cholesterol HDL in serum
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Indications
- US Preventive Services Task Force recommendations (2001) sets no upper limit to age for routine screening for lipid disorders
- total cholesterol plus HDL cholesterol is recommended for screening purposes
Reference interval
- mg/dL -> mmol/L, multiply by 0.0259
| gender | value | SI units |
|---|---|---|
| Male: | >/= 35 mg/dL | (0.91 mmol/L) |
| Female: >/= 45 mg/dL | (1.17 mmol/L) |
* HDL cholesterol does not vary with age in men or post-menopausal women
Principle
The Kodak Ektachem HDL Cholesterol Kit is used to prepare samples for analysis of HDL Cholesterol, which is measured by the Kodak Ektachem Clinical Chemistry (CHOL) Slide.
LDL & VLDL are separated from HDL in a patient by selective precipitation using a reagent with a final concentration of 50,000 MW dextran sulfate (0.9g/L) & magnesium chloride (45 mmol/L). The precipitated lipoproteins are removed via centrifugation.
The Kodak Ektachem Clinical Chemistry Slide (CHOL) is a dry, multilayered, self-contained analytical element coated on a clear polyester support.
A 10 microliter drop of pretreated sample is deposited on the slide & is distributed evenly by the spreading layer.
HDL Cholesterol undergoes reactions described in the Kodak Ektachem Test Methodologies, to produce hydrogen peroxide. Hydrogen peroxide reacts with a leuco dye to produce a highly- colored complex.
By measuring the amount of light spectrophotometrically reflected from the dyed layer after a fixed incubation period, the analyzer calculates the amount of HDL Cholesterol present in the pretreated sample.
Clinical significance
- controversy exists over clinical significance of HDL cholesterol
- there is an inverse relationship between HDL cholesterol & risk & developing coronary heart disease, regardless of the LDL cholesterol levels.[7][8][9]
- a 1% increase in HDL is associated with a 2% decrease in risk[8]
- coronary artery atherosclerosis correlates with a high plasma LDL:HDL ratio
- increases in total Cholesterol are associated with increased risk of atherosclerosis
- total Cholesterol is a better indicator in persons under age 50 than it is in older age groups
- in persons over 50 years of age, HDL cholesterol is a much better predictor of coronary artery disease (CAD ) than total serum Cholesterol
- a total cholesterol/HDL cholesterol ratio of > 5 predicts an increased risk of CAD
- high HDLC levels tend to protect against atherosclerosis.
- a ratio of LDL/HDL of > 4 also predicts increased risk of CAD
- raising HDL cholesterol through lifesytle or drugs does not necessarily reduce risk of cardiovascular disease
- very high HDL-cholesterol (> 74 mg/dL) associated with increased risk of fractures in older adults[20]
- very high HDL-cholesterol (> 80 mg/dL) associated with increased all-cause mortality (RR=1.96) & cardiovascular mortality (RR=1.71)[18]
- low HDL-cholesterol is associated with increased risk of coronary artery disease in White but not Black adults[19]
- high HDL-cholesterol is not protective from coronary artery disease in either White or Black adults[19]
- both low & high HDL cholesterol is associated with increased risk of dementia (RR=1.1)[21]
Increases
- niacin[6]
- statins (HMG CoA reductase inhibitors)
- estrogen
- variant in scavenger receptor B1 (SCARB1)[17]
Decreases
- smoking
- acute & chronic hepatocellular disease
- acute stress (surgery, trauma, myocardial infarction)
- intravenous hyperalimentation
- severe malnutrition
- diabetes
- hypothyroidism & hyperthyroidism
- chronic anemia
- myeloproliferative disorder
- drugs (androgens, beta-blockers)
Specimen
Patient Preparation: If the HDL Cholesterol test is part of a complete lipid profile, a 12 to 14 hour fast is necessary.
Sample Preparation: Collect serum or plasma specimens using standard venipuncture technique. EDTA or heparin may be used as an anticoagulant for plasma specimens. Values in serum or heparinized plasma are 2 to 3 mg/dL lower than values in EDTA plasma. Remove the serum or plasma promptly from the cells. The original sample or the prepared supernatant removed from the pellet may be stored frozen. Do not subject the samples to repeated freeze-thaw cycles.
Sample requirements: Minimum- 1 mL serum or plasma. Optimum: 2 mL serum or plasma.
Interferences
- Ascorbic acid (vitamin C) at levels typically encountered in patients do not affect HDL cholesterol values. However, individuals taking high doses of vitamin C may show falsely low HDL cholesterol results. Interference tests indicate that 3 mg/dL of ascorbic acid lowers HDL cholesterol at 44 mg/dL by 12mg/dL in serum & 9.4 mg/dL in EDTA plasma.
- Profile samples that are not collected fasting at least 12-14 hours.
