Antipyretics for children are prescribed by a pediatrician. But there are emergency situations with fever when the child needs to be given medicine immediately. Then the parents take responsibility and use antipyretic drugs. What is allowed to be given to infants? How can you lower the temperature in older children? What medications are the safest?
Lipidogram - what kind of blood test is this?
A lipidogram is a comprehensive biochemical blood test that determines its lipid profile (status/spectrum). That is, all levels (quantities) of fats/lipids in the composition of various blood fractions (in particular, in the structure of lipoproteins). As a rule, it is prescribed by treating specialists (cardiologists, therapists or doctors general practice) for adequate assessment of the risks of developing CVD (cardiovascular diseases of atherosclerotic origin/origin). In addition, a lipid profile allows you to identify and evaluate atherogenicity, that is, the body’s tendency to. For example, when there is suspicion (of this disease), but total cholesterol levels (respectively, in a general blood test / finger prick) are normal.
Foreign synonyms/names: Coronary Risk Panel, Lipid Profile, Fasting Lipid Panel, Non-fasting Lipid Panel, Cholesterol Panel, Lipid Test.
Lipid profile - main indicators
Some lipid profile indicators are determined directly (using special laboratory equipment), others - by the usual/calculated method (using medical formulas). Next, we will consider the main indicators of both our (domestic) laboratories and foreign ones (in case of treatment of cardiovascular diseases abroad).
Total Cholesterol (Blood Cholesterol)– total amount of cholesterol (in all its fractions / lipoprotein particles: cholesterol + apoproteins). Determined - directly.
HDL cholesterol (HDL-C)– quantity (High-density Lipoprotein Cholesterol). It is called “good” cholesterol, because it “collects” excess “bad” cholesterol in the blood and transports it back to the liver (for processing or removal from the body through the gastrointestinal tract). Determined - directly.
LDL cholesterol (LDL-C)– concentration (Low-Density Lipoprotein Cholesterol). It is usually called conditionally “bad” cholesterol. Since, being in excess, it is able to be deposited in the walls blood vessels (see video below), forming "cholesterol/atherosclerotic plaques".
As a rule, (in many of our and foreign clinical laboratories) its quantity is determined by a calculation method (using the Friedwald formula, developed in 1972). By the way, at the same time with the concentration of VLDL cholesterol in the blood. Using the indicators of the so-called “classical” lipid profile: total cholesterol, HDL cholesterol and triglycerides (TG).
- LDL cholesterol (mg/dl) = total cholesterol – HDL cholesterol – (TG/5)*
- LDL cholesterol (mmol/l) = total cholesterol – HDL cholesterol – (TG/2.2)*
* – this is, after all, VLDL cholesterol.
IMPORTANT NOTE: This calculation method is NOT (!) used by laboratories if the triglyceride level is more than 4.5 mmol/l (400 mg/dl).
Triglycerides (Triglycerides/TG/TRIG)– level in all lipoprotein particles, most of which are found in VLDL particles.
VLDL cholesterol (VLDL-C)– the amount of Cholesterol in Very Low-Density Lipoprotein Cholesterol. As a rule, it is almost always determined by the Friedwald formula (listed above): Triglycerides (TRIG) / 5 (or 2.2). That is, simply put, by dividing the total amount of TG (TG) by 5 (for results in mg/dL) or by 2.2 (for results in mmol/L).
Atherogenicity coefficient (index) (CA/IA)– this is the ratio of “bad” cholesterol to “good” cholesterol. It is used by both our doctors and foreign ones, only by calculation - according to (slightly) different formulas, although, in essence, the same:
- KA (IA) = (Total cholesterol - HDL cholesterol) / HDL cholesterol
- KA (foreign) = Non-HDL-C / HDL-C
Foreign lipid profile
And now the indicators of foreign lipid profiles. They list almost everything the same. With the exception of…
Non-HDL-C (non-HDL cholesterol)– that is, everything that is NOT HDL cholesterol.
Non-HDL-C = Total Cholesterol – HDL-C or
Non-HDL cholesterol = Total cholesterol – HDL cholesterol
Until 2013, it was used for the (usual) calculation of the atherogenicity coefficient, until new recommendations appeared (from the American Academy of Heart). However, it is still used to decipher “planned” lipid profiles (in healthy men and women) every 4-6 years. It is also indicated in the results of the lipid profile of adolescents/boys and girls, as a rule, donating blood without fasting/not on an empty stomach (9-12 hours before the test).
Cholesterol/HDL ratio– according to new recommendations (American Academy of Heart / American Heart Association), doctors now use not the ratio of “bad” cholesterol to “good”, but the ratio of “total/absolute” (still) “good”. To put it very simply and easily. That is, TC: HDL cholesterol.
When is a lipid profile prescribed?
For healthy/adult women and men (i.e. without any risk factors for cardiovascular disease) it is recommended to undergo a lipid profile (fasting) every 4-6 years (after reaching 20 years of age). In addition, it must be appointed if, based on the results of the annual biochemical analysis blood (for health monitoring purposes) a “high” Total Cholesterol was detected. That is, from 6.22 mmol/l (240 mg/dl) and above. Or “borderline/high” (at the discretion of the doctor) in the range: from 5.18 to 6.18 mmol/l (200-239 mg/dl).
For adult women and men who already have RISK FACTORS for the development of CVD of atherogenic origin ( they are listed below ), or elevated cholesterol levels (based on the results of a previous comprehensive study of the lipid profile / blood spectrum), a lipid profile may be prescribed more often (at the discretion of the treating specialist).
Seals in the walls of blood vessels, caused by the formation (and growth) of so-called “cholesterol plaques,” seriously interfere with blood circulation. Thus, provoking the development of vascular diseases...
Atherogenic RISK FACTORS for the development of CVD (cardiovascular diseases) according to the NCEP (National Cholesterol Research Program) recommendations of 2002 include:
- smoking (interestingly, both active and excessive - passive);
- overweight / BMI of 25 or more (or obesity / BMI of 30 or more);
- “unhealthy” diet (what is bad and good, see;
- physical inactivity (sedentary lifestyle/sedentary work);
- age (when men reach 45 years old or women reach 50-55 years old);
- hypertension (increased arterial pressure from 140/90 mm. rt. Art. and higher);
- family history of premature CVD cardiovascular diseases (heart attacks/heart attacks in the father before the age of 55 years or in the mother under the age of 65 years);
- heart failure syndrome (CHS), as well as previous myocardial infarction or stroke;
- diabetes or pre/diabetes.
