Cholesterol, Total

Laboratory assay overview

This panel provides the 10-year and lifetime risk of atherosclerotic cardiovascular disease (ASCVD) using lipid results with anthropomorphic data and family history. The ASCVD risk assessment is recommended in the 2013 ACC/AHA Guidelines on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults.

Quest Diagnostics population reference ranges

Quest Diagnostics calculates these statistical intervals for this specific assay and demographic group, not as universal optimal targets.

Laboratory assay overview

This test is intended for noninvasive assessment of liver status in patients with alcoholic liver disease. Quantitative results of 10 biochemicals in combination with age, gender, height, and weight are analyzed using a computational algorithm to provide a quantitative surrogate marker (0.0-1.0) of liver fibrosis (Metavir F0-F4), hepatic steatosis (0.0-1.0, S0-S3), and alcoholic steatohepatitis (ASH) (0.0-1.0, H0-H3).

Laboratory assay overview

This panel provides the 10-year and lifetime risk of atherosclerotic cardiovascular disease (ASCVD) using lipid results with anthropomorphic data and family history. The ASCVD risk assessment is recommended in the 2013 ACC/AHA Guidelines on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults.

Quest Diagnostics population reference ranges

Quest Diagnostics calculates these statistical intervals for this specific assay and demographic group, not as universal optimal targets.

Laboratory assay overview

Total serum cholesterol analysis is useful in the diagnosis of hyperlipoproteinemia, atherosclerosis, hepatic and thyroid diseases.

Quest Diagnostics population reference ranges

Quest Diagnostics calculates these statistical intervals for this specific assay and demographic group, not as universal optimal targets.

Laboratory assay overview

According to the National Kidney Foundation, there are approximately 37 million adults in the U.S. who have chronic kidney disease (CKD), and about 90% are unaware of their condition. Diabetes is the leading cause of CKD in the United States. The significant impact of CKD on cardiovascular disease (CVD) risk has been increasingly recognized. Patients with CKD are far more likely to die, predominantly from CVD, than to progress to end-stage renal disease (ESRD). Currently, mainstays of treatment for diabetic kidney disease include control of hypertension, hyperglycemia and dyslipidemia. This panel has been established to aid in the identification and monitoring of hyperglycemia, dyslipidemia and CKD in patients with a history of diabetes and/or kidney disease. Guidelines and expert panels advocate renal function testing patients with diabetes and/or hypertension at least annually with urinary albumin to creatinine ratio (uACR) and estimated glomerular filtration rate (eGFR). CKD is characterized by gradual loss of kidney function over time, defined as presence of either kidney damage (as indicated by the presence of albuminuria) or declining kidney function (as indicated by the level of GFR) for more than three months.1 Non-HDL-C is a calculation (total cholesterol minus HDL-C), and includes the sum of the VLDL-C, LDL-C, and IDL-C. While LDL-C has long been the primary focus of cholesterol reduction efforts, there are several other lipoproteins that also affect cardiovascular health. The advantage of non-HDL-C measurement is that it accounts for cholesterol in the other potentially atherogenic lipoprotein particles, which include VLDL-C, IDL-C, LDL-C, and lipoprotein(a). Recent guidelines suggest that non-HDL levels above 190 mg/dL enhances the risk for CVD.2 Hemoglobin A1c values are used to assess glucose control in diabetes, and in 2010, the American Diabetes Associations affirmed the decision of an international expert committee recommendation to use the A1c test to diagnose diabetes with a threshold ≥6.5%. The Cardiorenal-glycemic Panel can be collected non-fasting.

Laboratory assay overview

This panel measures serum concentrations of total cholesterol and high-density lipoprotein (HDL) cholesterol and provides a calculated total cholesterol/HDL cholesterol ratio. Measurements of cholesterol in conjunction with lipoproteins are used primarily in the risk assessment of atherosclerotic cardiovascular disease (ASCVD) [1]. Elevated total cholesterol is an established risk factor for atherosclerotic coronary disease [1]. HDL cholesterol level has been inversely related to the ASCVD risk, whereas very high HDL levels may increase all-cause mortality [2]. The cholesterol/HDL cholesterol ratio, also known as atherogenic or Castelli index, has been proposed as a stronger predictor of ASCVD risk than total cholesterol or HDL cholesterol alone [3]. Treatment with N-acetyl cysteine for acetaminophen overdose may generate a falsely low result for cholesterol [4]. Venipuncture immediately after or during administration of the painkiller metamizole (dipyrone) may also lead to falsely low results for cholesterol [5]. Note: Any or all individual tests from a panel can be ordered separately. The results of this test should be interpreted in the context of pertinent clinical and family history as well as physical examination findings. References 1. Meeusen J, et al. Lipids and lipoproteins. In: Rifai R, et al. eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier Inc; 2022. 2. Madsen CM, et al. Eur Heart J. 2017;38(32):2478-2486. 3. Millan J, et al. Vasc Health Risk Manag. 2009;5:757-765. 4. Beckman Coulter AU analyzers. Instructions for use. Beckman Coulter Inc; 2015. Accessed January 19, 2023. https://www.beckmancoulter.com/wsrportal/techdocs?docname=/cis/BAOSR6X16/%25%25/EN_CHOL%20OSR%20General%20Chemistry.pdf 5. Gascon N, et al. Clin Chem. 1993;39(6):1033-1036.

Quest Diagnostics population reference ranges

Quest Diagnostics calculates these statistical intervals for this specific assay and demographic group, not as universal optimal targets.

