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Blood test metrics interpretation cholesterol et al

Blood test metrics explained briefly, with a summary of the conversion factors for US/European Cholesterol and Triglyceride units. See the presentation at https://www.youtube.com/watch?v=YRFRRqe0vrE

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The Cholesterol Conundrum - 
“Know Your Metrics” 
www.thefatemperor.com
Metrics Content: 
2013 Ivor Cummins BE(Chem) MIEI 
1. Cholesterol Units 101 
2. Standard Lipid Test 
• Total Cholesterol Concentration 
• LDL / HDL Cholesterol Concentration 
• Serum Triglyceride 
3. The All-Important Ratios 
• Total Cholesterol / HDL 
• Triglyceride / HDL 
4. Introduction to some other Critical Metrics 
• Fasting Insulin, Blood Glucose/HbA1c, 25 Hydroxy Vitamin D 
5. Conclusion
1. Cholesterol Units 101 
2013 Ivor Cummins BE(Chem) MIEI
1. Cholesterol Units 101 
Cholesterol and Triglyceride can be measured in mg/dL (e.g. USA) or 
mmol/L (e.g. Europe) 
2013 Ivor Cummins BE(Chem) MIEI
1. Cholesterol Units 101 
Cholesterol and Triglyceride can be measured in mg/dL (e.g. USA) or 
mmol/L (e.g. Europe) 
Be careful converting – Cholesterol and Triglyceride both have DIFFERENT 
conversion factors as you switch from one unit to another 
2013 Ivor Cummins BE(Chem) MIEI
1. Cholesterol Units 101 
Cholesterol and Triglyceride can be measured in mg/dL (e.g. USA) or 
mmol/L (e.g. Europe) 
Be careful converting – Cholesterol and Triglyceride both have DIFFERENT 
conversion factors as you switch from one unit to another 
To convert CHOLESTEROL from mmol/L to mg/dL, multiply by 38.7 
2013 Ivor Cummins BE(Chem) MIEI

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ICSE English Literature Class X Handwritten Notes
 

