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Blood test metrics interpretation cholesterol et al

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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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Blood test metrics interpretation cholesterol et al

  1. 1. The Cholesterol Conundrum - “Know Your Metrics” www.thefatemperor.com
  2. 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. 3. 1. Cholesterol Units 101 2013 Ivor Cummins BE(Chem) MIEI
  4. 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. 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. 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. 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. 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. 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. 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. 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. 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
  13. 13. 2 Standard Lipid Test
  14. 14. 2.1 Total Cholesterol
  15. 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. 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. 17. 2.2 LDL & HDL Cholesterol
  18. 18. 2.2 LDL & HDL Cholesterol
  19. 19. 2.2 LDL & HDL Cholesterol LDL •Confounded HDL •Guide >40mg/dL •Generally true…
  20. 20. 2.3 Serum Triglyceride
  21. 21. 2.3 Serum Triglyceride (< 2.25 mmol/L) (> 2.25 mmol/L)
  22. 22. 2.3 Serum Triglyceride (< 2.25 mmol/L) (> 2.25 mmol/L) Triglyceride: •Guide <150mg/dL •Ideally <100mg/dL
  23. 23. 3 All-Important Ratios
  24. 24. 3.1 – The Total Chol / HDL Ratio
  25. 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. 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. 27. 3.2 The Trig / HDL Ratio
  28. 28. 3.2 The Trig / HDL Ratio Study: “High Ratio of Triglycerides to HDL-Cholesterol Predicts Extensive Coronary Disease”
  29. 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. 30. 4 Other Key Metrics
  31. 31. 4.1 Fasting Insulin
  32. 32. 4.1 Fasting Insulin
  33. 33. 4.1 Fasting Insulin Fasting Insulin: •Guide: Unclear •Ideally <10uU/mL •Again, watch the units!
  34. 34. 4.2 Fasting Glucose
  35. 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. 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. 37. 4.3 25 Hydroxy Vitamin D
  38. 38. 4.3 25 Hydroxy Vitamin D Study: “Association of vitamin D deficiency and coronary artery disease with cardiovascular risk factors”
  39. 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)
  40. 40. 5 – Conclusion
  41. 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. 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.

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