Laboratory assay overview

Evaluate lipid status and metabolic disorders. High levels of cholesterol that reflect high levels of HPLs may be caused by an inherited defect in lipoprotein metabolism, by disease of the endocrine system, by liver disease, or by renal disease. Low levels of cholesterol in the plasma may reflect an inherited deficiency of either LDL or HDL, or they may reflect impairment of liver function. Various hormone conditions are also related to cholesterol levels. Increased serum cholesterol in hypothyroid persons shows an increased LDL and decreased HDL. Low cholesterols are found in cases of hyperthyroidism, severe liver disease, pernicious anemia, and with increased estrogens. Pregnancy is accompanied by a moderate increase. Cholesterol is increased in early hepatitis, obstructed bile ducts, primary biliary cirrhosis, nephrotic syndrome, and diabetic meningitis. Finally, through much controversy, it appears that cholesterol is implicated in atherosclerosis and heart disease. Evaluate risk of coronary arterial occlusion, atherosclerosis, myocardial infarction, and complications including the demise of the patient. Increased in primary hypercholesterolemia, secondary hyperlipoproteinemias including nephrotic syndrome, hypothyroidism, primary biliary cirrhosis, and some cases of diabetes mellitus. Low levels have been found in cases of malnutrition, malabsorption, hyperthyroidism, myeloma, macroglobulinemia of Waldenström, polycythemia vera, myeloid metaplasia, myelofibrosis, chronic myelocytic leukemia, analphalipoproteinemia (Tangier disease), abetalipoproteinemia (Bassen-Kornzweig syndrome) (acanthocytosis), and in some individuals who subsequently present with carcinoma. Levy points out that the weak inverse relationship with cancer, mostly colon carcinoma, is limited to cholesterol levels <190 mg/dL and is limited to men.1 Hypocholesterolemia may occur with sideroblastic anemia or in the thalassemias. Cholesterol relates to coronary heart disease risk.2 Since premature mortality from coronary arterial disease is rampant and since cholesterol levels are available as a test which can detect a modifiable risk factor, serum cholesterol remains a critical and genuinely newsworthy topic and an important test. Effective intervention is available when cholesterol studies identify subjects likely to benefit, asymptomatic persons as well as those with recognized coronary disease.

Laboratory assay overview

Total LDL and HDL cholesterol, in conjunction with a triglyceride determination, provide valuable information for the risk of coronary artery disease. Total serum cholesterol analysis is useful in the diagnosis of hyperlipoproteinemia, atherosclerosis, hepatic and thyroid diseases.

Laboratory assay overview

To assist with control of blood glucose levels, the American Diabetes Association (ADA) has recommended glycated hemoglobin testing (HbA1c) twice a year for patients with stable glycemia, and quarterly for patients with poor glucose control. Interpretative ranges are based on ADA guidelines.

Laboratory assay overview

This test is intended to help inform the clinician about the presence of hyperlipidemia as an index to cardiovascular disease and to identify patients with chronic kidney disease.

Laboratory assay overview

To assist with control of blood glucose levels, the American Diabetes Association (ADA) has recommended glycated hemoglobin testing (HbA1c) twice a year for patients with stable glycemia, and quarterly for patients with poor glucose control. Interpretative ranges are based on ADA guidelines.

Laboratory assay overview

To assist with control of blood glucose levels, the American Diabetes Association (ADA) has recommended glycated hemoglobin testing (HbA1c) twice a year for patients with stable glycemia, and quarterly for patients with poor glucose control. Interpretative ranges are based on ADA guidelines.

Laboratory assay overview

To assist with control of blood glucose levels, the American Diabetes Association (ADA) has recommended glycated hemoglobin testing (HbA1c) twice a year for patients with stable glycemia, and quarterly for patients with poor glucose control. Interpretative ranges are based on ADA guidelines.

Laboratory assay overview

Low-density lipoprotein cholesterol (LDL-C), the most commonly measured atherogenic lipid particle, has been associated with diagnostic, prognostic, and therapeutic goal attainment criteria for several decades. The LDL molecule is comprised of various lipids- primarily cholesterol as cholesterol esters and free cholesterol, as well as some triglyceride and a single Apolipoprotein B (ApoB) which is a key structural component of all atherogenic lipoproteins. It is well established that the measurement of LDL-C lacks correlation to the actual number of LDL particles in circulation due to the changing cholesterol content of the LDL particle; thus, monitoring LDL-C levels may not provide adequate assurance that therapeutic treatment to LDL-C goals is achieved. However, as each atherogenic lipoprotein particle contains exactly one molecule of ApoB, its measurement is a powerful tool for assessment of atherogenic lipid status providing a direct correlation to circulating atherogenic LDL particles. The National Institutes of Health has demonstrated that ApoB measurements may be translated to LDL-C values so that conventional risk assessment and therapeutic targets that utilize LDL-C could continue to be used. This would provide a transition of ApoB measurements into an equivalent LDL unit until ApoB guided decision making can be facilitated. The new LDL-C equivalent (LDL-C EQ) calculation is derived from an ApoB measurement, and is incorporated into in a standard lipid panel that includes the current LDL-C (NIH) calculation, ApoB, as well as traditional triglycerides, total cholesterol and high density lipoprotein cholesterol (HDL-C). The side-by-side LDL-C (NIH) and LDL-C EQ calculation from ApoB will allow the clinician to quickly assess the necessity if more stringent intervention is needed to obtain therapeutic goals based on the LDL-C EQ value.