NOTE: HDL cholesterol levels: 60 mg/dL (1.55 mmol/L) and above are considered a “negative risk factor” according to the same NCEP recommendations. This allows us to exclude from the total one of the above/listed atherogenic factors.
- mandatory - gender (male or female);
- race (Mongoloid, African-American, etc.);
- and the so-called “Aspirin Therapy” (daily aspirin therapy), necessary for almost all men and women aged 50-60 years (depending on health status, and, of course, the absence of problems with blood clotting).
For children/teenagers, boys and girls , according to the recommendations of the AAP (American Academy of Pediatrics), a regular lipid profile (for preventive purposes) is prescribed:
- for the first time - for children in the transitional period of life: 9-11 years old (entry into adolescence);
- and one more time - for boys and girls aged 17 to 21 years.
Early (between 2 and 8 years of age) or more frequent testing lipid spectrum blood tests are recommended for children/adolescents/young men and women at increased risk of developing heart disease. Some of which are similar to adult atherogenic factors: family history of CVD, diabetes, high blood pressure, overweight/obesity, etc. For children under 2 years of age, a lipid profile is NEVER prescribed!
A biochemical analysis of the blood lipid profile can be prescribed even for children aged 2 to 9 years...
And finally, another case when doctors necessarily prescribe an extended/biochemical analysis of the lipid profile/blood spectrum is to monitor the effectiveness of the treatment they have prescribed. Either by lifestyle changes, a special diet and exercise therapy (physical therapy), or lipid-lowering medications, for example. Using last option treatment – you will be prescribed a repeat lipid profile in 4-12 weeks(since the start of drug therapy). And then - through every 3-12 months.
Proper preparation for a blood test
As a rule, a biochemical analysis of the blood lipid profile (spectrum) is taken on an empty stomach. However, at the discretion of the physician (especially for young people without the risk factors for cardiovascular disease listed above), this test can be performed without fasting. That is, without prior fasting 9-12 hours before donating venous blood. Immediately before the lipid profile (30-40 minutes) it is not recommended to: smoke and over/exert yourself (both physically and emotionally). In most laboratories, before drawing blood (from a vein), the person is allowed to sit in peace and quiet for at least 5 minutes.
What can negatively affect the results of a lipid profile, distorting its truthfulness?
- taking medications (read them), both lowering and increasing the levels of Total Cholesterol, HDL, LDL and triglycerides (directly or indirectly);
- equally, reception food additives, oral contraceptives or “sports” steroids, both lowering and increasing lipid levels;
- incorrect body position during venous blood sampling (for example, half/standing, half/sitting or lying), the test is taken while sitting;
- the presence of concomitant diseases (either still hidden, or advanced, or occurring without adequate treatment);
- “stormy holidays” the day before (with excessive consumption alcoholic drinks and/or fatty/fried foods);
- intense physical activity (most often, this happens to athletes during preparation for important competitions);
- following a diet that is too “strict” (even to the point of anorexia syndrome);
- prolonged stay in a stressful state (after divorce, accidents, accidents/disasters or other troubles in life);
- a study of the lipid profile / blood spectrum should never (!) be carried out - immediately after a myocardial infarction, as well as for another 3 months after it;
- taking a lipid profile during pregnancy (this blood test is prescribed to women at least 6 weeks after the birth of the child).
Explanation of lipid profile results (in tables)
Next, we invite you to familiarize yourself with what the results of a biochemical analysis for the lipid profile / blood spectrum mean, separately (in tables) for all its indicators. At the same time, both ours / domestic (TC, HDL, LDL, Triglycerides, Atherogenicity Coefficient / Index) and foreign (non-HDL cholesterol / non-HDL-C).
LDL cholesterol (low density lipoprotein cholesterol / LDL-C)
| Decoding the results | LDL cholesterol (mmol/l) | LDL-C (mg/dL) |
|---|---|---|
| optimal values (for women and men): | less than 2.59 | below 100 |
| for patients with such diseases, such as diabetes mellitus (type II) or CVD (atherosclerotic origin) are normal indicators: | less than 1.81 | below 70 |
| levels close to optimal: | 2,59 - 3,34 | 100-129 |
| borderline/high level: | 3,37 - 4,12 | 130 - 159 |
| high performance: | 4,15 - 4,90 | 160 - 189 |
| very high level: | more than 4.90 | over 190 |
Total cholesterol (CS / Cholesterol total)
HDL cholesterol (high density lipoprotein cholesterol/HDL-C)
| Decoding the results | HDL cholesterol (mmol/l) | HDL-C (mg/dL) |
|---|---|---|
| low level (increased risks) | less than 1.0 (for men) less than 1.3 (for women) | below 40 (for men) below 50 (for women) |
| boundary values (medium risks) | 1.0 - 1.3 (for men) 1.3 - 1.5 (for women) | 40 - 50 (for men) 50 - 59 (for women) |
| excellent level (“negative” risk factor; "longevity syndrome") | over 1.55 | more than 60 |
| too high rate (possibly hyper-alpha lipoproteinemia) | over 2.1 | more than 80 |
| dangerous values (according to the results latest research) | over 3.0 (for men) over 3.5 (women) | over 115 (for men) more than 135 (for women) |
Triglycerides (TG, TAG / TRIG) fasting blood test
| Decoding the results | TG / TAG (mmol/l) | TRIG (mg/dl) |
|---|---|---|
| optimal indicator | less than 1.7 | below 150 |
| borderline / high | 1,7 - 2,2 | 150 - 199 |
| increased values | 2,3 - 5,6 | 200 - 499 |
| very high level | over 5.6 | more than 500 |
For information on how , and what it means for a person (or vice versa -) - click on the links. There is one for women.
Atherogenicity coefficient (index)
Reference values of the atherogenic index (for adult men and women of age) based on lipid profile results are in the range from 2.0 to 3.5. High performance: over 3.0– for women (up to 55 - 60 years old) or more than 4.0– for men (up to 45 - 55 years of age) who do not suffer from coronary artery disease, they can indicate to the treating specialist (doctor) the presence of atherosclerosis. Although, for a more accurate assessment of the risks of developing atherosclerotic cardiovascular diseases, it is necessary to take into account all other FACTORS (which we described above).
non-HDL-C (not HDL cholesterol)
It is used abroad and represents the total amount of cholesterol in lipoproteins with the exception of high-density lipoprotein cholesterol, i.e. HDL cholesterol. Determined (based on the results of a lipid profile) by subtracting HDL cholesterol from total cholesterol using the formula:
non-HDL-C = Total cholesterol (TC) – HDL cholesterol (HDL-C)
| Decoding the results | non-HDL cholesterol (mmol/l) | non-HDL-C (mg/dL) |
|---|---|---|
| optimal values | less than 3.37 | below 130 |
| acceptable indicators | 3,37 - 4,12 | 130 - 159 |
| high/borderline level | 4,15 - 4,90 | 160 - 189 |
| increased values | 4,90 - 5,70 | 190 - 219 |
| very high levels | over 5.7 | more than 220 |
What to do if lipid levels are higher or lower than normal?
