Diseases (157)
Diagnostic Testing (73)

Note:

Evaluate cardiovascular risk.


Note:

Rule out hyperlipidemia.


Note:

Patients with DM have an increased incidence of lipid abnormalities, creating risk for CVD


Note:

Can be elevated in polycysitc ovarian syndrome (PCOS).


Note:

Note:

Rule out atherosclerosis as a cause of disease.


Note:

Lipid profiles may be deranged in a patient with ACS and lend little to the immediate diagnosis.


Note:

Monitor lipids, cholesterol.


Note:

R/O pseudohyponatremia due to either elevated triglycerides or cholesterol.


Note:

Smokers usually have lower high-density lipoprotein cholesterol. Intern Med 2006;45(18):1027.

Disease Management Testing (57)

Note:

Note:

Patients with DM have an increased incidence of lipid abnormalities, creating risk for CVD


Note:

Monitor for dyslipidemia in patients receiving cyclosporin, tacrolimus, sirolimus, everolimus or prednisone


Note:

Patients should be screened annually for dyslipidemia after transplantation


Note:

If elevated, to monitor therapy.


Note:

Patients with DM have an increased incidence of lipid abnormalities, creating risk for CVD


Note:

Elevated LDL concentrations are common and may require therapy.


Note:

Evaluate for hyperlipidemia in patients treated with second generation anti-psychotics

Overview

The lipid profile, also known as the coronary risk panel, is comprised of total cholesterol, triglyceride, LDL-C (low density lipoprotein cholesterol), and HDL-C (high density lipoprotein cholesterol). It is usually used for evaluation of the risk for coronary heart disease and stroke. Testing lipid profile and especially cholesterol and cholesterol particles is the first step in screening for atherosclerosis risk, which might be the cause of heart attack and stroke. A heart attack or stroke is most commonly caused by blood vessels being blocked or by atherosclerosis (hardening of the arteries).

If through lipid testing it is discovered that a lipid disorder exists, treatments can be started to normalize lipid levels. Normalization can be achieved through medication, changes in diet, weight loss, and exercise. Therefore, this profile can be used as a screening test for risk evaluation for coronary heart disease and stroke, as well as diagnostic test for diagnosis and treatment monitoring of coronary heart disease, and familial hypercholesterolemia. It can be also used to monitor cholesterol and lipid-lowering lifestyle changes such as diet and exercise or to monitor cholesterol lowering drug therapy. Individuals with high blood pressure, tobacco smokers, individuals with a family history of cardiovascular disease, older people, and diabetes mellitus patients are at risk and should be screened. A more extended panel called NMR LipoProfile® test can be used for further screening and/or diagnosis. This test measures LDL particle number and size of LDL particles, as well as direct measurement of HDL and VLDL subclasses.

Cholesterol
Cholesterol is a steroid, a waxy substance that is found in the blood, tissues, and organs of all mammals including humans. Cholesterol is synthesized mainly in the liver. Metabolized cholesterol accounts for 75% of the cholesterol level, and diet accounts for the other 25%. Total cholesterol level in the body is dependent on many factors such as diet, liver function, lipid metabolism, heredity, and lifestyle choices. Testing serum cholesterol is the first step in screening for atherosclerosis risk.

Triglycerides
Triglycerides are stored in the fat cells of the body and serve as a main source of body energy. Triglycerides are absorbed in the intestine and are also synthesized in the liver. Elevated triglycerides are now considered an independent risk factor for coronary artery disease, and a major risk factor for acute pancreatitis, particularly when serum triglyceride levels are >1000 mg/dL.

High density lipoproteins (HDL)
HDL is responsible for the transport of cholesterol from the peripheral cells to the liver, where it is converted to bile acids which are excreted into the intestine via the biliary tract. Elevated HDL concentrations are protective against coronary heart disease, while reduced HDL concentrations indicate increased cardiovascular risk.

Low-density lipoprotein (LDL)
LDL belongs to a group of lipoproteins which serve as a transporter for cholesterol and lipids. Testing for LDL is used to evaluate the risk for coronary heart disease and stroke. High levels are associated with an increased risk of atherosclerosis and coronary heart disease and stroke.