Laboratory assay overview

Familial hypercholesterolemia (FH) is an inherited disease and is the most common of the monogenic dyslipidemias. The prevalence of heterozygous FH is estimated at 1:250 in the U.S. population, making it the most common morbid monogenic disorder. Despite this, it is estimated that fewer than 10% of those living with FH have been diagnosed. Early childhood diagnosis is imperative due to the eventual onset of premature CVD shortening the lifespan of the affected individual. FH is characterized by very high cholesterol and LDL levels with 80% of patients expressing genetic mutations. Xanthomas or arcus cornealis may occur in patients due to abnormal lipid deposition in body tissues. Diagnosis of probable FH may be determined by lipid test results, clinical presentation or genetic testing. This test uses the Simon Broome lipid criteria for the diagnosis of FH to determine if the total cholesterol and/or the LDL cholesterol test results exceed specific cutpoints, depending upon age. If suspicion of FH is present, genetic testing may be considered. Genetic testing for FH has been recommended by many key professional societies including the American College of Cardiology, American Heart Association and National Lipid Association. The American Academy of Pediatrics (AAP) also recommends that in a clinical setting of FH suspicion, or family history, children should be offered genetic testing for diagnosis as genetic testing for FH has a 95% diagnostic yield in children. The AAP also recommends universal lipid screening for all children 9 to 11 years of age for early detection of FH. Aggressive pharmacologic treatment is usually undertaken beginning as early as 8-10 years of age upon diagnosis. There are several genetic pathogenic alterations responsible for the defects in LDL metabolism in FH. Mutations in the LDL receptor gene (LDLR) are most common, accounting for >90% of all genetic variants, whereas the apolipoprotein B (ApoB) gene and the protein convertase subtilisin/kexin type 9 (PCSK9) gene account for 5-10% and <1%, respectively. Genetic testing for FH has been recommended by many key professional societies including the American College of Cardiology, American Heart Association, and the National Lipid Association.

Laboratory assay overview

The lipid cascade supports risk assessment and management of patients who present with cardiometabolic risk (CMR) factors (e.g., elevated blood pressure, abdominal obesity, insulin resistance (IR), lipoprotein abnormalities and elevated blood glucose). Conventional lipid profile results are indirect estimates of the actual lipoproteins that transport cholesterol, many of which may be atherogenic. Additionally, basic lipid profile results do not: (1) account for the variability in cholesterol subfraction content; (2) measure lipoprotein particle size and number; or (3) provide information suggestive of changes associated with IR progression. In patients with an LDL cholesterol result <130 mg/dL, the lipid cascade automatically reflexes to lipoprotein analysis by NMR to evaluate LDL particle number (additional charge on reflex). This reflex is derived from the Multi-Ethnic Study of Atherosclerosis (MESA), a medical research study involving more than 6,000 men and women from six communities in the United States and sponsored by the National Heart Lung and Blood Institute of the National Institutes of Health.1 In this study, it was found that where the LDL cholesterol (LDL-C) and LDL particle number (LDL-P) are discordant (i.e., LDL/C "normal," but the LDL-P is elevated), CVD risk always follows the LDL-P. This means the patient with high LDL-P but "normal" LDL-C is really at high risk for future cardiovascular events. The reflex is therefore designed to look for residual CVD risk in patients where cholesterol does not tell the whole story. The lipid cascade provides a lipoprotein IR score as a qualitative indicator of the patient's insulin resistance and risk for diabetes. In patients with a triglyceride result >800 mg/dL, the lipid cascade automatically reflexes to a direct LDL (additional charge on reflex). If the direct LDL result is <130 mg/dL, the lipid cascade automatically reflexes to lipoprotein analysis by NMR.

Laboratory assay overview

The lipid cascade supports risk assessment and management of patients who present with cardiometabolic risk (CMR) factors (e.g., elevated blood pressure, abdominal obesity, insulin resistance (IR), lipoprotein abnormalities and elevated blood glucose). Conventional lipid profile results are indirect estimates of the actual lipoproteins that transport cholesterol, many of which may be atherogenic. Additionally, basic lipid profile results do not: (1) account for the variability in cholesterol subfraction content; (2) measure lipoprotein particle size and number; or (3) provide information suggestive of changes associated with IR progression. In patients with an LDL cholesterol result <130 mg/dL, the lipid cascade automatically reflexes to lipoprotein analysis by NMR to evaluate LDL particle number (additional charge on reflex). This reflex is derived from the Multi-Ethnic Study of Atherosclerosis (MESA), a medical research study involving more than 6,000 men and women from six communities in the United States and sponsored by the National Heart Lung and Blood Institute of the National Institutes of Health.1 In this study, it was found that where the LDL cholesterol (LDL-C) and LDL particle number (LDL-P) are discordant (i.e., LDL/C "normal," but the LDL-P is elevated), CVD risk always follows the LDL-P. This means the patient with high LDL-P but "normal" LDL-C is really at high risk for future cardiovascular events. The reflex is therefore designed to look for residual CVD risk in patients where cholesterol does not tell the whole story. The lipid cascade provides a lipoprotein IR score as a qualitative indicator of the patient's insulin resistance and risk for diabetes. In patients with a triglyceride result >800 mg/dL, the lipid cascade automatically reflexes to a direct LDL (additional charge on reflex). If the direct LDL result is <130 mg/dL, the lipid cascade automatically reflexes to lipoprotein analysis by NMR.

Laboratory assay overview

This test is used to evaluate hyperlipidemia as an index to coronary artery disease.

Laboratory assay overview

This "Extended Lipid Panel" quantifies the components of a typical lipid panel (TC, HDL-C and TG) along with ApoB by nuclear magnetic resonance (NMR) spectroscopy using the Vantera NMR Clinical Analyzer. Results from the Extended Lipid Panel Assay can be used by physicians to assist in CVD risk assessment. The principal protein component of LDL particles, ApoB, has been shown to be associated with CVD and is also an important CVD risk factor.

