Lipoprotein Tests

 Lipoprotein measurements are diagnostic indicators for hyperlipidemia and hypolipidemia

 Lipids are fatty substances made up of cholesterol, cholesterol esters (liquid compounds), triglycerides,
nonesterized fatty acids, and phospholipids
 Lipoproteins are unique plasma proteins that transport otherwise insoluble lipids
o Categorized as chylomicrons, β-lipoproteins (low-density lipoproteins [LDL]), pre-β-lipoproteins
(very-low-lipoproteins [VLDL]), and α-lipoproteins (high-density lipoproteins [HDL])
 Apolipoprotein A is mainly composed of HDL
 Apolipoprotein B is the main component of LDL and VLDL
 Lipids provide energy for metabolism, serve as precursors of steroid hormones (adrenals, ovaries, testes)
and bile acids, and play an important role in cell membrane development
 A lipid panel usually consists of cholesterol, triglycerides, LDL, and HDL levels

Cholesterol (140-199 mg/dL)

Cholesterol testing evaluates the risk for atherosclerosis, myocardial occlusion, and coronary artery
occlusion. Cholesterol relates to coronary heart disease (CHD) and is an important screening test for heart disease.
Elevated cholesterol levels are a major component of hereditary hyperlipoproteinemias. Cholesterol determinations
are also frequently part of thyroid function, liver function, renal function, and diabetes mellitus studies.

 Total Cholesterol = HDL + LDL + (Triglycerides/5)

 Only valid if the triglyceride value is <400 mg/dL

Hypercholesterolemia

 Familial hypercholesterolemia
 Diet high in cholesterol and fat
 Obesity
 Hypothyroidism
 Alcoholism
 Chronic renal failure
 Nephrotic syndrome
 Hepatocellular disease
 Pancreatic and prostatic malignant neoplasms

Hypocholesterolemia

 Severe hepatocellular disease

 Myeloproliferative diseases
 Hyperthyroidism
 Malabsorption syndromes, malnutrition

High-Density Lipoprotein (Men >40 mg/dL; Women >46 mg/dL)

HDL is a class of lipoproteins produced by the liver and intestines. HDL is composed of phospholipids and
one or two lipoproteins. It plays a role in the metabolism of the other lipoproteins and in cholesterol transport from
peripheral tissues to the liver.
  LDL and HDL may combine to maintain cellular cholesterol balance through the mechanism of LDL moving
cholesterol into the arteries and HDL removing if from the arteries
 Decreased HDL levels are atherogenic, whereas elevated HDL levels protect against atherosclerosis by
removing cholesterol from the vessel walls and transporting it to the liver where it is removed from the
body
o “reverse cholesterol transport pathway”
 There is a strong relationship between HDL and CAD
 “good cholesterol”

Low-Density Lipoprotein (<130 mg/dL)

LDL is 60-70% of the total serum cholesterol. LDLs are the cholesterol-rich remnants of VLDL lipid
transport vehicle. Because LDL has a longer half-life (3 to 4 days) than its precursor VLDL, LDL is more prevalent in
the blood.

 Closely associated with increased incidence of atherosclerosis and CAD

 “bad cholesterol”
 There is a direct test for LDL that may be ordered if triglycerides are >400 mg/dL

Increased LDL

 Familial hypercholesterolemia
 Diet high in cholesterol and saturated fats
 Multiple myeloma
 Diabetes mellitus
 Chronic renal failure
 Hyperlipidemia secondary to hypothyroidism

Decreased LDL

 Hyperthyroidism
 Myocardial infarction

Apolipoprotein A and B (Apo-A-I, Apo-B)

 This test is used to evaluate the risk for CAD

 Apo A-I deficiencies are often associated with premature cardiovascular disease
 Apo A-I is the main component of HDL
 Apo B is the main component of LDL and VLDL

Triglycerides (<150 mg/dL)

Triglycerides account for >90% of dietary fat intake and comprise 95% of fat stored in tissues. Because they
are insoluble in water, they are the main plasma glycerol ester.

 Normally stored in adipose tissue as glycerol, fatty acids, and monoglycerides, the liver reconverts these to
triglycerides
 This test evaluates suspected atherosclerosis and measures the body’s ability to metabolize fat
 Elevated triglycerides, together with elevated cholesterol, are atherosclerotic disease risk factors
Increased triglycerides

 Alcoholism
 Nephrotic syndrome
 Liver disease
 Myocardial infarction
 Hypothyroidism
 Pancreatitis

Decreased triglycerides

 Malnutrition
 Hyperthyroidism
 Brain infarction