Lipid Profile

Also known as: Lipid Panel; Coronary Risk Panel

Formal name: Lipid Profile

Related tests: Cholesterol; HDL-C; LDL-C; Triglycerides; Direct LDL-C; VLDL-C; Cardiac Risk Assessment; Lp-PLA2

What is a lipid profile?

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:

Total cholesterol
High density lipoprotein cholesterol (HDL-C) — often called good cholesterol
Low density lipoprotein cholesterol (LDL-C) —often called bad cholesterol
Triglycerides

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.

When is it ordered?
It is recommended that healthy adults with no other risk factors for heart disease be tested with a fasting lipid profile once every five years. You may be screened using only a cholesterol test and not a full lipid profile. However, if the cholesterol test result is high, you may have follow-up testing with a lipid profile.

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.

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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.html.
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What are risk factors (in addition to high LDL-C) for coronary heart disease?

Risk factors include:

Cigarette smoking
Age (if you are a male 45 years or older or a female 55 years or older)
Low HDL cholesterol (less than 40 mg/dL (1.04 mmol/L))
Hypertension (Blood Pressure of 140/90 or higher or taking high blood pressure medications)
Family history of premature heart disease (heart disease in a first degree male relative under age 55 or a first degree female relative under age 65)
Diabetes

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.

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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-2.html.
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What do the results mean?

In general, your doctor will take into consideration the results of each component of a lipid profile plus other risk factors to determine whether treatment is necessary and, if so, which treatment will best help you to lower your risk of heart disease. The National Cholesterol Education Program offers the following guidelines for adults for classifying results of the tests:

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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How is treatment determined?

Treatment is determined by your overall risk of coronary heart disease. Based on the results of lipid tests and other major risk factors, your target LDL cholesterol is identified. If your LDL-C is above the target value, you will be treated.

Your target LDL-C value is:

Less than 100 mg/dL (2.59 mmol/L) if you have heart disease or diabetes.
Less than 130 mg/dL (3.37 mmol/L) if you have 2 or more risk factors.
Less than 160 mg/dL (4.14 mmol/L) if you have 0 or 1 risk factor.

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.

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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-4.html.
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Common Questions

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.

Is there anything else I should know?

There is increasing interest in measuring triglycerides in people who have not fasted. The reason is that a non-fasting sample may be more representative of the “usual” circulating level of triglyceride since most of the day blood lipid levels reflect post-meal (post-prandial) levels rather than fasting levels. However, it is not yet certain how to interpret non-fasting levels for evaluating risk, so at present there is no change in the current recommendations for fasting prior to tests for lipid levels.

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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-5.html.
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On This Site
Conditions: Heart disease, Cardiovascular disease, Stroke, Hypertension
In the News: Menopause Linked to Worsening Cholesterol Levels (2010)

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.

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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-6.html.
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