Condition #1 for solving lipid problems is healthy image life! And if you have it wrong, then this “matter” needs to be urgently – radically changed! First of all, quit smoking (if you like to smoke, for example, in order to think normally), and do not look for “truth in wine.” Avoid foods high in saturated (and trans) fat. Examine your heart and blood pressure, and then take moderate exercise. Just always start small - with regular walks in the fresh air and “simplified” morning exercises. Be sure to find a dietitian to tailor a diet specifically for your situation (according to lipid levels). Do not follow diet “recipes” described by dubious “specialists”.
And finally, as a last resort, go to the clinic, who can prescribe you drug therapy. As a rule, after assessing the risks of developing atherosclerotic CVD, as well as taking into account borderline or high levels of LDL cholesterol in the blood plasma. At the moment, there are already quite a lot of such drugs that normalize lipid levels (check them out). If any of the drugs (according to the results of a repeated lipid profile) does not sufficiently reduce the concentration of “bad” cholesterol or provokes side effects, then the treating specialist will replace it with something else. Just don’t self-medicate! Most lipid-lowering drugs (for example,) have many conditions for use!
Thank you
The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!
What is a lipid profile?
Lipidogram is an analysis that evaluates lipid ( fatty) metabolism in the body. This analysis typically includes cholesterol and three types of lipoproteins. Also, a lipid profile allows you to identify the atherogenicity coefficient and, thus, assess the level of risk of certain diseases. The lipid profile is based on both the processes of fat metabolism in the human body and the state of the body as a whole. Thus, when fats come with food, they are subject to digestion and absorption. However, these processes already depend on the condition of the mucous membrane, on the presence of the necessary elements of vitamins and coenzymes in the body.
Thus, fat metabolism consists of several interrelated processes occurring in the body.
The following stages of fat metabolism in the body are distinguished:
- taken with food;
- breakdown of fats into smaller components;
- digestion of incoming fats, mainly with the help of bile acids;
- absorption of fats at the level of the intestinal mucosa;
- transport with blood to liver cells;
- synthesis of fatty acids ( lipogenesis);
- metabolism of triglycerides, phospholipids;
- breakdown of fats ( lipolysis).
What are lipids?
Lipids- These are substances of different chemical structure, popularly often simply called fats. They tend to form various compounds with proteins ( in the form of lipoproteins) and carbohydrates. Lipids, also known as fats, are highly soluble in other fatty solvents ( broadcasts), they do not dissolve well in water.It is incorrect to assume that fats and fatty acids pose a threat to humans. Lipids and their compounds ( esters, lipoproteins) are vital for the body. Along with other structural elements ( proteins and carbohydrates) they perform a number of structural and regulatory functions. The main one is structural, since fats are essential components of cell membranes. Lipids are also used for the synthesis of various biologically active substances - hormones, vitamins, bile acids, prostaglandins ( neurotransmitter involved in inflammation processes).
The main functions of lipids include:
- Structural. Fats ( namely cholesterol) are an integral part of cell membranes. The highest concentration of cholesterol is found in nerve cells, that is, neurons. So, cholesterol is a basic element nerve endings (myelin sheath). A deficiency of cholesterol and other fats in nervous tissue leads to various neurological diseases, since neurons are not able to fully perform their functions without fats.
- Regulatory. Fats and fat complexes are part of steroid hormones and most vitamins. They also take an active part in the transmission of nerve impulses.
- Transport. Fats, in combination with proteins, form compounds called lipoproteins, which, in turn, transport various substances throughout the body.
- Protective. Almost every organ in the body ( mostly kidneys) is surrounded by adipose tissue. By forming a kind of fat pad, fats protect internal organs from external negative influences.
- Supportive. Adipose tissue forms the support of those organs that surround it, as well as the nerves and choroid plexuses.
- Energy. Fats are a source of energy in the body. In terms of the amount of energy generated, fats exceed carbohydrates by two times, and proteins by three times.
- Thermoregulatory. Body fats also form subcutaneous fatty tissue, which prevents the body from hypothermia.
- Trophic. Lipids take part in the absorption and assimilation of vitamins and other active substances.
- Reproductive. Fats play a major role in human reproductive function. Thus, they take part in the synthesis of sex hormones, in the absorption of vitamins and minerals, in the regulation hormonal levels.
- Aesthetic. Lipids take an active part in ensuring the elasticity of the skin, thus protecting the skin from excess moisture loss.
The human body is most adapted to seasonal rhythms. In areas with cold climates, the body uses fat reserves to more economically expend energy during the cold winter season. For some peoples, the accumulation of fat in winter has become an important protective device. Therefore, it is in winter that a person has the most pronounced fat anabolism ( higher body fat content), while in summer catabolism predominates ( minimum body fat content).
Impaired fat metabolism underlies many pathologies. In turn, these violations can be of a different nature.
The main causes of lipid metabolism disorders include:
- Nutritional ( food) deficit. In this case, initially there is a lack of lipids coming from food. Nutritional lipid deficiency can be due to rational reasons ( fasting, fasting), and due to a lack of essential fats in a particular region.
- Pathologies of the pancreas and liver. It is these two organs that take an active part in the absorption of fats. When they are damaged, insufficient absorption of lipids is observed, despite the fact that they are supplied sufficiently with food.
- Nutritional excess. Excessive intake of fat leads to excess accumulation of fat in organs and subcutaneous fat.
- Nutritional imbalance. It is observed when there is insufficient intake of carbohydrates with food. In this case, the energy function of carbohydrates is taken over by fatty acids. As a result, the production of keto acids increases. At the same time, with an excess of carbohydrates in the diet, lipids begin to be intensively deposited in the depot ( fatty tissue).