Laboratory assay overview

This "Extended Lipid Panel" quantifies the components of a typical lipid panel (TC, HDL-C and TG) along with ApoB by nuclear magnetic resonance (NMR) spectroscopy using the Vantera NMR Clinical Analyzer. Results from the Extended Lipid Panel Assay can be used by physicians to assist in CVD risk assessment. The principal protein component of LDL particles, ApoB, has been shown to be associated with CVD and is also an important CVD risk factor. GlycA is hypothesized to be a nonspecific measure of global inflammation status. Unlike existing biomarkers of inflammation that are discrete molecular species, such as CRP or inflammatory cytokines, GlycA is a composite biomarker that integrates the protein levels and glycosylation states of several of the most abundant acute- phase proteins in serum. This allows for a more stable measure of systemic inflammation with lower intra-individual variability of GlycA than hsCRP. While guidelines recommend two serial measurements be taken at least two weeks apart when using hsCRP for CV disease risk assessment, only one measurement is necessary for evaluation of a patient's CV risk using the GlycA test. The Diabetes Risk Index (DRI) is intended for use in adult subjects for the quantitative determination of a risk score in serum or plasma. The DRI score (1-100) may be used as an aid in stratifying the risk of developing type 2 diabetes in individuals with normo-glycemia or prediabetes. The Diabetes Risk Index (DRI) is a nuclear magnetic resonance spectroscopy (NMR)-derived multimarker score (values 1-100) that predicts a patient's risk of developing type 2 diabetes mellitus (T2D) independent of glycemic status. DRI derives its performance from the weighted addition of the Lipoprotein Insulin Resistance Index (LP-IR) scores with simultaneously-measured levels of branched-chain amino acids (BCAA).1-6

Laboratory assay overview

The Diabetes Risk Index (DRI) is intended for use in adult subjects for the quantitative determination of a risk score in serum or plasma. The DRI score (1-100) may be used as an aid in stratifying the risk of developing type 2 diabetes in individuals with normo-glycemia or prediabetes. The Diabetes Risk Index (DRI) is a nuclear magnetic resonance spectroscopy (NMR)-derived multimarker score (values 1-100) that predicts a patient's risk of developing type 2 diabetes mellitus (T2D) independent of glycemic status. DRI derives its performance from the weighted addition of the Lipoprotein Insulin Resistance Index (LP-IR) scores with simultaneously-measured levels of branched-chain amino acids (BCAA).1-6 For clinical use, DRI can be divided into three groups, corresponding to a low, intermediate, and high risk of developing T2D, with cutpoints corresponding closely to the 40th and 80th percentile values in the Multi-Ethnic Study of Atherosclerosis (MESA) reference population, using gender-specific cutpoints. Therefore, the low DRI category would include men and women with DRI scores less than 50 and 40, respectively. The intermediate DRI category would include men with DRI 50-65 and women with DRI 40-55. The high DRI group would consist of men and women with DRI >65 and >55, respectively.

Laboratory assay overview

As an (1) aid in the identification and stratification of individuals at risk for future cardiovascular (CV) disease, (2) independent marker of prognosis for recurrent cardiovascular events in patients with stable coronary disease or acute coronary syndrome, (3) aid in the assessment of disease activity and risk of CV disease in adult Rheumatoid Arthritis (RA) and psoriasis patients, when used in conjunction with standard clinical assessment and for monitoring of anti-inflammatory treatment.

Laboratory assay overview

GlycA is hypothesized to be a nonspecific measure of global inflammation status. Unlike existing biomarkers of inflammation that are discrete molecular species, such as CRP or inflammatory cytokines, GlycA is a composite biomarker that integrates the protein levels and glycosylation states of several of the most abundant acute- phase proteins in serum. This allows for a more stable measure of systemic inflammation with lower intra-individual variability of GlycA than hsCRP. While guidelines recommend two serial measurements be taken at least two weeks apart when using hsCRP for CV disease risk assessment, only one measurement is necessary for evaluation of a patient's CV risk using the GlycA test. The Diabetes Risk Index (DRI) is intended for use in adult subjects for the quantitative determination of a risk score in serum or plasma. The DRI score (1-100) may be used as an aid in stratifying the risk of developing type 2 diabetes in individuals with normo-glycemia or prediabetes. The Diabetes Risk Index (DRI) is a nuclear magnetic resonance spectroscopy (NMR)-derived multimarker score (values 1-100) that predicts a patient's risk of developing type 2 diabetes mellitus (T2D) independent of glycemic status. DRI derives its performance from the weighted addition of the Lipoprotein Insulin Resistance Index (LP-IR) scores with simultaneously-measured levels of branched-chain amino acids (BCAA).1-6

Laboratory assay overview

Abbreviations used are as follows: HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; VLDL-C, very low-density lipoprotein cholesterol. Evaluation of hyperlipidemia as an index to coronary artery disease. Investigation of serum lipids is indicated in those with coronary and other arterial disease, especially when it is premature, and in those with family history of atherosclerosis or of hyperlipidemia. In this sense, the expression “premature” is mostly used to include those with a family history of premature CHD (definite myocardial infarction), or sudden death before 55 years of age in father or other male first-degree relative, or before 65 years of age in mother or other female first-degree relative. Patients with xanthomas should be worked up with lipid panels, but not those with xanthelasmas or xanthofibromas in the sense of dermatofibromas. Those whose fasting serum is lipemic should have a lipid panel, but the serum of a subject with high cholesterol but normal triglyceride is not milky in appearance. The patient with high cholesterol (>240 mg/dL) should have a lipid panel. Patients with cholesterol levels between 200−240 mg/dL plus two other coronary heart disease risk factors should also have a lipid panel.1 In addition to application in programs for evaluation of risk factors for coronary arterial disease, lipid profiling may lead to detection of some cases of hypothyroidism. If a patient has low LDL-C, but very low HDL-C, he/she may still be in jeopardy (Castelli of the Framingham study); therefore, LDL-C:HDL-C ratios are useful. Primary hyperlipoproteinemia includes hypercholesterolemia, a direct risk factor for coronary heart disease. Secondary hyperlipoproteinemias include increases of lipoproteins secondary to hypothyroidism, nephrosis, renal failure, obesity, diabetes mellitus, alcoholism, primary biliary cirrhosis, and other types of cholestasis. Decreased lipids are found with some cases of malabsorption, malnutrition, advanced liver disease. In abetalipoproteinemia, cholesterol is <70 mg/dL.

