non-HDL-C is associated with increased risk. As recommended by the National Cholesterol Education Program, Adult Treatment Plan III, if you have high triglycerides (greater than 200 mg/dL), the non-HDL-C result can be used as a secondary target of treatments such as lifestyle changes and drugs that aim to lower lipid levels.
Elsewhere on the Web
Familydoctor.org: Heart Disease, Assessing Your Risk
American Heart Association: Test Your Cholesterol IQ
Article Sources
NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.
Sources Used in Current Review
(September 2002) National Heart, Lung, Blood Institute. National Cholesterol Education Program Guidelines, Cholesterol, ATP III. II.3-b, II.9-c. PDF available for download at http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf through http://www.nhlbi.nih.gov. Accessed June 2009.
American Heart Association. Guide to primary prevention of cardiovascular diseases: Risk intervention, Blood Lipid Management. Available online at http://www.americanheart.org/presenter.jhtml?identifier=4704 through http://www.americanheart.org. Accessed June 2009.
(Updated December 19, 2008) American Heart Association. What your Cholesterol Levels Mean. Available online at http://www.americanheart.org/presenter.jhtml?identifier=183#HDL through http://www.americanheart.org. Accessed May 2009.
American Academy of Family Physicians. Cholesterol: What Your Level Means. (Updated October 2007). Available online at http://familydoctor.org/online/famdocen/home/common/heartdisease/risk/029.html through http://familydoctor.org. Accessed September 2008.
(May 12, 2008) Medline Plus Medical Encyclopedia. Coronary Risk Profile. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003491.htm. Accessed October 2008.
ARUP Consult. Physicians Guide. Lipid Panel, Extended. Available online at http://www.aruplab.com/guides/ug/tests/0020468.jsp through http://www.aruplab.com. Accessed October 2008.
Clarke, W. and Dufour, D. R., Editors (2006). Contemporary Practice in Clinical Chemistry. AACC Press. Washington, DC. Pp 251-253.
Pagana K, Pagana T. Mosby's Manual of Diagnostic and Laboratory Tests. 3rd Edition, St. Louis: Mosby Elsevier; 2006. Pp 351-356.
Sources Used in Previous Reviews
Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA (2001) 285: 2486-2497.