More general terms
More specific terms
Additional terms
Component of
- lipid panel (fasting lipid panel, FLP)
- triglyceride/HDL cholesterol in serum/plasma
- cholesterol LDL/cholesterol HDL in serum/plasma
- cholesterol total/cholesterol HDL in serum/plasma
- cholesterol HDL/cholesterol total in serum/plasma
- chronic kidney disease panel
- apolipoprotein A1/HDL cholesterol in serum
References
- ↑ Kodak Ektachem 700 Test Methodologies Manual, Kodak Clinical Products, Rochester, N.Y., 1990.
- ↑ Kodak Ektachem 700 Operators Manual, Kodak Clinical Products, Rochester, N.Y., 1987.
- ↑ Package Insert, Kodak Ektachem Special Calibrators, Kodak Clinical Products, Rochester, N.Y., 1985.
- ↑ Package Insert, Bio-Rad Liquichek Controls, Bio-Rad ECS Division, Anaheim, CA., 1992.
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998.
- ↑ 6.0 6.1 Prescriber's Letter 11(5):27 2004 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=200504&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 7.0 7.1 Barter P, Gotto AM, LaRosa JC, Maroni J, Szarek M, Grundy SM, Kastelein JJ, Bittner V, Fruchart JC; Treating to New Targets Investigators. HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events. N Engl J Med. 2007 Sep 27;357(13):1301-10. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17898099
- ↑ 8.0 8.1 8.2 Grover SA et al Evaluating the Incremental Benefits of Raising High-Density Lipoprotein Cholesterol Levels During Lipid Therapy After Adjustment for the Reductions in Other Blood Lipid Levels Arch Intern Med. 2009;169(19):1775-1780. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19858435 <Internet> http://archinte.ama-assn.org/cgi/content/abstract/169/19/1775
- ↑ 9.0 9.1 Mora S et al. Association of high-density lipoprotein cholesterol with incident cardiovascular events in women, by low-density lipoprotein cholesterol and apolipoprotein B100 levels: A cohort study. Ann Intern Med 2011 Dec 6; 155:742 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22147713
- ↑ Voight BF et al Plasma HDL cholesterol and risk of myocardial infarction: a mendelian randomisation study. The Lancet, Early Online Publication, 17 May 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22607825 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2960312-2/fulltext
Harrison SC et al Mendelian randomisation, lipids, and cardiovascular disease The Lancet, Early Online Publication, 17 May 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22607824 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2960481-4/fulltext - ↑ HDL Cholesterol Laboratory Test Directory ARUP: http://www.aruplab.com/guides/ug/tests/0020053.jsp
- ↑ Panel of 6 tests Laboratory Test Directory ARUP: http://www.aruplab.com/guides/ug/tests/0020421.jsp
- ↑ Panel of 6 tests Laboratory Test Directory ARUP: http://www.aruplab.com/guides/ug/tests/0020468.jsp
- ↑ Panel of 6 tests Laboratory Test Directory ARUP: http://www.aruplab.com/guides/ug/tests/0050021.jsp
- ↑ Panel of 7 tests Laboratory Test Directory ARUP: http://www.aruplab.com/guides/ug/tests/0080503.jsp
- ↑ Shah PK. Residual risk and high-density lipoprotein cholesterol levels: is there a relationship? Rev Cardiovasc Med. 2011;12(2):e55-9. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21796083
- ↑ 17.0 17.1 Zanoni P et al Rare variant in scavenger receptor BI raises HDL cholesterol and increases risk of coronary heart disease. Science. 2016 March 11 351(6278):1166-71 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26965621 <Internet> http://science.sciencemag.org/content/351/6278/1166
- ↑ 18.0 18.1 Liu C, Dhindsa D, Almuwaqqat Z et al. Association Between High-Density Lipoprotein Cholesterol Levels and Adverse Cardiovascular Outcomes in High-risk Populations. JAMA Cardiol. Published online May 18, 2022. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35583863 https://jamanetwork.com/journals/jamacardiology/fullarticle/2792282
Khan SS, Fonarow GC. Very Elevated High-Density Lipoprotein Cholesterol and Mortality
The Good Gone Bad? JAMA Cardiol. Published online May 18, 2022. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35583861 https://jamanetwork.com/journals/jamacardiology/fullarticle/2792285 - ↑ 19.0 19.1 19.2 Zakai NA, Minnier J, Safford MM et al Race-Dependent Association of High-Density Lipoprotein Cholesterol Levels With Incident Coronary Artery Disease. J Am Coll Cardiol. 2022 Nov, 80 (22) 2104-2115 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36423994 https://www.jacc.org/doi/10.1016/j.jacc.2022.09.027
- ↑ 20.0 20.1 Larkin M High HDL-C Levels Linked to Increased Fracture Risk. January 20, 2023 https://www.medscape.com/viewarticle/987282
- ↑ 21.0 21.1 Ferguson EL, Zimmerman SC, Jiang C et al Low- and High-Density Lipoprotein Cholesterol and Dementia Risk Over 17 Years of Follow-up Among Members of a Large Health Care Plan. Neurology. 2023. Oct 4. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37793911 https://n.neurology.org/content/early/2023/10/04/WNL.0000000000207876