Laboratory assay overview

This panel measures serum cholesterol and triglyceride (TG) levels. It includes evaluation of the LDL/HDL ratio (calculated), cholesterol/HDL-C ratio (calculated), HDL-C, LDL-C (calculated), non-HDL-C (calculated), total cholesterol, and TG. Comprehensive lipid assessment aids in evaluating cardiovascular disease (CVD) risk and the likelihood of an ischemic event. It is also useful for the prevention and management of atherosclerotic disease and diagnosis of metabolic syndrome [1]. CVD is the leading cause of death in the United States. Individuals with high LDL-C and TG levels are at elevated risk for developing CVD and having an ischemic event [2,3]. The American Heart Association recommends that Americans aged 20 and above have their lipid levels tested every 4 to 6 years. Children should have their cholesterol tested for the first time between ages 9 and 11 and again between ages 17 and 21. Testing should start earlier if there is a family history of high cholesterol [4]. This panel reports a calculated LDL/HDL ratio in addition to all the components included in Lipid Panel, Standard (test code 7600). High LDL/HDL ratio may be a stronger predictor of coronary heart disease than LDL and HDL alone in patients with hypertriglyceridemia [5]. Treatment with N-acetyl cysteine for acetaminophen overdose may generate a falsely low result for cholesterol [6]. Venipuncture immediately after or during administration of the painkiller metamizole (dipyrone) may also lead to falsely low results for cholesterol [7]. Note: Any or all individual tests from a panel can be ordered separately. The results of this test should be interpreted in the context of pertinent clinical and family history as well as physical examination findings. References 1. Stone NJ, et al. Circulation. 2014;129(25 Suppl 2):S1-S45. 2. CDC. Heart disease facts. Accessed January 3, 2022. https://www.cdc.gov/heartdisease/facts.htm 3. Arbel Y, et al. Card Diabetol. 2016;15:11. 4. Grundy SM, et al. Circulation. 2019;139(25):e1082-e1143. 5. Manninen V, et al. Circulation. 1992;85(1):37-45. 6. Cholesterol. Instructions for use. Beckman Coulter Inc; 2015. 7. Gascon N, et al. Clin Chem. 1993;39(6):1033-1036.

Quest Diagnostics population reference ranges

Quest Diagnostics calculates these statistical intervals for this specific assay and demographic group, not as universal optimal targets.

Laboratory assay overview

The Lipid Panel with Reflex to Direct LDL panel includes evaluation of total cholesterol, HDL-cholesterol, triglyceride (TG), LDL-cholesterol (calculated), cholesterol/HDL ratio (calculated), and non-HDL cholesterol; direct LDL-C measurement will be performed at additional cost if the TG level is >400 mg/dL. This panel is useful in the detection, classification, and monitoring of hyperlipidemia, especially those expected to have highly elevated TG levels. LDL-C is widely accepted as a key factor for assessing the risk of coronary artery disease (CAD) [1]. The American Heart Association recommends lipid testing for adults over the age of 20 every 4 to 6 years [2]. Direct LDL-C measurement is more accurate than calculated LDL-C for patients with TG levels >400 mg/dL, and patients with hyperlipoproteinemia type III (dysbetalipoproteinemia). Thus, as indicated above, this panel is especially useful for individuals likely to have highly elevated TG and provides a basis for more realistic assessment of CAD risk in this group. It may also help track treatment progress by allowing healthcare practitioners to evaluate overall lipid levels, as well as direct LDL-C [3]. In addition to genetic causes that lead to highly elevated TG levels, certain medical conditions can also increase TG, including diabetes, thyroid disease, liver and kidney diseases, and obesity [4]. Calculated LDL values have a variance of 11% to 26%, whereas direct LDL-C values have a variance of less than 4% [5]. In rare cases, gammopathy, especially monoclonal IgM (Waldenstrom’s macroglobulinemia), may cause unreliable results. References 1. Grundy SM, et al. Circulation. 2019;139:e1082-e1143. 2. Stone NJ, et al. Circulation. 2014;129 (suppl 2):S1-S45. 3. Armbruster DA, Lambert PA. Lab Med. 1996;9:613-617. 4. NHLBI. High blood triglycerides. https://www.nhlbi.nih.gov/health-topics/high-blood-triglycerides. 5. Schectman G, et al. Clin Chem. 1994;39:1495-1503.

Quest Diagnostics population reference ranges

Quest Diagnostics calculates these statistical intervals for this specific assay and demographic group, not as universal optimal targets.

Laboratory assay overview

Evaluation of hyperlipidemia as an index to coronary artery disease. Investigation of serum lipids is indicated in those with coronary and other arterial disease, especially when it is premature, and in those with family history of atherosclerosis or of hyperlipidemia. In this sense, the expression “premature” is mostly used to include those younger than 40 years of age.

Laboratory assay overview

The lipid panel is used to determine an individual's risk of developing cardiovascular disease and to monitor the efficacy of therapy or lifestyle changes.