Blood test metrics interpretation cholesterol et al

  • 1. The Cholesterol Conundrum - “Know Your Metrics” www.thefatemperor.com
  • 2. Metrics Content: 2013 Ivor Cummins BE(Chem) MIEI 1. Cholesterol Units 101 2. Standard Lipid Test • Total Cholesterol Concentration • LDL / HDL Cholesterol Concentration • Serum Triglyceride 3. The All-Important Ratios • Total Cholesterol / HDL • Triglyceride / HDL 4. Introduction to some other Critical Metrics • Fasting Insulin, Blood Glucose/HbA1c, 25 Hydroxy Vitamin D 5. Conclusion
  • 3. 1. Cholesterol Units 101 2013 Ivor Cummins BE(Chem) MIEI
  • 4. 1. Cholesterol Units 101 Cholesterol and Triglyceride can be measured in mg/dL (e.g. USA) or mmol/L (e.g. Europe) 2013 Ivor Cummins BE(Chem) MIEI
  • 5. 1. Cholesterol Units 101 Cholesterol and Triglyceride can be measured in mg/dL (e.g. USA) or mmol/L (e.g. Europe) Be careful converting – Cholesterol and Triglyceride both have DIFFERENT conversion factors as you switch from one unit to another 2013 Ivor Cummins BE(Chem) MIEI
  • 6. 1. Cholesterol Units 101 Cholesterol and Triglyceride can be measured in mg/dL (e.g. USA) or mmol/L (e.g. Europe) Be careful converting – Cholesterol and Triglyceride both have DIFFERENT conversion factors as you switch from one unit to another To convert CHOLESTEROL from mmol/L to mg/dL, multiply by 38.7 2013 Ivor Cummins BE(Chem) MIEI
  • 7. 1. Cholesterol Units 101 Cholesterol and Triglyceride can be measured in mg/dL (e.g. USA) or mmol/L (e.g. Europe) Be careful converting – Cholesterol and Triglyceride both have DIFFERENT conversion factors as you switch from one unit to another To convert CHOLESTEROL from mmol/L to mg/dL, multiply by 38.7 To convert CHOLESTEROL from mg/dL to mmol/L, divide by 38.7 2013 Ivor Cummins BE(Chem) MIEI
  • 8. 1. Cholesterol Units 101 Cholesterol and Triglyceride can be measured in mg/dL (e.g. USA) or mmol/L (e.g. Europe) Be careful converting – Cholesterol and Triglyceride both have DIFFERENT conversion factors as you switch from one unit to another To convert CHOLESTEROL from mmol/L to mg/dL, multiply by 38.7 To convert CHOLESTEROL from mg/dL to mmol/L, divide by 38.7 To convert TRIGLYCERIDE from mmol/L to mg/dL, multiply by 88.6 2013 Ivor Cummins BE(Chem) MIEI
  • 9. 1. Cholesterol Units 101 Cholesterol and Triglyceride can be measured in mg/dL (e.g. USA) or mmol/L (e.g. Europe) Be careful converting – Cholesterol and Triglyceride both have DIFFERENT conversion factors as you switch from one unit to another To convert CHOLESTEROL from mmol/L to mg/dL, multiply by 38.7 To convert CHOLESTEROL from mg/dL to mmol/L, divide by 38.7 To convert TRIGLYCERIDE from mmol/L to mg/dL, multiply by 88.6 To convert TRIGLYCERIDE from mg/dL to mmol/L, divide by 88.6 2013 Ivor Cummins BE(Chem) MIEI
  • 10. 1. Cholesterol Units 101 Metric Current Desired Action Result Tot Chol 200 mg/dL mmol/L Divide by 38.7 5.16 mmol/L LDL 100 mg/dL mmol/L Divide by 38.7 2.58 mmol/L Tot Chol 6.8 mmol/L mg/dL Multiply by 38.7 263 mg/dL HDL 1.7 mmol/L mg/dL Multiply by 38.7 66 mg/dL 2013 Ivor Cummins BE(Chem) MIEI
  • 11. 1. Cholesterol Units 101 Metric Current Desired Action Result Tot Chol 200 mg/dL mmol/L Divide by 38.7 5.16 mmol/L LDL 100 mg/dL mmol/L Divide by 38.7 2.58 mmol/L Tot Chol 6.8 mmol/L mg/dL Multiply by 38.7 263 mg/dL HDL 1.7 mmol/L mg/dL Multiply by 38.7 66 mg/dL Triglyceride 150 mg/dL mmol/L Divide by 88.6 1.69 mmol/L Triglyceride 0.78 mmol/L Multiply by 88.6 69 mg/dL 2013 Ivor Cummins BE(Chem) MIEI
  • 12. 1. Cholesterol Units 101 Metric Current Desired Action Result Tot Chol 200 mg/dL mmol/L Divide by 38.7 5.16 mmol/L LDL 100 mg/dL mmol/L Divide by 38.7 2.58 mmol/L Tot Chol 6.8 mmol/L mg/dL Multiply by 38.7 263 mg/dL HDL 1.7 mmol/L mg/dL Multiply by 38.7 66 mg/dL Triglyceride 150 mg/dL mmol/L Divide by 88.6 1.69 mmol/L Triglyceride 0.78 mmol/L Multiply by 88.6 69 mg/dL 2013 Ivor Cummins BE(Chem) MIEI Ratio Use mg/dL(!) Ivor Guide My Target Result Tot Chol/HDL 263 / 66 <4.5 <4.0 ~3.5 Trig/HDL 69 / 66 <2.0 <1.0 ~1.0
  • 15. 2.1 Total Cholesterol <200 200-240 240-280 >280 Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Ten years prospective data from the Norwegian HUNT 2 study (>58,000 Participants) Halfdan Petursson MD,1 Johann A. Sigurdsson MD Dr med,2 Calle Bengtsson MD Dr med,3 Tom I. L. Nilsen Dr Philos4 and Linn Getz MD PhD5