- Disturbance of intermediate lipid metabolism. From the moment fats enter the body with food until the synthesis of structural elements from them, a chain of complex reactions occurs. Violation at one of these stages ( for example, at the transport stage) leads to disruption at the level of the entire metabolism. The most significant disorders are observed in the absence of bile acids, which take an active part in the absorption of fats. Such disorders are most often recorded in liver diseases.
Decoding the lipid profile
A lipidogram is a variant of a biochemical blood test that evaluates disorders in the fat metabolic process. Prescribed for the purpose of diagnosing liver pathologies, heart diseases, and metabolic disorders. Also, lipid profile data are used to assess risk factors for myocardial infarction, arterial hypertension, and atherosclerosis. Lipid profile parameters include:
- cholesterol;
- LDL);
- very low density lipoproteins ( VLDL);
- HDL);
- triglycerides;
- atherogenic index.
Cholesterol in lipid profile
Cholesterol is the main and most commonly used component of the lipid profile. According to its chemical structure, cholesterol is an unsaturated alcohol and belongs to the group of steroids called sterols ( sterols).Cholesterol is found in almost every cell of the human body. It is part of cell membranes. Combining with phospholipids and proteins, it gives them selective permeability and also has a regulatory effect on the activity of cellular enzymes. In addition, cholesterol is present in the cytoplasm of the cell, where it is predominantly in a free state with fatty acids, forming small droplets - vacuoles. In blood plasma, cholesterol can be in a free state ( unesterified), and as part of lipoproteins ( esterified).
At the macroorganism level, cholesterol also performs several important functions. Thus, it is a source of synthesis of bile acids and steroid hormones ( androgens, estrogens, adrenal hormones). An intermediate product of cholesterol oxidation under the influence of sunlight in the skin is converted into vitamin D3. Thus, cholesterol also plays an important role in metabolism. In general, the physiological functions of cholesterol are very diverse. However, it is worth knowing that cholesterol is present exclusively in animal fats, but not in vegetable fats.
The problem of high cholesterol is acute in modern society. This is explained, first of all, by active urbanization - the dominance of fast food, a sedentary lifestyle, an unbalanced diet, and the presence of concomitant metabolic pathologies. Taking these factors into account, the World Health Organization ( WHO) a scale was developed for each lipid profile indicator, reflecting the danger of each level.
Reference values for total cholesterol according to WHO recommendations include:
- optimal value– no more than 5.15 millimoles per liter;
- borderline value– from 5.15 to 6.18 millimoles per liter;
- high value– more than 6.2 millimoles per liter.
Lipoproteins
Lipoproteins are complex compounds lipids and proteins. Since lipids themselves are insoluble compounds, they combine with proteins for transport in the blood serum. Based on the hydrated density, the lipidogram reveals three types of lipoproteins - low-density lipoproteins, very low-density lipoproteins and high-density lipoproteins. The level of lipoproteins in the blood is an important indicator. It reflects the development of the atherosclerotic process in the body, which, in turn, is taken into account when analyzing risk factors for coronary heart disease, arterial hypertension and diabetes mellitus.The constituent acids of lipoproteins include:
- myristic fatty acid;
- palmitic fatty acid;
- stearic fatty acid;
- oleic fatty acid;
- linoleic fatty acid;
- linolenic fatty acid.
Low density lipoproteins ( LDL)
Low-density lipoproteins are synthesized in liver cells. Their main function is to transport triglycerides from the liver to the circulatory system. Therefore, they, along with very low density lipoproteins, are the main coefficient of atherogenicity. Normally, low-density and very low-density lipoproteins contain the majority of circulating cholesterol.Synthesis ( education) low and very low density lipoproteins occur in the liver. Then they are secreted into the bloodstream, from where they reach organs and tissues. By specifically binding to receptors, lipoproteins release cholesterol, which subsequently goes into the synthesis of membranes and other cellular structures.
Low and very low density lipoproteins are conventionally called “bad” lipoproteins. Being small in size, they easily penetrate the vascular endothelium, where they can subsequently be deposited. It is low-density lipoproteins that are a risk factor for the development of vascular atherosclerosis. Also, the level of lipoproteins directly affects the concentration of cholesterol in the blood.
Very low density lipoproteins ( VLDL)
Very low density lipoproteins are also atherogenic ( bad) lipoproteins. However, they contain no more than 10 percent cholesterol, while in low-density lipoproteins their concentration reaches 70 percent. They contain mostly triglycerides. Very low density lipoproteins are the precursors of low density lipoproteins. This means that they go to synthesize the “badest” lipoproteins.High density lipoproteins ( HDL)
High-density lipoproteins belong to the class of so-called “good” lipoproteins. Their main function is antiatherogenic, which means preventing the development of atherosclerosis. This happens due to the ability of this class of lipoproteins to remove cholesterol from blood vessels, organs and tissues. High-density lipoproteins remove cholesterol from blood vessels and transport it to the liver, where it is synthesized bile acids and bile.Triglycerides
Triglycerides are another lipid complex whose main function is energy. Thus, this class of lipids is the main source of energy in the body. However, at the same time, an increase in triglyceride concentrations leads to the development of cardiovascular diseases. In triglyceride metabolism, the main condition is the balance between the amount synthesized and consumed. If not all triglycerides are used for energy ( that is, they were burned), then the remainder goes to cholesterol synthesis or is stored in fat.The concentration of triglycerides per liter of blood plasma usually correlates with total cholesterol levels. This means that for various pathologies these indicators increase almost simultaneously. This is explained by the fact that both triglycerides and cholesterol are carried by the same lipoproteins. If there is an isolated increase in triglycerides, this may indicate that the person has recently consumed a large amount of fat in food.
Reference values for triglycerides according to WHO recommendations include:
- optimal value– no more than 1.7 millimoles per liter;
- borderline value– from 1.7 to 2.2 millimoles per liter;
- high value– from 2.3 to 5.6 millimoles per liter;
- extremely high value– more than 5.6 millimoles per liter.
Alanine aminotransferase ( ALAT)
Alanine aminotransferase is an active intracellular liver enzyme involved in numerous reactions. Belongs to the group of transaminases - the main function of which is the transfer of functional groups from one molecule to another. This enzyme is found in small quantities in muscles, myocardium, kidneys, and liver. Contains only small amounts in blood serum. In case of active destruction of liver cells ( cytolysis), the enzyme enters the blood in large quantities. Normally, an increase in transaminase activity is observed with protein diets or when eating foods rich in sucrose. However, as a rule, an increase in alanine aminotransferase is caused by pathological processes in the body and/or the use of certain drugs that have hepatotoxicity ( ability to destroy liver cells).High levels of alanine aminotransferase are predominantly characteristic of liver pathologies, while increased levels of aspartate aminotransferase are more characteristic of damage to the heart muscle.
