Lipids Testing
Screening measures for clinical dyslipidemia can be performed in a non-fasting state. However, if the total cholesterol is > 240 mg/dl, or the HDL is < 35, a new blood draw and retesting are required in a fasting state.
Some values are measured, while others are calculated. LDL cholesterol and HDL is calculated. by dividing triglycerides by 5, which provides the VLDL level. Then the VLDL is subtracted from the HDL to get the LDL. This calculation works for everyone except for patients with dysbetalipoproteinemia, due to its extreme high levels of triglycerides over 400 mg/dl. It is important to note that when ordering blood tests for lipids, exercise and diet will decrease LDL cholesterol.
Normal Distribution for Plasma Lipids and Lipoprotein Cholesterol
| Age | Cholesterol mg/dl | Triglycerides mg/dl | VLDL mg/dl | LDL mg/dl |
HDL mg/dl Male | HDL mg/dl Female |
| 0-19 | under 180 | 10-140 | 5-25 | 50-170 | 30-65 | 30-70 |
| 20-29 | under 200 | 10-140 | 5-25 | 60-170 | 35-70 | 35-75 |
| 30-39 | under 220 | 10-150 | 5-35 | 70-190 | 30-65 | 35-80 |
| 40-49 | under 240 | 10-160 | 5-35 | 80-190 | 30-65 | 40-95 |
| 50-59 | under 240 | 10-190 | 10-40 | 10-40 | 30-65 | 35-85 |
Risk Levels and Factors
The National Institutes for Health in the United States has developed a public screening guide to risk levels and risk factors for total cholesterol levels, as well as goals for HDL- and LDL-cholesterol. It examines 100 risk factors, including diabetes, LDL, HDL, smoking, lack of exercise, estrogen use, obesity, age, family history, hypertension, and gender. HDL under 30 mg/dl, smoking more than 10 cigarettes a day, blood sugar over 126 in a fasting state are all considered significant risk factors.
Risk Levels
Total cholesterol of 240 mg/dl or higher: A person found to have a total cholesterol level 240 mg/dl or higher should undergo further evaluation and further lipo-protein analysis, regardless of other risk factors.
HDL-cholesterol less than 35 mg/dl: A person found to have an HDL-cholesterol level less than 35 mg/dL should undergo further evaluation and further lipo-protein analysis, regardless of other risk factors.
Total cholesterol between 200 and 239 mg/dl: A person with total cholesterol between 200 and 239 mg d/l with two or more risk factors should be referred to further medical care. The value of good nutrition and regular physical activity should be reinforced.
Total cholesterol below 200 mg/dl: A person with total cholesterol below 200 mg/dL should undergo a regular cholesterol check every 5 years. The potential benefits of healthy eating habits, weight reduction (if overweight), and regular physical activity should be emphasized.
Risk Factors
- Coronary heart disease
- Heart attack (myocardial infarction)
- Angina pectoris
- Coronary bypass surgery
- Abdominal aortic aneurysm
- Blockage of arteries to legs
- Transient ischemic attacks
- Blockage of carotid artery
- Cigarette smoking
- High Blood pressure
- Diabetes
- Heart attack of first-degree relative (mother, fathers, siblings) – if a male before age 55 or female before age 65
- Male 45 years or over
- Female 55 years or over
