cholesterol LDL in serum

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Genetics

* genetic testing for familial hypercholesterolemia

Indications

Reference interval

mg/dL -> mmol/L, multiply by 0.0259

risk LDL cholesterol
high-risk > 160 mg/dL (< 4.14 mmol/L)
borderline 130 - 159 mg/dL (3.37 - 4.12 mmol/L)
desirable < 130 mg/dL (< 3.37 mmol/L)
vasculopathy* < 100 mg/dL (< 2.50 mmol/L)
intensive control < 70 mg/dL (< 1.8 mmol/L)[4][5][16][18]

* vasculopathy = CAD, diabetes, ischemic stroke target LDL for high risk patients with coronary artery disease (CAD) has been lowered to 70 mg/dL[3]. (NCEP)

Clinical significance

intensive lipid-lowering therapy to very low LDL cholesterol

Increases

Decreases

  • poor health

Procedure

LDL-cholesterol is generally calculated from measurements of total cholesterol, HDL-cholesterol & triglycerides obtained from a lipid panel & the assumption that the VLDL-cholesterol is equal to 1/5 of the triglyceride concentration, using the formula:

[[[A144160|LDL]]-chol] = [total chol] - [HDL-chol] - [[[A18141|triglycerides]]/5]

This equation works well for triglycerides < 400 mg/dL in the absence of dysbetalipoproteinemia.

The lipoprotein LDL may be measured directly using lipoprotein electrophoresis or determined from apolipoprotein B measurement.