TO medicines that cause an increase in alanine aminotransferase activity include:
- antidepressants from the group of monoamine oxidase inhibitors ( moclobemide);
- steroids;
Aspartate aminotransferase ( ASAT)
Aspartate aminotransferase ( ASAT) is also an endogenous intracellular liver enzyme involved in transamination reactions. The maximum activity of this enzyme is observed in nervous tissue, skeletal muscles, myocardium, and liver. An increase in the level of aspartate aminotransferase is observed in liver and cardiac pathologies, as well as in common diseases body.Pathologies that are accompanied by increased levels of aspartate aminotransferase include:
- tumor processes in the body;
- viral hepatitis;
- pulmonary tuberculosis and lymph nodes;
- acute period of myocardial infarction.
Coefficient ( index) atherogenicity
The atherogenic index or coefficient is the ratio of the difference in total cholesterol and high-density lipoproteins to the total amount of high-density lipoproteins. It can also be calculated as the ratio of the sum of low- and very low-density lipoproteins to high-density lipoproteins.In other words, the index is calculated using the following formula:
Atherogenic coefficient = (total cholesterol - high-density lipoproteins)/high-density lipoproteins.
Or,
Atherogenic coefficient = (low-density lipoproteins + very low-density lipoproteins)/high-density lipoproteins.
Normally, the atherogenic index varies from 2.2 to 3.5. As can be seen from the formula, the coefficient reflects the ratio between harmful and beneficial cholesterol. Calculation of this parameter helps to summarize the lipid profile and objectively assess risk factors. Simply the level of total cholesterol does not provide a complete assessment of lipid metabolism. This is explained by the fact that cholesterol itself is part of various compounds and is the same everywhere. Therefore, only the type of lipoprotein determines where cholesterol will go.
Lipid profile control
An increase in the atherogenicity coefficient of more than 3.5 indicates an increase in the amount of bad lipoproteins. This, in turn, indicates a greater likelihood of atherosclerosis. That is why today most clinicians use exclusively the atherogenic coefficient in the diagnosis of various diseases. Analysis of the atherogenic coefficient is recommended for all people over 20 years of age, at least once a year. This is explained by the fact that many treatment methods for an already formed atherosclerotic plaque are ineffective. Therefore, it is much more effective to start treatment at the stage of formation of atherosclerosis. It is worth noting that the formation of an atherosclerotic plaque lasts for years, which creates a large reserve for early detection.Normal lipid profile in men and women
The lipidogram, like most laboratory indicators, is characterized by its own age characteristics. Also, lipid profile indicators are characterized by differences by gender. Numerous metabolic disorders are characterized by an increase in “bad” blood lipoproteins and the atherogenic index, as well as a decrease in “good” ones. In order to diagnose lipid metabolism disorders, clear biochemical criteria are needed. It is also important to know that in more than 90 percent of individuals, hyperlipidemia is hereditary.
Therefore, the analysis of the lipid profile should occur in parallel with the analysis of risk factors - heredity, the presence of bad habits ( smoking) and concomitant diseases ( arterial hypertension).
Lipid profile norms by age
Index | Children | Women | Men |
Total Cholesterol |
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Triglycerides |
|
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Low-density lipoproteins (LDL) |
|
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Very low density lipoproteins (VLDL) |
|
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High density lipoproteins (HDL) |
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Deviations in lipid profile
When analyzing a lipid profile, it is very important to take into account the hormonal characteristics of females. Thus, it is known that in women before menopause the level of high-density lipoproteins ( good) higher than in men. Therefore, their risk of cardiovascular diseases in this period is lower than that of men. However, after menopause, there is a decrease in “good” lipoproteins and an increase in total cholesterol, resulting in an increased risk of cardiovascular disease.The main deviations in the lipid profile include:
- hyperlipidemia;
- hypolipemia;
- hypercholesterolemia;
- hypocholesteremia.
Pathologies that are accompanied by a constant elevated lipid content include:
- spicy and chronic diseases kidney;
- cirrhosis;
- hepatitis in the acute period;
- pathology of the pancreas.
Hypercholesterolemia is a phenomenon characterized by increased cholesterol levels ( more than 6.1 millimoles per liter). Just like the previous deviations, they may have a different nature. Cholesterol's chemical structure is a secondary monohydric aromatic alcohol. According to its functions, it is an indispensable component of cell membranes. Lack of cholesterol in nervous tissue leads to serious neurological and mental disorders.
In the blood, cholesterol is presented in several forms - in the form of lipoproteins ( mainly low and very low density), and also in a free state.
Hypercholesterolemia can also be of nutritional origin and observed after meals. However, the most common cause is a pathological increase in cholesterol.
Conditions that are accompanied by high blood cholesterol include:
- cholestasis – stagnation of bile;
- kidney pathologies – chronic renal failure, glomerulonephritis, nephrotic syndrome;
- malignant tumors of the pancreas;
- endocrine disorders, especially diabetes, hypothyroidism, vitamin B deficiency, obesity.
Pathologies characterized by a decrease in the concentration of cholesterol in the blood are:
- malabsorption syndrome ( impaired absorption);
- central lesion nervous system;
- chronic cardiovascular failure;
- hyperthyroidism ( increased function thyroid gland );
- acute infectious and purulent-inflammatory diseases;
- acute pancreatitis;
- prolonged fever;
- tuberculosis of the lungs and lymph nodes;
- sarcoidosis of the pulmonary system;
- anemia ( low hemoglobin and red blood cell levels);
- hemolytic jaundice;
- oncological diseases (more common with bowel cancer);
Why is a lipid profile done?
A lipid profile is a commonly ordered test. Any specialist can recommend it, since deviations in the lipid profile are characteristic of a wide variety of diseases. Thus, analysis of lipid metabolism is recommended for monitoring treatment, assessing risk factors for coronary heart disease, and also simply for screening for cardiovascular diseases. Situations when it is necessary to take a lipid profile include:
- Preventive examination of healthy people. World Health Organization ( WHO) recommends checking lipid levels for people over 20 years of age at least once every 5 years.
- Increased total cholesterol levels. The upper limit of normal for total cholesterol is an indication for a detailed analysis of lipid metabolism ( that is, for a lipid profile).
