Lipoprotein measurements are pivotal in the management of patients at risk for atherosclerotic
coronary heart disease (CHD) with
myocardial infarction and coronary death as the main outcomes, and for atherosclerotic
cardiovascular disease (ASCVD), which includes CHD and
stroke. Recent developments and changes in guidelines affect optimization of using
lipid measures as cardiovascular
biomarkers. This scientific statement reviews the pre-analytical, analytical, post-analytical, and clinical aspects of
lipoprotein measurements. Highlights include the following: i) It is acceptable to screen with nonfasting
lipids. ii) non-
high-density lipoprotein HDL-cholesterol (non-HDL-C) is measured reliably in either the fasting or the nonfasting state and can effectively guide ASCVD prevention. iii)
low density lipoprotein cholesterol (
LDL-C) can be estimated from total
cholesterol,
high density lipoprotein cholesterol (HDL-C), and
triglyceride (TG) measurements. For patients with
LDL-C>100 mg/dL and TG ≤150 mg/dL it is reasonable to use the Friedewald formula. However, for those with TG 150-400 mg/dL the Friedewald formula for
LDL-C estimation is less accurate. The Martin/Hopkins method is recommended for
LDL-C estimation throughout the range of
LDL-C levels and up to TG levels of 399 mg/dL. For TG levels ≥400 mg/dL
LDL-C estimating equations are currently not recommended and newer methods are being evaluated. iv) When
LDL-C or TG screening results are abnormal the clinician should consider obtaining fasting
lipids. v) Advanced
lipoprotein tests using
apolipoprotein B (
apoB),
LDL Particle Number (
LDL-P) or remnant
cholesterol may help to guide therapeutic decisions in select patients, but data are limited for patients already on
lipid lowering
therapy with low
LDL-C levels. Better harmonization of advanced
lipid measurement methods is needed.
Lipid measurements are recommended 4-12 weeks after a change in
lipid treatment.
Lipid laboratory reports should denote desirable values and specifically identify extremely elevated
LDL-C levels (≥190 mg/dL at any age or ≥160 mg/dL in children) as severe
hypercholesterolemia. Potentially actionable abnormal
lipid test results, including fasting
triglycerides (TG) ≥500 mg/dL, should be reported as
hypertriglyceridemia. Appropriate use and reporting of
lipid tests should improve their utility in the management of persons at high risk for ASCVD events.