Management

Comparative biology

More general terms

More specific terms

Additional terms

Component of

References

  1. 1.0 1.1 Tietz Textbook of Clinical Chemistry, 2nd ed. Burtis CA & Ashwood ER (eds), WB Saunders Co, Philadelphia PA, 1993, pg 1055-56
  2. 2.0 2.1 2.2 2.3 Medical Knowledge Self Assessment Program (MKSAP) 11, 18, 19. American College of Physicians, Philadelphia 1998, 2018, 2021.
  3. 3.0 3.1 Prescriber's Letter 11(8): 2004 New National Cholesterol Education Program (NCEP) Recommendations Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=200801&pb=PRL (subscription needed) http://www.prescribersletter.com
  4. 4.0 4.1 4.2 Wiviott SD, Cannon CP, Morrow DA, Ray KK, Pfeffer MA, Braunwald E; PROVE IT-TIMI 22 Investigators. Can low-density lipoprotein be too low? The safety and efficacy of achieving very low low-density lipoprotein with intensive statin therapy: a PROVE IT-TIMI 22 substudy. J Am Coll Cardiol. 2005 Oct 18;46(8):1411-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16226163
  5. 5.0 5.1 5.2 Hayward RA, Hofer TP, Vijan S. Narrative review: lack of evidence for recommended low-density lipoprotein treatment targets: a solvable problem. Ann Intern Med. 2006 Oct 3;145(7):520-30. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17015870
  6. LDL Cholesterol, Direct Laboratory Test Directory ARUP: http://www.aruplab.com/guides/ug/tests/0020257.jsp
  7. Panel of 6 tests Laboratory Test Directory ARUP: http://www.aruplab.com/guides/ug/tests/0020421.jsp
  8. Panel of 6 tests Laboratory Test Directory ARUP: http://www.aruplab.com/guides/ug/tests/0020468.jsp
  9. Panel of 6 tests Laboratory Test Directory ARUP: http://www.aruplab.com/guides/ug/tests/0050021.jsp
  10. 10.0 10.1 Panel of 7 tests Laboratory Test Directory ARUP: http://www.aruplab.com/guides/ug/tests/0080503.jsp
  11. Ding Q et al Permanent alteration of PCSK9 with in vivo CRISPR-Cas9 genome editing. Circ Res 2014 Jun 10 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24916110 <Internet> http://circres.ahajournals.org/content/early/2014/06/10/CIRCRESAHA.115.304351
  12. 12.0 12.1 The Myocardial Infarction Genetics Consortium Investigators Inactivating Mutations in NPC1L1 and Protection from Coronary Heart Disease. N Engl J Med. Nov 12, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25390462 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1405386
  13. 13.0 13.1 13.2 Watson KE How Many Patients with Severe Hypercholesterolemia Have FH? NEJM Journal Watch. April 19, 2016 Massachusetts Medical Society (subscription needed) http://www.jwatch.org
  14. 14.0 14.1 White J, Swerdlow DI, Preiss D et al. Association of lipid fractions with risks for coronary artery disease and diabetes. JAMA Cardiol 2016 Aug 3 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27487401
  15. 15.0 15.1 Ravnskov U, Diamond DM, Hama R et al Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review. BMJ Open. 2016 Jun 12;6(6):e010401. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27292972 Free PMC Article <Internet> http://bmjopen.bmj.com/content/6/6/e010401.full
  16. 16.0 16.1 16.2 Shin S et al. Impact of intensive LDL cholesterol lowering on coronary artery atherosclerosis progression: A serial CT angiography study. JACC Cardiovasc Imaging 2016 Oct 19; PMID: https://www.ncbi.nlm.nih.gov/pubmed/27771404
    Ahmadi A, Narula J. Primary and secondary prevention, or subclinical and clinical atherosclerosis. JACC Cardiovasc Imaging 2016 Oct 19; PMID: https://www.ncbi.nlm.nih.gov/pubmed/27771400
  17. 17.0 17.1 Martin SS, Giugliano RP, Murphy SA et al Comparison of Low-density Lipoprotein Cholesterol Assessment by Martin/Hopkins Estimation, Friedewald Estimation, and Preparative Ultracentrifugation. Insights From the FOURIER Trial. JAMA Cardiol. Published online June 13, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29898218 https://jamanetwork.com/journals/jamacardiology/fullarticle/2684503
    Stone NJ Measuring Low-Density Lipoprotein Cholesterol. When Is More Accurate Better? JAMA Cardiol. Published online June 13, 2018. https://jamanetwork.com/journals/jamacardiology/fullarticle/2684505
  18. 18.0 18.1 18.2 Sabatine MS, Wiviott SD, Im K et al Efficacy and Safety of Further Lowering of Low-Density Lipoprotein Cholesterol in Patients Starting With Very Low Levels. A Meta-analysis. JAMA Cardiol. Published online August 1, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30073316 https://jamanetwork.com/journals/jamacardiology/fullarticle/2695047
    Gotto AM Jr Low-Density Lipoprotein Cholesterol and Cardiovascular Risk Reduction. How Low Is Low Enough Without Causing Harm? JAMA Cardiol. Published online August 1, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30073330 https://jamanetwork.com/journals/jamacardiology/article-abstract/2695045
  19. 19.0 19.1 Abdullah SM, Defina LF, Leonard D et al Long-Term Association of Low-Density Lipoprotein Cholesterol With Cardiovascular Mortality in Individuals at Low 10-Year Risk of Atherosclerotic Cardiovascular Disease. Results From the Cooper Center Longitudinal Study. Circulation. Aug 16, 2018 Not indexed in PubMed https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.034273
    Virani SS, Ballantyne CM Low-Density Lipoprotein Cholesterol. Circulation. Aug 16, 2018 Not indexed in PubMed https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.034922
  20. 20.0 20.1 Grundy SM, Stone NJ, Bailey AL 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 Nov 3. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30423391
    Grundy SM, Stone NJ, Bailey AL et al. AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018 Nov 8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30423393 https://www.sciencedirect.com/science/article/pii/S073510971839034X
  21. 21.0 21.1 Nanna MG, Navar AM, Wojdyla D, Peterson ED. The association between low-density lipoprotein cholesterol and incident atherosclerotic cardiovascular disease in older adults: Results from the National Institutes of Health pooled cohorts. J Am Geriatr Soc 2019 Dec; 67:2560 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31411740 https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16123
  22. Pooled Cohort Risk Assessment Equations. Predicts 10-year risk for a first atherosclerotic cardiovascular disease (ASCVD) event. ClinCalc.com http://clincalc.com/cardiology/ascvd/pooledcohort.aspx
  23. 23.0 23.1 Maihofer AX, Shadyab AH, Wild RA, LaCroix AZ. Associations between serum levels of cholesterol and survival to age 90 in postmenopausal women. J Am Geriatr Soc 2020 Feb; 68:288 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31930739 https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16306
  24. 24.0 24.1 24.2 Sittiwet C. Simonen P. Gylling H, Strandberg TE Mortality and Cholesterol Metabolism in Subjects Aged 75 Years and Older: The Helsinki Businessmen Study. J Am Geriatr Soc. 2020 Feb;68(2):281-287. Epub 2020 Jan 13. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31930737 https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.16305
  25. 25.0 25.1 Mortensen MB, Nordestgaard BG. Elevated LDL cholesterol and increased risk of myocardial infarction and atherosclerotic cardiovascular disease in individuals aged 70-100 years: A contemporary primary prevention cohort. Lancet 2020 Nov 21; 396:1644. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33186534 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32233-9/fulltext
    Gencer B et al Efficacy and safety of lowering LDL cholesterol in older patients: a systematic review and meta-analysis of randomised controlled trials. Lancet. 2020. Nov 10 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33186535 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32332-1/fulltext
    Raal FJ, Mohamed F. Never too old to benefit from lipid-lowering treatment. Lancet 2020 Nov 21; 396:1608 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33186536 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32333-3/fulltext
  26. 26.0 26.1 26.2 Johannesen CDL et al. Association between low density lipoprotein and all cause and cause specific mortality in Denmark: Prospective cohort study. BMJ 2020 Dec 8; 371:m4266 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33293274 PMCID: PMC7722479 Free PMC article https://www.bmj.com/content/371/bmj.m4266
  27. Arigi EA High LDL-C Bad for CAD but Good for CKD? Optimal Range Proposed. Medscape. 2022. March 17 https://www.medscape.com/viewarticle/970468 (Paper retracted by authors)
  28. 28.0 28.1 Goldstein LB, Toth PP, Dearborn-Tomazos JL et al Aggressive LDL-C Lowering and the Brain: Impact on Risk for Dementia and Hemorrhagic Stroke: A Scientific Statement From the American Heart Association. Arterioscler Thromb Vasc Biol. 2023;43. Sept 14. https://www.ahajournals.org/doi/abs/10.1161/ATV.0000000000000164

Patient information

LDL & VLDL cholesterol in serum patient information