- Increased level history of cholesterol. If an elevated level of total cholesterol has previously been identified, it is recommended to take a lipid profile once every three months.
- Family history. It is the main indication for the active identification of risk factors for cardiovascular diseases. So, if at least one family member suffers from diabetes or arterial hypertension or he suffered a stroke, then it is recommended that all family members take a lipid profile once a quarter.
- Presence of risk factors. If the patient has been identified with risk factors for cardiovascular diseases, as well as metabolic pathologies, then this is an indication for regular monitoring of the lipid spectrum.
- Control of statin treatment. High concentrations of cholesterol and low-density lipoproteins are an indication for drug treatment. For this purpose, drugs called statins are prescribed. To evaluate the effect of statins, a lipid profile is done before and after treatment.
- Monitoring the effectiveness of a lipid-lowering diet. For high lipid levels, a special lipid-lowering diet is also recommended. Its effectiveness is also assessed using a lipid profile.
When is a lipid profile prescribed?
The main indication for a lipid profile is to assess the risk of cardiovascular diseases. Thus, high numbers of total cholesterol and its fraction ( lipoproteins) are one of the main risk factors for coronary heart disease and myocardial infarction. If other factors are associated with high cholesterol ( age associated with excess weight), then in this case it is necessary to adhere to special treatment tactics.Risk factors for cardiovascular diseases are:
- age over 45 years for men;
- age 55 for women;
- smoking;
- overweight;
- carbohydrate metabolism disorders - type 1 or type 2 diabetes mellitus;
- arterial hypertension - increased blood pressure more than 140 millimeters of mercury;
- history of stroke;
- previous myocardial infarction.
Preparation for a lipid profile
Like any other analysis, a lipid profile requires certain preparation. The main condition is to take the test on an empty stomach ( as, indeed, for most analyzes). It is also recommended to refrain from smoking at least half an hour before the test, since smoking strongly concentrates and “thickens” the blood. This, in turn, can lead to incorrect interpretation of the lipid profile.Conditions for preparing for a lipid profile are:
- refusal to eat for 12 hours before the test;
- quit smoking 30 minutes before the test;
- elimination of physical and emotional stress on the day of analysis.
Thus, in diabetes mellitus, due to impaired metabolism, a large amount of ketone bodies and cholesterol is synthesized. Therefore, this disease is most often characterized by hypercholesterolemia ( cholesterol level more than 6 millimoles per liter). Large titers of endogenous cholesterol are recorded in glomerulonephritis. This is explained by the fact that with this pathology there is an accelerated excretion of plasma protein. As a result, the viscosity and osmotic pressure of the blood are disrupted, which is reflected in the relative cholesterol levels.
The amount of triglycerides strongly depends on this indicator, their increase with various diseases happens simultaneously. This is due to the fact that these compounds are transported by the same lipoproteins. Triglyceride levels help determine whether the lipid test was performed correctly. If an increase in the amount of these substances is detected at normal cholesterol levels, the analysis is considered unreliable. This is observed when consuming fatty foods before donating blood.
Lipidogram for myocardial infarction ( THEM)
One of the most important values of a lipid profile is its use in assessing risk factors for cardiovascular pathology, and in particular in assessing the risk of myocardial infarction. At the same time, the concept of risk factors itself underlies the primary and secondary prevention of coronary heart disease. A thorough study of risk factors for coronary artery disease is necessary both to establish the cause of the disease and to develop stages of its prevention.The risk of myocardial infarction and its death is assessed using the SCORE system. The SCORE score is a questionnaire specifically designed to assess the risk of fatal cardiovascular disease ( myocardial infarction) for 10 years. This takes into account the lipid profile, age, gender, smoking and systolic blood pressure. Data ( systolic blood pressure, cholesterol) are entered into a calculator specially designed for this purpose. The figure obtained during the calculation represents the probability of death from myocardial infarction as a percentage. Further, if the amount received was less than 5 percent, then the patient belongs to the low-risk group. If the number is 5 or more, then the patient is included in the high-risk group. However, the risk group is also influenced by other signs. These include low levels of good lipoproteins, high cholesterol, associated obesity and a sedentary lifestyle.
Lipid profile indicators can be divided into three main risk groups. This interpretation is consistent with international recommendations.
Myocardial infarction risk level | Total cholesterol | High density lipoproteins ( HDL) | Low density lipoproteins ( LDL) | Triglycerides |
Low risk | less than 5.18 millimoles per liter | More than 1.55 millimoles per liter - for men and women. | 2.59 – 3.34 millimoles per liter | 1.7 – 2.2 millimoles per liter |
Medium risk | 5.18 - 6.18 millimoles per liter |
| 3.37 – 4.12 millimoles per liter | 2.3 – 5.6 millimoles per liter |
High risk | more than 6.22 millimoles per liter |
| 4.15 – 4.90 millimoles per liter | more than 5.6 millimoles per liter |
Stool lipid profile
A fecal lipid profile is a test to determine the concentration of fats ( lipids) in feces. In this case, the amount of triglycerides, phospholipids, and non-esterified fatty acids is determined. This test allows you to evaluate the function of the pancreas. It is known that the enzymes of this organ are directly involved in the absorption of fats. If there are no enzymes or there are not enough of them, then this is manifested by an increased fat content in the feces. Therefore, stool lipid profile data also helps diagnose pancreatic pathologies.However, the presence of fats in the lipid profile does not always indicate pathology. Sometimes they may be present due to increased intestinal motility. In this case, the food bolus quickly passes through the intestinal loops, as a result of which fats simply do not have time to be completely absorbed.
Normal stool lipid profile
Deviations from the above norms, as a rule, indicate a deficiency of certain enzymes and pancreatic pathology. The main cause of increased lipids in feces is a deficiency of the enzyme lipase. This is the main enzyme produced by the pancreas, whose function is to break down fats in the large intestine. Insufficient levels of this enzyme are a consequence of acute or chronic organ damage. These may be sharp and chronic pancreatitis, cysts, tumors, as well as the consequences of removing part of the pancreas ( resection). Special mention should be made of cystic fibrosis, which is accompanied by significant changes in the fecal lipid profile. Cystic fibrosis is a hereditary disease that affects all organs that secrete mucus, but mostly the pancreas.