Laboratory assay overview

This is the most common Lipid Panel. Components include those useful in the detection, classification, and monitoring of patients with hyperlipidemia.

Quest Diagnostics population reference ranges

Quest Diagnostics calculates these statistical intervals for this specific assay and demographic group, not as universal optimal targets.

Laboratory assay overview

This Lipid Panel includes Total Cholesterol, HDL Cholesterol and calculated non-HDL Cholesterol. It does not include triglycerides and may be best used in patients for whom fasting is difficult.

Quest Diagnostics population reference ranges

Quest Diagnostics calculates these statistical intervals for this specific assay and demographic group, not as universal optimal targets.

Laboratory assay overview

The Lipid Panel, Standard measures serum cholesterol and triglyceride (TG) levels; it includes evaluation of the cholesterol/HDL-C ratio (calculated), HDL-C, LDL-C (calculated), non-HDL-C (calculated), total cholesterol, and TG. Comprehensive lipid assessment aids in the evaluation of cardiovascular risk and the likelihood of suffering an ischemic event. It is also useful for the prevention and management of atherosclerotic disease, as well as the diagnosis of metabolic syndrome [1]. Cardiovascular disease (CVD) is the leading cause of death in the United States. The risk of developing CVD and having an ischemic event is significantly increased in individuals with high LDL-cholesterol (LDL-C) and TG levels [2,3]. The American Heart Association (AHA) recommends that Americans aged 20 and above have their lipid levels tested every 4 to 6 years. Children should have their cholesterol tested for the first time between ages 9 and 11, and again between ages 17 and 21. Testing should start earlier if there is family history of high cholesterol [4]. The AHA recommends repeat measurement of LDL-C within 4 to 12 weeks of starting or changing lipid-lowering therapy, to assess response and adherence, and then every 3 to 12 months as appropriate [4]. Treatment with N-acetyl cysteine (NAC) for acetaminophen overdose may generate a falsely low result for cholesterol. Venipuncture immediately after or during administration of the painkiller metamizole (dipyrone) may also lead to falsely low results for cholesterol. Note: Any or all individual tests from a panel can be ordered separately. References 1. Stone NJ, et al. Circulation. 2014;129(suppl 2):S1-S45. 2. CDC. Heart disease fact sheet. Reviewed August 23, 2017. https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_disease.htm 3. Arbel Y, et al. Card Diabetol. 2016;15:11. 4. AHA. Cholesterol management guide for healthcare practitioners. November 10, 2018. https://www.heart.org/-/media/files/health-topics/cholesterol/chlstrmngmntgd_181110.pdf

Quest Diagnostics population reference ranges

Quest Diagnostics calculates these statistical intervals for this specific assay and demographic group, not as universal optimal targets.

Laboratory assay overview

The Third Report of the National Cholesterol Education Program (NCEP) Expert Panel's revised guidelines1 for the treatment of cholesterol in adults called for increased attention to the metabolic syndrome and diabetes. These guidelines highlighted the increased inaccuracy of the LDL-C measurement in these patients because of elevated triglycerides. To overcome the inaccuracy of the calculated LDL-C method when triglycerides are elevated, measurement of nonhigh-density lipoprotein (non-HDL) was recommended as a better means to follow these patients toward their treatment goals. Non-HDL-C is a calculation (total cholesterol minus HDL-C), ie, the sum of the VLDL-C, LDL-C, and IDL-C. While LDL-C has long been the primary focus of cholesterol reduction efforts, researchers have identified several other lipoproteins that also affect cardiovascular health. The advantage of non-HDL-C measurement is that it accounts for cholesterol in the other potentially atherogenic lipoprotein particles, which include VLDL-C, IDL-C, LDL-C, and lipoprotein(a). Studies2,3 have shown that the measurement of non-HDL-C, rather than LDL-C, would be a better target for therapy, especially in persons with a triglyceride level >200 mg/dL. Cut-points for non-HDL-C are 30 mg/dL higher than the LCL-C cut-points (eg, if the patient's LDL-C goal is <160 mg/dL, the non-HDL-C goal should be <190 mg/dL).

Laboratory assay overview

Assessment of cardiovascular health and risk stratification in pediatric, adolescent, and young adult populations

Laboratory assay overview

Assessment of cardiovascular health and risk stratification in pediatric, adolescent, and young adult populations.

Laboratory assay overview

This panel measures serum concentrations of total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, and low-density lipoprotein (LDL) cholesterol and provides a calculated concentration of very low-density lipoprotein (VLDL) cholesterol. Comprehensive lipid assessment aids in evaluating cardiovascular disease (CVD) risk and the likelihood of an ischemic event. It is also useful for the prevention and management of atherosclerotic disease and diagnosis of metabolic syndrome [1]. CVD is the leading cause of death in the United States. Individuals with high LDL cholesterol and triglyceride levels are at elevated risk for developing CVD and having an ischemic event [2,3]. The American Heart Association recommends that Americans aged 20 and above have their lipid levels tested every 4 to 6 years. Children should have their cholesterol tested for the first time between ages 9 and 11 and again between ages 17 and 21. Testing should start earlier if there is a family history of high cholesterol [4]. Treatment with N-acetyl cysteine for acetaminophen overdose may generate a falsely low result for cholesterol [5]. Venipuncture immediately after or during administration of the painkiller metamizole (dipyrone) may also lead to falsely low results for cholesterol [6]. Note: Any or all individual tests from a panel can be ordered separately. The results of this test should be interpreted in the context of pertinent clinical and family history as well as physical examination findings. References 1. Stone NJ, et al. Circulation. 2014;129(25 Suppl 2):S1-S45. 2. CDC. Heart disease facts. Accessed January 3, 2022. https://www.cdc.gov/heartdisease/facts.htm 3. Arbel Y, et al. Card Diabetol. 2016;15:11. 4. Grundy SM, et al. Circulation. 2019;139(25):e1082-e1143. 5. Beckman Coulter AU analyzers. Instructions for use. Beckman Coulter Inc; 2015. Accessed January 19, 2023. https://www.beckmancoulter.com/wsrportal/techdocs?docname=/cis/BAOSR6X16/%25%25/EN_CHOL%20OSR%20General%20Chemistry.pdf 6. Gascon N, et al. Clin Chem. 1993;39(6):1033-1036.