Clinical Utility
  • Evaluate the risk for coronary heart disease
  • Diagnosis of Atherosclerosis (arteriosclerotic vascular disease)
  • Diagnosis of familial hypercholesterolemia
  • Used to evaluate the effectiveness of drug therapy (cholesterol lowering drugs)
  • As an aid in evaluation of diabetes mellitus, nephrotic syndrome, and liver disease with biliary obstruction
  • As an aid in evaluation of fatty liver in chronic alcoholism
  • As an aid in diagnosis of lipoproteinemia due to lipase deficiency
  • Monitoring drug treatment therapy

Interpretation

Increased in:

  • Coronary heart disease and stroke
  • Familial hypercholesterolemia
  • Familial combined hyperlipidemia
  • Atherosclerotic coronary artery disease
  • Hypertension
  • Hypothyroidism
  • Uncontrolled diabetes mellitus
  • Nephrotic syndrome
  • Liver disorders such as biliary obstruction and hepatocellular carcinoma
  • Cushing’s syndrome
  • Acute intermittent porphyria
  • Chronic alcoholism (fatty liver)
  • Biliary tract obstruction
  • Familial lipoprotein lipase deficiency
  • Familial dysbetalipoproteinemia
  • Obesity
  • Use of corticosteroids

Decreased in:

  • Severe liver disease (acute hepatitis, cirrhosis, malignancy)
  • Hyperthyroidism
  • Severe, acute, or chronic illness
  • Malnutrition and malabsorption
  • Extensive burns
  • Gaucher’s disease
  • Tangier disease (lipoprotein deficiency)
  • Hypolipoproteinemia and abetalipoproteinemia
  • Malnutrition
  • Decreased in use of some drugs such as: ascorbic acid, clofibrate, nicotinic acid, gemfibrozil

Reference Ranges
Element Optimal Borderline High risk
LDL Cholesterol <100 130-159 160+
HDL Cholesterol >60 35-45 <35
Triglycerides <150 150-199 >200
Total Cholesterol <200 200-239 >240
Cholesterol:HDL Ratio <4 5 >6



Methodology

RIA (Radioimmunoassay), ELISA (Enzyme-Linked Immunosorbent Assay), RID (Radial ImmunoDiffusion), Enzymatic, Colorimetric methods to separate LDL, HDL and Triglycerides. Refer to individual laboratory methods.

Specimen Collection

Serum (SST)

Red top acceptable. 1 mL minimum. 12 hour fasting. No alcohol 24 hours prior to draw.

Stability:

  • Ambient: 48 hours
  • Refrigerated: 7 days
  • Frozen: 30 days

Additional Testing

Apolipoprotein A-I, Apolipoprotein B-100, C-reactive protein (CRP), Homocysteine, VLDL-C (very low density lipoprotein cholesterol), NMR Lipo profile, Liver panel, Comprehensive metabolic panel, CBC.

CPT
80061$13.39$13.39
82465$4.35$4.35

ICD10
ICD CODE AND DESCRIPTIONLCD CODENCD CODE
B20 - Human immunodeficiency virus [HIV] disease190.23B
B97.35 - Human immunodeficiency virus, type 2 [HIV 2] as the cause of diseases classified elsewhere190.23B
C25 - Malignant neoplasm of pancreas190.23B
C74 - Malignant neoplasm of adrenal gland190.23B
C74.0 - Malignant neoplasm of cortex of adrenal gland190.23B
C74.00 - Malignant neoplasm of cortex of unspecified adrenal gland190.23B
C74.01 - Malignant neoplasm of cortex of right adrenal gland190.23B
C74.02 - Malignant neoplasm of cortex of left adrenal gland190.23B
C74.1 - Malignant neoplasm of medulla of adrenal gland190.23B
C74.10 - Malignant neoplasm of medulla of unspecified adrenal gland190.23B
C74.11 - Malignant neoplasm of medulla of right adrenal gland190.23B
C74.12 - Malignant neoplasm of medulla of left adrenal gland190.23B
C74.9 - Malignant neoplasm of unspecified part of adrenal gland190.23B
C74.90 - Malignant neoplasm of unspecified part of unspecified adrenal gland190.23B
C74.91 - Malignant neoplasm of unspecified part of right adrenal gland190.23B
C74.92 - Malignant neoplasm of unspecified part of left adrenal gland190.23B
C79.70 - Secondary malignant neoplasm of unspecified adrenal gland190.23B
C79.71 - Secondary malignant neoplasm of right adrenal gland190.23B
C79.72 - Secondary malignant neoplasm of left adrenal gland190.23B
D13 - Benign neoplasm of other and ill-defined parts of digestive system190.23B
D13.6 - Benign neoplasm of pancreas190.23B
D35 - Benign neoplasm of other and unspecified endocrine glands190.23B
D35.0 - Benign neoplasm of adrenal gland190.23B
D35.00 - Benign neoplasm of unspecified adrenal gland190.23B
D3A - Benign neuroendocrine tumors190.23B
D3A.8 - Other benign neuroendocrine tumors190.23B
D49 - Neoplasms of unspecified behavior190.23B
D49.7 - Neoplasm of unspecified behavior of endocrine glands and other parts of nervous system190.23B
D63 - Anemia in chronic diseases classified elsewhere190.23B
D63.1 - Anemia in chronic kidney disease190.23B
D68.9 - Coagulation defect, unspecified190.23B
E00 - Congenital iodine-deficiency syndrome190.23B
E00.9 - Congenital iodine-deficiency syndrome, unspecified190.23B
E01 - Iodine-deficiency related thyroid disorders and allied conditions190.23B
E01.0 - Iodine-deficiency related diffuse (endemic) goiter190.23B
E02 - Subclinical iodine-deficiency hypothyroidism190.23B
E03 - Other hypothyroidism190.23B
E03.0 - Congenital hypothyroidism with diffuse goiter190.23B
E03.1 - Congenital hypothyroidism without goiter190.23B
E03.2 - Hypothyroidism due to medicaments and other exogenous substances190.23B
E03.3 - Postinfectious hypothyroidism190.23B
E03.8 - Other specified hypothyroidism190.23B
E03.9 - Hypothyroidism, unspecified190.23B
E04 - Other nontoxic goiter190.23B
E04.2 - Nontoxic multinodular goiter190.23B
E04.9 - Nontoxic goiter, unspecified190.23B
E05 - Thyrotoxicosis [hyperthyroidism]190.23B
E05.0 - Thyrotoxicosis with diffuse goiter190.23B
E05.1 - Thyrotoxicosis with toxic single thyroid nodule190.23B
E05.8 - Other thyrotoxicosis190.23B