In addition to pathology of the pancreas, pathologies of the liver and gall bladder may be the cause of increased lipid content in the stool. Lack of bile entering the intestines is one of the most common causes of indigestion of fats. This is explained by the fact that normally bile is involved in the breakdown of fats. Thus, it activates the lipase necessary for this, which breaks down the complex fat molecule into an emulsion. In an emulsified state, fats are maximally absorbed at the level of the intestinal mucosa. Thus, the lack or complete absence of bile leads to incomplete breakdown of fats, which, in turn, leads to their appearance in the feces.
Similar situations are observed with cholelithiasis, dyskinesia of the gallbladder.
The appearance of fats in stool can also be influenced by the condition of the lymphatic tract. Impairment of the patency of these paths ( which, fortunately, is rare), also leads to impaired absorption. A similar thing is observed with tumors of the lymph nodes, Whipple's disease, intestinal tuberculosis, as well as with other pathologies that are accompanied by damage to the lymph nodes.
Many patients in therapeutic and cardiology departments, and indeed older people in general, are prescribed an analysis called a “blood lipid profile”. But many doctors forget to explain what it is and what it includes. But this study clarifies how disturbed lipid metabolism is, and how it should be corrected: with diet, folk remedies, or the use of specific medications is already required.
Considering that the level of fat depends on individual characteristics, to decipher the analysis, a special table of norms for the entire lipid spectrum is used, both in women and men, taking into account their age.
Fats received from food or synthesized in the body perform their specific functions, and in some chemical reactions no substance can replace them. They are insoluble in the aqueous environment (which is blood, lymph, intracellular fluid), therefore they bind to proteins, forming lipoproteins.
These complex compounds contain the same lipid components, only each fat-protein complex contains them in its own percentage. These are triglycerides, phospholipids, cholesterol, its esters and fat-soluble vitamins (E and carotenoids). And the higher the concentration of fat, the less carrier protein, and the lower the density of the lipoprotein. It can be very low, intermediate, low and high.
A feature of the biochemistry of lipid metabolism is the gradual transition of one fraction to another after the cleavage or addition of the fatty component. It turns out that the result of a lipid profile shows at what stage the lipid balance was disturbed and how deep. Moreover, based on the study, doctors calculate the risk of development and dynamics of cardiovascular diseases, and monitor treatment.
In medicine there are several synonyms for analysis. In addition to the lipid profile, it is called “lipid profile” or “lipid status”, although its essence does not change. The hemotest includes determining the concentration of lipoproteins, the total cholesterol contained in them, triglycerides, and the extended test also includes the level of some carrier proteins.
Indications for analysis
Lipid metabolism disorders are just a condition of the body. It progresses slowly and imperceptibly. And the presence of an imbalance is often learned after the development of the independent pathology caused by it, primarily of the heart and blood vessels. And the first manifestations of dyslipidemia are nonspecific symptoms:
- drowsiness, lethargy, increased fatigue;
- nervous irritability;
- headaches (such as migraines);
- heaviness, discomfort, pain in the right hypochondrium.
In this situation, using a lipid profile, you can assess the level of risk of developing vascular atherosclerosis, cholelithiasis, hypertension, type II diabetes.
To more characteristic features lipid imbalances include deposits of cholesterol deposits under skin epidermis that occur with persistently elevated cholesterol levels. These are xanthomas, xanthelasmas, yellow rims around the cornea (lipoid arches). Their presence indicates an advanced disorder of lipid metabolism. With such changes in the skin, doctors usually prescribe a lipid profile.
The analysis of venous blood for a lipid profile also has clearly formulated absolute indications:
- hereditary dyslipidemia;
- hereditary predisposition to it;
- hypertension and secondary arterial hypertension;
- previous heart attack or stroke;
- diabetes;
- pathology of the thyroid gland with dysfunction;
- obesity;
- liver diseases with symptoms of blockage of the bile ducts;
- inflammation of the pancreas;
- renal pathology accompanied by failure;
- premenopausal and menopausal age;
- poor nutrition with uncontrolled consumption of animal fats, simple carbohydrates, fast food, physical inactivity, bad habits.
It is important to know that atherosclerosis, diabetes, hypertension, and obesity are not only the result of lipid balance disorders, but also contribute to its deterioration. Doctors call this process a vicious circle. Therefore, in case of the listed pathology, one study is not enough: regular monitoring of the state of fat metabolism is necessary. Periodically, blood is donated for lipid status even when therapy is started in order to know how adequate it is.
Lipid spectrum indicators: interpretation, norms and deviations
If the level of glucose, blood cells, and liver condition indicators are static and do not depend on gender, and in adults - on age, then lipid metabolism data change every 5 years. Moreover, not only the numbers change, but also the relationship between the factions. Which, in essence, plays a major role in assessing the patient’s condition.
Separately, it is worth mentioning the physiological change in reference lipid values that occurs after eating, physical and psychological stress, during pregnancy and in the first months of lactation. It is transient, lipid metabolism is restored on its own and does not require correction.
And now a little about each indicator.
Total cholesterol
This is the total value of all cholesterol contained in the blood. It is part of lipoproteins of different densities and does not circulate in free form. A simplified lipid profile only provides for the determination of total cholesterol. But a deviation from the norm informs doctors little about anything, because they need to know which fractions accounted for the change in lipid metabolism. But without it it is impossible to calculate the atherogenicity coefficient - the main indicator of the degree of risk of atherosclerotic vascular damage.
Depending on age, the range is between the lower and upper limit The norm is 2–3 mmol/l. The growth chart for total cholesterol differs between men and women:
- in males, the maximum concentration is observed during puberty, which is associated with an increased level of sex hormones, and with a decrease in hormonal levels it begins to fall;
- In females, total cholesterol levels increase gradually, and the older the woman, the higher they are.
The norms for total cholesterol depending on age and gender are presented below.
High density lipoproteins (HDL, HDL)
The density of lipoproteins depends on the amount of protein they contain: the more protein they contain, the denser they are. And since we are talking about high density, then these fat-protein complexes contain a lot of protein and little fat. They are formed as a result of the cleavage of lipids used for the needs of cells. Consequently, high-density lipoproteins are “waste” substances, which only have to return to the liver and transport the remaining lipids to it.
These residues, as a result of complex chemical processes, are converted into bile acids and excreted into gallbladder. Later, during meals, the gallbladder contracts, squeezing bile into the intestinal lumen. Here, bile acids break down the food bolus into absorbable elements, and themselves are destroyed.
It turns out that high-density lipoproteins help remove excess fat and cholesterol from the body. That is why they are called “good”. Consequently, the higher their level, the lower the risk of developing diseases caused by lipid metabolism disorders, and vice versa.
