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lipid panel (fasting lipid panel, FLP)

Indications: - screening for dyslipidemia, especially hyperlipidemia - cardiovascular risk assessment - USPSTF recommends screening all adults 40-75 years [1] - screening for dyslipidemia with a lipid panel is recommended - annually for high-risk patients - every 4-6 years for patients with borderline LDL cholesterol [12,15] - borderline LDL cholesterol = 130-190 mg/dL [14] - every 5 years for patients at low risk with normal lipid profiles [6] - longer intervals may be considered for consistently normal results [1] - monitoring of lipid disorders & cardiovascular risk - assessment of response to hypolipidemic agent Procedure: - panel generally consists of - total cholesterol in serum - HDL cholesterol in serum - triglycerides in serum after an overnight fast * serum LDL cholesterol is generally calculated 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 serum triglycerides > 400 mg/dL, fasting lipid panel recommended, otherwise fasting is unnecessary [13] Clinical significance: mean total cholesterol & HDL cholesterol vary by < 2%, with differing fasting times [8] - HDL cholesterol does not vary with age in men or post-menopausal women mean LDL cholesterol varies by < 10% with differing fasting times [8] - fasting & non-fasting LDL-cholesterol determinations yield similar prognostic value for all-cause mortality [11,13] - LDL cholesterol decreases with frailty & poor healh mean serum triglcerides varies by < 20% with differing fasting times [8] post-prandial serum triglycerides are increased in the elderly 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 is equivalent to fasting lipid panel for cardiovascular risk assessment: 1) does not require fasting 2) risks for coronary disease & ischemic stroke are not associated with serum triglyceride levels A novel method to estimate LDL-cholesterol using an adjustable factor for the triglyderide:VLDL-cholesterol ratio derived from a 180 cell table provides more accurate risk classification than the standard method of TC/5 [10] 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. NCEP* Adult treatment goals for LDL-cholesterol & non-HDL cholesterol# Risk Factor@ LDL goal non-HDL goal Absent 160 190 Present 130 160 Coronary Artery Disease 100 130 high risk 70 100 * National Cholesterol Education Program # all values in mg/dL @ Risk Factor - 2 or more of the following: 1) male sex 2) family history of CAD < 55 years of age 3) hypertension 5) smoking 6) obesity 7) diabetes mellitus 8) HDL-cholesterol < 40 mg/dL 9) 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 [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. Specimen: - serum - fasting not necessary [11,13,14] Notes: - patients with dyslipidemia & LDL cholesterol at goal do not need repeat lipid panels more frequently than annually [9]

Related

LDL cholesterol direct (LDL direct) in serum

General

chemistry panel

Figures/Diagrams

Figures/diagrams/slides/tables related to lipid panel Dyslipoproteinemias

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 19. American College of Physicians, Philadelphia 1998, 2012, 2021.
  2. Prescriber's Letter 11(10): 2004 Detail-Document#: 201010 (subscription needed) http://www.prescribersletter.com
  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: 15358046
  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: 15450039
  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: 15755765
  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: 19903920
  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 PMID: 22453571 http://jama.ama-assn.org/content/307/12/1302.short
  8. Grover SA et al Evaluating the Incremental Benefits of Raising High-Density Lipoprotein Cholesterol Levels During Lipid Therapy After Adjustment for the Reductions in Other Blood Lipid Levels Arch Intern Med. 2009;169 PMID: 19858435 http://archinte.jamanetwork.com/article.aspx?articleid=224849 - Gaziano JM Should We Fast Before We Measure Our Lipids? Arch Intern Med. Nov 2012 PMID: 23401886 http://archinte.jamanetwork.com/article.aspx?articleid=1391012 - Khera AV and Mora S Fasting for Lipid Testing. Comment on "Fasting Time and Lipid Levels in a Community-Based Population" Arch Intern Med. Nov 2012 PMID: 23405395 http://archinte.jamanetwork.com/article.aspx?articleid=1391005 - Bansal S et al. Fasting compared with nonfasting triglycerides and risk of cardiovascular events in women. JAMA 2007 Jul 18; 298:309-16. PMID: 17635891 - Nordestgaard BG et al. Nonfasting triglycerides and risk of myocardial infarction, ischemic heart disease, and death in men and women. JAMA 2007 Jul 18; 298:299-308. PMID: 17635890 - McBride PE. Triglycerides and risk for coronary heart disease. JAMA 2007 Jul 18; 298:336-8. PMID: 17635897
  9. Virani SS et al Correlates of Repeat Lipid Testing in Patients With Coronary Heart Disease. JAMA Intern Med. July 1, 2013 PMID: 23817669 http://archinte.jamanetwork.com/article.aspx?articleid=1705724 - Drozda JP Physician Performance Measurement The Importance of Understanding Physician Behavior: Comment on "Correlates of Repeat Lipid Testing in Patients With Coronary Heart Disease" JAMA Intern Med. July 1, 2013 PMID: 23817538 http://archinte.jamanetwork.com/article.aspx?articleid=1705719
  10. Martin SS et al. Comparison of a novel method vs the Friedewald equation for estimating low-density lipoprotein cholesterol levels from the standard lipid profile. JAMA 2013 Nov 20; 310:2061 PMID: 24240933 http://jama.jamanetwork.com/article.aspx?articleid=1779534
  11. Doran B et al. Prognostic value of fasting versus nonfasting low-density lipoprotein cholesterol levels on long-term mortality: Insight from the National Health and Nutrition Examination Survey III (NHANES-III). Circulation 2014 Aug 12; 130:546. PMID: 25015340 http://circ.ahajournals.org/content/130/7/546 - Eckel RH. LDL Cholesterol as a predictor of mortality, and beyond: To fast or not to fast, that is the question? Circulation 2014 Aug 12; 130:528 PMID: 25015339 http://circ.ahajournals.org/content/130/7/528
  12. Stone NJ et al 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk on Adults. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. Nov 12, 2013 PMID: 24222016 http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437738.63853.7a
  13. Mora S. Nonfasting for routine lipid testing: From evidence to action. JAMA Intern Med 2016 Apr 27; PMID: 27119719
  14. Mora D, Chang CL, Moorthy MV et al Association of Nonfasting vs Fasting Lipid Levels With Risk of Major Coronary Events in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm. JAMA Intern Med. Published online May 28, 2019. PMID: 31135812 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2733560
  15. NEJM Knowledge+ Endocrinology - Grundy SM, Stone NJ, Bailey AL et al 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019 Jun 18;139(25):e1082-e1143. PMID: 30586774 - Grundy SM, Stone NJ, Bailey AL et al 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019 Jun 18;139(25):e1046-e1081. PMID: 30565953 - Forman DE, Stone NJ, Grundy SM. Treating Hypercholesterolemia in Older Adults. JAMA. 2019 Aug 20;322(7):695. No abstract available. PMID: 31429891

Component-of

diabetes mellitus management panel general health panel

Components

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