Additional ICD10
ICD CODE AND DESCRIPTIONLCD CODENCD CODE
A02.25 - Salmonella pyelonephritis190.23B
A36.81 - Diphtheritic cardiomyopathy190.23B
A52.04 - Syphilitic cerebral arteritis190.23B
B18.0 - Chronic viral hepatitis B with delta-agent190.23B
B18.1 - Chronic viral hepatitis B without delta-agent190.23B
B18.2 - Chronic viral hepatitis C190.23B
B19.0 - Unspecified viral hepatitis with hepatic coma190.23B
B19.1 - Unspecified viral hepatitis B190.23B
B19.10 - Unspecified viral hepatitis B without hepatic coma190.23B
B19.11 - Unspecified viral hepatitis B with hepatic coma190.23B
B19.2 - Unspecified viral hepatitis C190.23B
B19.20 - Unspecified viral hepatitis C without hepatic coma190.23B
B19.21 - Unspecified viral hepatitis C with hepatic coma190.23B
B19.9 - Unspecified viral hepatitis without hepatic coma190.23B
B25.2 - Cytomegaloviral pancreatitis190.23B
B26.3 - Mumps pancreatitis190.23B
B33.24 - Viral cardiomyopathy190.23B
C25.0 - Malignant neoplasm of head of pancreas190.23B
C25.1 - Malignant neoplasm of body of pancreas190.23B
C25.2 - Malignant neoplasm of tail of pancreas190.23B
C25.3 - Malignant neoplasm of pancreatic duct190.23B
C25.4 - Malignant neoplasm of endocrine pancreas190.23B
C25.7 - Malignant neoplasm of other parts of pancreas190.23B
C25.8 - Malignant neoplasm of overlapping sites of pancreas190.23B
C25.9 - Malignant neoplasm of pancreas, unspecified190.23B
C74.0 - Malignant neoplasm of cortex of adrenal gland190.23B
C74.00 - Malignant neoplasm of cortex of unspecified adrenal gland190.23B
C74.01 - Malignant neoplasm of cortex of right adrenal gland190.23B
C74.02 - Malignant neoplasm of cortex of left adrenal gland190.23B
C74.1 - Malignant neoplasm of medulla of adrenal gland190.23B
C74.10 - Malignant neoplasm of medulla of unspecified adrenal gland190.23B
C74.11 - Malignant neoplasm of medulla of right adrenal gland190.23B
C74.12 - Malignant neoplasm of medulla of left adrenal gland190.23B
C74.9 - Malignant neoplasm of unspecified part of adrenal gland190.23B
C74.90 - Malignant neoplasm of unspecified part of unspecified adrenal gland190.23B
C74.91 - Malignant neoplasm of unspecified part of right adrenal gland190.23B
C74.92 - Malignant neoplasm of unspecified part of left adrenal gland190.23B
D13.0 - Benign neoplasm of esophagus190.23B
D13.1 - Benign neoplasm of stomach190.23B
D13.2 - Benign neoplasm of duodenum190.23B
D13.3 - Benign neoplasm of other and unspecified parts of small intestine190.23B
D13.30 - Benign neoplasm of unspecified part of small intestine190.23B
D13.39 - Benign neoplasm of other parts of small intestine190.23B
D13.4 - Benign neoplasm of liver190.23B
D13.5 - Benign neoplasm of extrahepatic bile ducts190.23B
D13.6 - Benign neoplasm of pancreas190.23B
D13.7 - Benign neoplasm of endocrine pancreas190.23B
D13.9 - Benign neoplasm of ill-defined sites within the digestive system190.23B
D35.0 - Benign neoplasm of adrenal gland190.23B
D35.00 - Benign neoplasm of unspecified adrenal gland190.23B

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