  • 16. 2.1 Total Cholesterol <200 200-240 240-280 >280 Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Ten years prospective data from the Norwegian HUNT 2 study (>58,000 Participants) Halfdan Petursson MD,1 Johann A. Sigurdsson MD Dr med,2 Calle Bengtsson MD Dr med,3 Tom I. L. Nilsen Dr Philos4 and Linn Getz MD PhD5 Total Cholesterol: •Hopelessly confounded •Only useful for research •But interesting interaction with w6/w3 ratio…
  • 17. 2.2 LDL & HDL Cholesterol
  • 18. 2.2 LDL & HDL Cholesterol
  • 19. 2.2 LDL & HDL Cholesterol LDL •Confounded HDL •Guide >40mg/dL •Generally true…
  • 21. 2.3 Serum Triglyceride (< 2.25 mmol/L) (> 2.25 mmol/L)
  • 22. 2.3 Serum Triglyceride (< 2.25 mmol/L) (> 2.25 mmol/L) Triglyceride: •Guide <150mg/dL •Ideally <100mg/dL
  • 24. 3.1 – The Total Chol / HDL Ratio
  • 25. 3.1 – The Total Chol / HDL Ratio Ratio <5, LDL being low or High is irrelevant Ratio >5, LDL being low or High is irrelevant Efficacy of cholesterol levels and ratios in predicting future coronary….. Am J Cardiol. 2001 Oct 1;88(7):737-43.
  • 26. 3.1 – The Total Chol / HDL Ratio Tot Chol / HDL Ratio: •Guide <4.5 or 5 •Ideally <4.0 Ratio <5, LDL being low or High is irrelevant Ratio >5, LDL being low or High is irrelevant Efficacy of cholesterol levels and ratios in predicting future coronary….. Am J Cardiol. 2001 Oct 1;88(7):737-43.
  • 27. 3.2 The Trig / HDL Ratio
  • 28. 3.2 The Trig / HDL Ratio Study: “High Ratio of Triglycerides to HDL-Cholesterol Predicts Extensive Coronary Disease”
  • 29. 3.2 The Trig / HDL Ratio Triglyceride / HDL Ratio: •Guide <2.0 •Ideally <1.0 Study: “High Ratio of Triglycerides to HDL-Cholesterol Predicts Extensive Coronary Disease”
  • 30. 4 Other Key Metrics
  • 33. 4.1 Fasting Insulin Fasting Insulin: •Guide: Unclear •Ideally <10uU/mL •Again, watch the units!
  • 35. 4.2 Fasting Glucose “The apoB/apoA-I ratio: a strong, new risk factor for cardiovascular disease and a target for lipid-lowering therapy – a review of the evidence” . WALLDIUS1,2 & I . JUNGNER3 , 4 From the 1King Gustaf V Research Institute, Karolinska Institute, Stockholm; 2AstraZeneca, So¨derta¨lje; 3Department of Medicine, Karolinska Institute, Epidemiological Unit, Stockholm; and 4CALAB Research, Stockholm; Sweden Journal of Internal Medicine 2006; 259: 493–519
  • 36. 4.2 Fasting Glucose Blood Glucose: •Guide <6 mmol/L •Ideally <5 mmol/L Note 1: watch the units(!) – mmol/L used above, but multiply by 18 to get mg/dL Note 2: HbA1c is a more stable indication of long-term blood glucose levels “The apoB/apoA-I ratio: a strong, new risk factor for cardiovascular disease and a target for lipid-lowering therapy – a review of the evidence” . WALLDIUS1,2 & I . JUNGNER3 , 4 From the 1King Gustaf V Research Institute, Karolinska Institute, Stockholm; 2AstraZeneca, So¨derta¨lje; 3Department of Medicine, Karolinska Institute, Epidemiological Unit, Stockholm; and 4CALAB Research, Stockholm; Sweden Journal of Internal Medicine 2006; 259: 493–519
  • 37. 4.3 25 Hydroxy Vitamin D
  • 38. 4.3 25 Hydroxy Vitamin D Study: “Association of vitamin D deficiency and coronary artery disease with cardiovascular risk factors”
  • 39. 4.3 25 Hydroxy Vitamin D Study: “Association of vitamin D deficiency and coronary artery disease with cardiovascular risk factors” 25 Hydroxy Vit D: •Should be >=75 nmol/L Note: watch the units again(!) – 75nmol/L used above equates to 30ng/ml: so, divide by 2.5 to get from nmol/L to ng/ml, and vice versa)
  • 41. 5 – Conclusion •Need to understand lipid unit conversion to avoid confusion •Traditional Tot Chol and LDL are outdated predictors •Tot Chol / HDL and Trig / HDL are powerful predictors •Fasting Insulin, HbA1c and other metrics are underused •25 Hydroxy Vitamin D level is critical and underemphasised
  • 42. 5 – Conclusion •Need to understand lipid unit conversion to avoid confusion •Traditional Tot Chol and LDL are outdated predictors •Tot Chol / HDL and Trig / HDL are powerful predictors •Fasting Insulin, HbA1c and other metrics are underused •25 Hydroxy Vitamin D level is critical and underemphasised Watch “The Cholesterol Conundrum – Root Cause and Solution” for engineering-level explanation of this arena.