The Laboratory Report: Cholesterol/lipoprotein profiles

Heart disease is the number one killer of men and women in the United States. Several
risk factors have been identified and one of the best known is elevated cholesterol levels
in the blood. Every adult, age 20 and older, should have their cholesterol measured at
least once every 5 years. Those with multiple risk factors (obesity, hypertension, known
elevated cholesterol) should have testing more often. The preferred test is the lipoprotein
profile.

A lipoprotein profile usually consists of 4 tests: total cholesterol, low-density lipoprotein

(LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides (TG).
The current recommendation for desirable cholesterol levels is as follows:

Total cholesterol <200 mg/dL

TG cholesterol <150 mg/dL

LDL cholesterol <100 mg/dL

HDL cholesterol 60 mg/dL or higher

Total cholesterol and HDL cholesterol can be measured on a random blood sample,
meaning the patient need not have fasted prior to the blood collection. LDL cholesterol
result is usually a calculation that depends on the level of triglycerides in the blood.
Triglycerides become elevated to various levels after eating; thus, to standardize the test,
blood for measuring LDL cholesterol and triglycerides needs to be collected after a 9- to
12-hour fast. Hence, the lipoprotein profile is done on a fasting specimen.

The specimen used for lipoprotein profiles can be serum or plasma (from EDTA tubes);
however, plasma values are approximately 3% lower than serum values. Patients should
be seated for at least 5 minutes prior to phlebotomy to avoid hemoconcentration. To
obtain the most accurate results to assess risk of heart disease, patients should be in their
usual stable condition and not suffering from any acute illnesses. Acute illness or injury
can affect cholesterol values and give misleading results. For persons being evaluated for
acute heart disease or undergoing coronary procedures, lipoprotein profiles should be
taken within 24 hours of admission because LDL cholesterol levels begin to decline
within the first few hours and may remain low for many weeks. Once a specimen is
drawn, the specimen can be stored at 4oC for 3 to 4 days. Blood that is turbid, lipemic, or
hemolyzed will interfere with most methods used to measure cholesterol.