Laboratory assay overview

This test is used to evaluate hyperlipidemia to determine abnormal lipoprotein distribution and concentration in the serum. Type I: Hyperchylomicronemia. A large, lipid-stained fraction remains at the application point. Other lipoproteins stain less intensely. It is a very rare pattern. The patient serum is very lipemic and shows a floating chylomicron band, after remaining overnight in the refrigerator. The infranatant is clear. There are two conditions that give a false type I pattern. The first is dysglobulinemia. In this condition, a large portion of the lipid is bound to immunoglobulins (IgM). Agarose gel protein electrophoresis of serum should be performed to confirm or exclude a diagnosis of dysglobulinemia. In the case of a positive result, an immunoelectrophoresis can determine the type of lipoprotein or lipoproteins involved. The second condition that can give a false type I pattern is delipidation of lipoproteins. Some drugs act as delipidizing agents and can result in patterns that are very misleading. It is imperative to confirm that the sample had been drawn from a fasting (>12 hours) patient before one classifies the electrophoretic pattern because hyperchylomicronemia is induced by food intake. The definitive test for confirmation of type I hyperlipoproteinemia is the postheparin lipase activity (PHLA) measurement. In contrast to type V hyperlipoproteinemia, PHLA is reduced or absent in true type I hyperlipoproteinemia. Type IIa: Hypercholesterolemia. In this condition, there is a high concentration of β-lipoprotein with normal pre−β-lipoprotein. The α-lipoprotein is normal or sometimes slightly decreased. The calculated LDL-cholesterol value should be >160 mg/dL. This is a relatively common disorder. Type IIb: Hypercholesterolemia with elevated triglycerides. This is a common type of hyperlipoproteinemia. Besides a high β-lipoprotein concentration, there is an elevated pre−β-lipoprotein concentration. Chylomicrons are not present, and the α-lipoprotein band is normal or slightly decreased. On nonfasting samples, a distinction cannot be made between the type IIa and type IIb patterns. Type III: Hypercholesterolemia with hypertriglyceridemia. Serum total cholesterol and triglyceride levels are present at about a 1:1 ratio. Chylomicrons are not usually present. The β-lipoprotein, present at high concentration, forms a broad band and has a faster mobility than the usual β-lipoprotein. The separation between the β-lipoprotein and pre−β-lipoprotein bands is very poor because of the increase in the concentration of abnormal intermediate-density lipoprotein (which lacks apolipoprotein E). This abnormal lipoprotein migrates between the β-lipoprotein and pre−β-lipoprotein bands. The α-lipoprotein usually is decreased. Final diagnosis of type III may require Apo E genotype testing. Type IV: Hypertriglyceridemia. Elevated pre−β-lipoproteins are present with a normal or low β-lipoprotein fraction. Sometimes the mobility of the β-lipoprotein fraction is faster than normal. The α-lipoprotein is usually decreased. There are no chylomicrons present. If the serum triglyceride concentration is 200−300 mg/dL, a “mild type IV” designation can be used. The patient should be completely fasting (> 12 hours); otherwise the type IV and type V patterns will be very difficult to distinguish. Type V: Hyperlipidemia with chylomicronemia. Chylomicrons, β-lipoprotein, and pre−β-lipoprotein are usually increased. Sometimes the serum triglyceride can be >10,000 mg/dL. The serum total cholesterol concentration can also be elevated. The presence of a floating-chylomicron band in serum stored at 4°C constitutes a positive identification for the presence of chylomicrons. The infranatant serum varies from very opalescent to lipemic in appearance. This appearance is caused by pre−β-lipoproteins being present. Because a chylomicron band is present, protein electrophoresis on agarose gel can allow detection of the abnormal globulin-lipoprotein complex.

Laboratory assay overview

Identifying patients who have metabolic syndrome and who are thus at higher risk of diabetes, coronary heart disease or stroke. Identifying patients who are insulin resistant (fasting insulin at or above the 75th percentile) and who are thus at higher risk of diabetes, coronary heart disease, stroke, or liver disease. Monitoring of risk factors and insulin levels after life style change, medication use, or both.

Laboratory assay overview

This test is a noninvasive assessment of liver status in patients with nonalcoholic fatty liver disease (NAFLD), now known as metabolic dysfunction-associated steatotic liver disease (MASLD). Quantitative results of 10 biochemicals in combination with age and gender are analyzed using a computational algorithm to provide a quantitative surrogate marker (0.0-1.0) of liver fibrosis (Metavir F0-F4), hepatic steatosis (0.0-1.0, S0-S3), and nonalcoholic steatohepatitis (NASH) (0.0-0.75, N0-N2). The absence of steatosis (S<0.41) precludes the diagnosis of NASH, now known as metabolic dysfunction-associated steatohepatitis (MASH).

