The document discusses lipid profile tests, which measure triglyceride, total cholesterol, HDL cholesterol, and LDL cholesterol levels. High levels of these lipids can increase the risk of coronary heart disease. The document provides details on normal reference values, testing procedures, clinical implications, and lifestyle factors that affect lipid levels.

1. SHARIQAAISHA
DEPARTMENTOF BIORESOURCES
UNIVERSITYOF KASHMIR

2. LIPID PROFILE TEST: The lipid profile test is a combination of tests conducted
together to check for any risks of coronary heart disease(CHD), or as a preventive
measure to check any risks depending on factors like eating habits, diet, stress,
exercise and life-style related. A typical lipid profile includes the following tests:
1. Triglyceride(TG) levels
2. Total Cholesterol
3. High Density Lipoprotein(HDL)-Cholesterol
4. Low Density Lipoprotein(LDL)-Cholesterol

3. TRIGLYCERIDES:
 A triglyceride (TG) is an ester derived from glycerol and three fatty acids.
 Triglycerides are the main constituents of body fat in humans and other vertebrates, as
well as vegetable fat.
 They are also present in the blood to enable the bidirectional transference of adipose fat
and blood glucose from the liver.
 The levels of TG’s get elevated in obese or diabetic patients.
 Level increases from eating extra calories- especially carbohydrates or drinking alcohol.
 Increased level is associated with heart, blood vessel disease, fatty liver diseases,
pancreatitis, diabetes and kidney diseases.

4. ReferencevaluesforTriglycerides
Normal <150mg/dl
Borderline 150-199mg/dl
High 200-499mg/dl
Veryhigh ≥500mg/dl

5. Procedure:
i) Clean the site with an antiseptic and wrap an elastic band around the arm to allow blood
to fill the veins.
ii) With the help of needle, draw 5 ml blood from a vein in the front of elbow or the back of
hand into the yellow top tube.
iii)Once the tube is full, remove the elastic band and needle and cover the puncture site with
cotton or Band-Aid.
iv)Serum is needed, for that allows the blood to clot and separate by centrifugation.

6. Pretest patient care:
 12 hour fast is required before blood is drawn.
 Patient should follow a normal diet for 1 week before the test.
No alcohol is permitted for at least 24 to 48 hours before testing
Posttest Patient care:
 Interpret test results and counsel appropriately.
 If levels are high, weight reduction, a low-fat diet, and an exercise program can reduce the
high triglyceride levels.

7. Clinical implications:
1. Increased triglycerides occur with the following conditions:
Hyperlipoproteinemia, liver disease, alcoholism, nephrotic syndrome, renal disease,
hypothyroidism, poorly controlled diabetes mellitus, pancreatitis, glycogen storage disease
(von Gierke’s disease), myocardial infraction (elevated levels may persist for several
months), gout, Werner’s syndrome, Down’s syndrome and Anorexia nervosa.
1. Decreased triglyceride levels occur with the following conditions:
Congenital α-β- lipoproteinemia, Malnutrition, Malabsorption syndromes,
Hyperthyriodism, hyperparathyroidism, Brian infraction and chronic obstructive lung
disease.

8. Cholesterol:
 Cholesterol is a type of fat, found in our blood.
 It is produced by our body and also comes from the foods we eat (animal
products).
 It is made by the liver and is also used by the liver to make bile, which helps in
the digestion of foods.
 Cholesterol is also needed to make certain hormones and to produce vitamin D.

9. Cholesterol testing:
 Cholesterol testing evaluates the risk for arthrosclerosis, myocardial occlusion, and
coronary arterial occlusion.
 Cholesterol relates to coronary heart disease (CHD) and is an important screening for
heart disease.
 It is a part of lipid profiles.
 Elevated levels are a major component in the hereditary hyperlipoproteinemias.
 Cholesterol determinations are also frequently a part of thyroid function, liver
function, renal function, and diabetes mellitus studies.
 It is also used to monitor effectiveness of diet, medications, lifestyle changes and
stress management.

10. ValuesforCholesterol
Children&Adolescents(12-18yrs.)
Normallevel Borderlinelevel Highlevel
<170mg/dl 170-199mg/dl >200mg/dl
140-199mg/dl 200-239mg/dl >240mg/dl
Adults

11. Procedure:
i) Clean the site with an antiseptic and wrap an elastic band around the arm to allow
blood to fill the veins.
ii) With the help of needle, draw 5 ml blood from an arm vein into a yellow top tube.
iii)Serum is needed, for that allows the blood to clot and separate by centrifugation.
Pretest patient care:
 An overnight fast before testing is recommended, however nonfasting specimens
may also be taken.
 A normal diet should be consumed for 7 days.
 The patient should abstain from alcohol for 48 hours before testing.
 Drugs like contraceptive pills should be avoided prior to test as they alter the
cholesterol levels.

12. Posttest patient care:
 Interpret test results and counsel appropriately.
 Cholesterol levels >200 mg/dl should be retested and the results averaged. If the two
results differ by >10 %, a third test should be done.
 Once hypecholesterolemia has been established, the diet should be lower in animal fats
and should replace saturated fats with polyunsaturated fats.
 Fruits, vegetables and whole-grain products should be increased.
 At least 6 months of dietary therapy should be tried before initiating cholesterol-
reducing drug therapy.
Drug therapy involves_ lovastatin, simvastatin, fluvastatin, clofibrate, etc

13. Clinical implications:
1. Elevated cholesterol levels occur with the following conditions:
Hyperlipoproteinemia, cholestasis, hepatocellular disease, Nephrotic syndrome,
Chronic renal failure, hyporthyroidism, poorly controlled diabetes mellitus, alcoholism,
glycogen storage disease (von Gierke’s disease), Werner’s syndrome, Diet high in
cholesterol and fats and Obesity.
1. Decreased cholesterol levels occur in the following conditions:
Severs hepatocellular disease, malabsorption syndrome, malnutrition,
hyperthyroidism, chronic anemias, conditions of acute illness, severe burns, chronic
obstructive lung disease, and mental retardation.

14. High- Density Lipoprotein Cholesterol (HDL-C):
 HDL-C is a class of lipoproteins produced by the liver and intestines.
 HDL is composed of phospholipids and one or two apolipoproteins.
 It plays a role in the metabolism of the other lipoproteins and in cholesterol transport from
peripheral tissues to the liver.
 Decreased HDL levels are atherogenic, whereas elevated HDL levels protect against
arthrosclerosis by removing cholesterol from vessel walls and transporting it to the liver
where it is removed from the body. This is known as the “reverse cholesterol transport
pathway.”

15. Values for HDL Cholesterol
Age and Sex Normal HDL Level
People aged 19 years
and younger
More than 45 mg/dl
Men aged 20 years
and older
40 mg/dl or higher
Women aged 20 years and older 50 mg/dl or higher

16. Procedure:
i) Clean the site with an antiseptic and wrap an elastic band around the arm to allow
blood to fill the veins.
ii) With the help of needle, draw 5 ml venous blood into the yellow/red top tube.
iii)Serum is needed, for that allow the blood to clot and separate by centrifugation.
Pretest patient care:
 An 8-12 hour fast is recommended.
 Alcohol should not be consumed for at least 24 hours before test.
 A person should be on a stable diet for 3 weeks.
Withhold all medications for at least 24 hours before testing

17. Posttest patient care:
 Interpret test results and counsel appropriately.
 If HDL levels are low, diet management, exercise, weight loss, and smoking cessation can raise the HDL
levels.
 Drug therapy may be necessary if these methods fail to raise HDL levels.
Clinical implications:
1. Increased HDL-C values occur in the following conditions:
Familial hyper-α-lipoproteinemia (HDL excess), Chronic liver disease (cirrhosis, alcoholism, hepatitis), Long
term aerobic or vigorous exercise.
1. Decreased HDL-C values are associated with increased risk for CHD and premature CHD and occur in the
following conditions:
Familial hypo-α-lipoproteinemia (Tangier disease), Hypertriglyceridemia, poorly controlled diabetes mellitus,
Hepatocellular diseases, cholestasis, and chronic renal failure

18. Low- Density Lipoprotein Cholesterol (LDL-C):
 They are formed from VLDL in the blood circulation.
 They transport cholesterol from liver to other tissues.
 The higher the number of LDL particles, the higher is the risk for heart disease.
 LDL can build up on the walls of the arteries and make them narrower. The fatty
deposits form plaque that lines the arteries and may cause blockages. This build-up is
called atherosclerosis.

19. Reference values for LDL-C
Children and Adolescents
Normal
<110 mg/dl
Borderline
110-129 mg/dl
High risk
>130 mg/dl
Adults <130 mg/dl 140-159 mg/dl >160 mg/dl

20. Procedure:
i) LDL cholesterol levels can be calculated by using Friedwald’s formula:
LDL-C = Total cholesterol _ HDL-C – (Triglycerides)
5
i) This formula is valid only if the cholesterol and triglyceride values are from
a fasting specimen and the triglyceride value is >400 mg/dl.
ii) LDL can also be measured directly in the laboratory.

21. Pretest patient care:
 An 8-12 hour fast is recommended.
 Alcohol should not be consumed for at least 24 hours before test.
 A person should be on a stable diet for 3 weeks.
 Withhold all medications for at least 24 hours before testing.
Posttest patient care:
 Interpret test results and counsel appropriately about results.
 If patient has high LDL levels, repeat the test in 2 to 8 weeks and average the values to
establish accurate values.
 Treatment may include one of the statins (e.g., Lipitor), niacin (e.g., Niaspan), fibrates (e.g.,
Lopid) or cholesterol absorption inhibitor (e.g., Zetia).

22. Clinical implications:
1. Increased LDL levels occur in the following conditions:
Familial type 2 hyperlipidemia, familial hypercholesterolemia, diet high in cholesterol and
saturated fat, hypothyroidism, nephrotic syndrome, Multiple myeloma, diabetes mellitus,
chronic renal failure, porphyria and premature CHD.
1. Decreased LDL levels occur in the following conditions: Hyperlipoproteinemia,
hyperthyroidism, chronic anemia, severe hepatocellular disease, type I hyperlipidemia,
acute stress, inflammatory joint disease, and chronic pulmonary disease.