Laboratory assay overview

NASH FibroSure® Plus is a noninvasive assessment of liver status in patients with nonalcoholic fatty liver disease (NAFLD). Quantitative results of 10 biochemicals in combination with age and gender are analyzed using a computational algorithm to provide a quantitative surrogate marker (0.0-1.0) of liver fibrosis (Metavir F0-F4), hepatic steatosis (0.0-1.0, S0-S3) and nonalcoholic steatohepatitis (NASH) (0.0-0.75, N0-N2). The absence of steatosis (S<0.41) precludes the diagnosis of NASH, now known as metabolic dysfunction-associated steatohepatitis (MASH). The Enhanced Liver Fibrosis (ELF™) blood test is a simple, accurate, noninvasive test that provides a simple, unitless numeric score that is generated via an algorithm for use in advanced liver fibrosis. It is indicated as a prognostic marker in conjunction with other laboratory findings and clinical assessments in patients with advanced fibrosis (F3 or F4) due to nonalcoholic steatohepatitis (NASH), now called metabolic dysfunction- associated steatohepatitis (MASH), to assess the likelihood of progression to cirrhosis and liver-related clinical events.1 Because ELF™ uses a blood sample rather than a biopsy, it can be used routinely for the same patient across time.

Laboratory assay overview

NMR LDL-P is a management tool used in appropriate high-risk patients (type 2 diabetes mellitus, metabolic syndrome, CVD risk equivalent, statin-treated patients) to adjudicate response to treatment and guide adjustment in therapy. It is used in conjunction with other lipid measurements and clinical evaluation to aid in the management of lipoprotein disorders associated with cardiovascular disease.

Laboratory assay overview

NMR LDL-P is a management tool used in appropriate high-risk patients (type 2 diabetes mellitus, metabolic syndrome, CVD risk equivalent, statin-treated patients) to adjudicate response to treatment and guide adjustment in therapy. It is used in conjunction with other lipid measurements and clinical evaluation to aid in the management of lipoprotein disorders associated with cardiovascular disease.

Laboratory assay overview

NMR LDL-P is a management tool used in appropriate high-risk patients (type 2 diabetes mellitus, metabolic syndrome, CVD risk equivalent, statin-treated patients) to adjudicate response to treatment and guide adjustment in therapy. It is used in conjunction with other lipid measurements and clinical evaluation to aid in the management of lipoprotein disorders associated with cardiovascular disease.

Laboratory assay overview

NMR LDL-P is a management tool used in appropriate high-risk patients (type 2 diabetes mellitus, metabolic syndrome, CVD risk equivalent, statin-treated patients) to adjudicate response to treatment and guide adjustment in therapy. It is used in conjunction with other lipid measurements and clinical evaluation to aid in the management of lipoprotein disorders associated with cardiovascular disease.

Laboratory assay overview

The third report of the National Cholesterol Education Program (NCEP) Expert Panel's revised guidelines1 for the treatment of cholesterol in adults called for increased attention to the metabolic syndrome and diabetes. These guidelines highlighted the increased inaccuracy of the LDL-C measurement in these patients because of elevated triglycerides. To overcome the inaccuracy of the calculated LDL-C method when triglycerides are elevated, measurement of non-high-density lipoprotein (non-LDL-C) was recommended as a better means to follow these patients toward their treatment goals. Non-HDL-C is a calculation (total cholesterol minus HDL-C), ie, the sum of the VLDL-C, LDL-C, and IDL-C. While LDL-C has long been the primary focus of cholesterol reduction efforts, researchers have identified several other lipoproteins that also affect cardiovascular health. The advantage of non-HDL-C measurement is that it accounts for cholesterol in the other potentially atherogenic lipoprotein particles, which include VLDL-C, IDL-C, LDL-C, and lipoprotein(a). Studies2,3 have shown that the measurement of non-HDL-C, rather than LDL-C, would be a better target for therapy, especially in persons with a triglyceride level >200 mg/dL. Cutpoints for non-HDL-C are 30 mg/dL higher than the LCL-C cutpoint (eg, if the patient's LDL-C goal is <160 mg/dL, the non-HDL-C goal should be <190 mg/dL).

Laboratory assay overview

Obesity, associated with a multitude of co-morbid conditions, is a serious health condition impacting a significant number of patients in the U.S. Per the Centers for Disease Control and Prevention (CDC), the prevalence of obesity in the U.S. increased from 30.5% in 1999-2000 to 41.9% in 2017- March 2020.1 Currently, there is great emphasis on being overweight and obesity as a disease, with societies providing guidance on the use of newly available pharmacologic therapies as well as bariatric surgical procedures to decrease the burden. Depending upon the type of bariatric surgery performed, deficiencies of micronutrients and some vitamins may ensue, and recommendations are to evaluate these parameters prior to surgery and at least annually thereafter.

Laboratory assay overview

Obesity, associated with a multitude of co-morbid conditions, is a serious health condition impacting a significant number of patients in the U.S. Per the Centers for Disease Control and Prevention (CDC), the prevalence of obesity in the U.S. increased from 30.5% in 1999-2000 to 41.9% in 2017- March 2020.1 Currently, there is great emphasis on being overweight and obesity as a disease, with societies providing guidance on the use of newly available pharmacologic therapies as well as bariatric surgical procedures to decrease the burden. Depending upon the type of bariatric surgery performed, deficiencies of micronutrients and some vitamins may ensue, and recommendations are to evaluate these parameters prior to surgery and at least annually thereafter.

Laboratory assay overview

This test is for PrEP use only and to evaluate hyperlipidemia as an index to coronary artery disease in individuals who are eligible for or who are receiving pre-exposure prophylaxis for HIV (PrEP).

Laboratory assay overview

This test can be used to establish a baseline when initiating a weight management treatment.

Laboratory assay overview

This test can be used to establish a baseline when initiating a weight management treatment.