For analysis, the amount of cholesterol in the lipoprotein, and not the entire fat-protein complex, is of primary importance. Its normal HDL levels are summarized in the table.
Low-density lipoproteins (LDL, LDL)
But they are called “bad”. This is due to the fact that low-density lipoproteins make up the bulk of fat-protein complexes circulating in the blood. They transport cholesterol and small amounts of other fats from liver cells, where they are synthesized, to peripheral tissues. And unused LDL is deposited in the vascular walls in the form of atherosclerotic plaques.
A large concentration of “bad” lipoproteins sharply increases the risk of atherosclerosis. What it is? This is a narrowing of the lumen of the arteries, thrombosis, decreased elasticity of the walls, their increased fragility, stratification. The result is a disruption of tissue nutrition up to necrosis. Low concentration is also unfavorable. It threatens to disrupt the formation of steroid hormones, selective hypovitaminosis (A and D), slowdown of regeneration processes, and decreased mental abilities.
The optimal levels of LDL cholesterol can be found in the table.
Very low density lipoproteins (VLDL)
These are elementary primary particles synthesized by liver cells, which are the basis for the formation of LDL. They also partially enter the blood, but the percentage of cholesterol in them is low. VLDL are transporters of triglycerides, although they also play an important role in cholesterol metabolism. The ability of lipoproteins with very low density to penetrate the thickness of vascular walls is enhanced in diabetes and kidney pathology with insufficiency.
Average cholesterol values in VLDL range from 0.26 mmol/L to 1.04 mmol/L. Their consistently increased synthesis automatically leads to an increase in the concentration of LDL, which leads to the development of atherosclerosis.
Triglycerides
They are named so because their molecules contain 3 fatty acids. The lipid composition of different triglycerides varies, and they can include both saturated and unsaturated fats. Depending on the composition, TGs perform different functions: either they are used to build cell membranes, or they are deposited in tissues in the form of fat depots, the ultimate goal of which is to supply energy to chemical processes in the body.
Triglycerides come from food and are formed in tissues, transported as part of lipoproteins of different densities, therefore, their concentration also depends on age and gender. An increased level of triglycerides in the blood occurs immediately after eating, during pregnancy, and hyperlipidemia of any etiology. Reduced - indicates accelerated metabolic processes (thyrotoxicosis), impaired absorption (malabsorption syndrome, starvation) and synthesis (liver pathology).
Atherogenic coefficient (AC)
This is the indicator for which, in essence, a blood test for the lipid spectrum is carried out. It is calculated using the formula:
Normal values of the atherogenic coefficient are considered to be:
- up to 30 years – no higher than 2.5 for men and 2.2 for women;
- after 40 years of age - less than 3.5 for men and 3.2 for women.
The higher the coefficient, the more likely and faster atherosclerotic plaques form.
Additional indicators
To understand the biochemical reasons for the high atherogenicity coefficient, additional information about lipid metabolism is needed. These include determining the level of the main transport proteins. Therefore, the extended lipid profile includes indicators of apolipoprotein A1, B and (a).
1) Apo A1– a carrier protein in HDL, synthesized by the liver and intestinal epithelium. It activates the enzyme lipase, which catalyzes the breakdown of cholesterol, and thereby promotes its elimination. A decrease in the level of Apo A1 threatens intensive deposition of lipids and proteins in the vascular walls with the formation of atherosclerotic plaques. Conversely, the higher its concentration, the lower the risk of developing atherosclerosis. Reference values for apolipoprotein A1 are presented below.
2) Apolipoprotein B found in all fat-protein complexes, except high-density ones. Apo B-100 consists of hundreds of amino acids and is synthesized by liver cells. Its half version, Apo B-48, is produced by the intestinal epithelium. In addition to transport, apolipoproteins B perform the function of recognizing LDL by receptors in peripheral cells, and therefore contribute to their fixation on cytoplasmic membranes.
Clinical and laboratory research proved that the level of apolipoprotein B is even more reliable than the concentration of LDL in determining the degree of risk of developing atherosclerosis. Therefore, in advanced lipid profile analyses, an additional “atherogenic coefficient” is calculated - the ratio of the amount of Apo B to Apo A1. Normally, it should not exceed 0.9 for men and 0.8 for women.
What to do if test results are bad
It is unlikely that the patient will independently understand the causes and consequences of disorders of his own fat metabolism. Only a doctor can restore the altered lipid spectrum. Moreover, in deciphering a detailed lipid profile, not only the local therapist is involved, but also many specialized specialists: a cardiologist, an endocrinologist, a gastroenterologist. Methods of correction and treatment are selected in consultation with the involvement of a nutritionist and a physical therapy doctor.
- In the case of minor and moderate disorders without genetic damage, changes in diet and lifestyle, folk and homeopathic remedies may be sufficient to restore lipid balance.
- Severe dyslipidemia is treated comprehensively and over a long period of time, possibly for a lifetime. In addition to diet, moderate exercise, and giving up bad habits, specific therapy is prescribed with statins, fibrates, cholesterol absorption inhibitors, vitamins, and bile acid sequestrants.
Lipidogram (lipid spectrum analysis) - advanced method biochemical research, aimed at determining deviations in fat balance.
This is essentially a routine blood test. Based on its results, they look at what lipid metabolism disorders the patient has.
Lipid profile indicators allow you to evaluate all fatty components of the blood. If you look at the biochemical analysis result form, you can see that it already includes the total cholesterol indicator. However, biochemical data are not enough to objectively assess the state of lipid complexes.
To identify the risks of developing coronary atherosclerosis and other dangerous pathologies of the cardiovascular type, a full lipid spectrum analysis is performed. Only on the basis of its results is a medical conclusion formed about the presence or absence of abnormalities.
The object of study of the lipid spectrum in medicine is the following indicators: total cholesterol or cholesterol, triglycerides, lipoproteins of various densities.
This indicator is basic in assessing lipid metabolism and, in addition to the lipid profile, is also checked during a routine biochemical blood test. Total cholesterol (TC) or cholesterol (CS) is a component that is part of the cell membrane and is responsible for its structural and strength properties.
In addition, it is involved in digestion and plays a key role in metabolic processes and hormone synthesis. Cholesterol enters the body through food products exclusively of animal origin, or is produced by the body itself, mostly in the liver.
In blood plasma, this substance is in a free state or combined with complex proteins (lipoproteins). Depending on the density of fats contained in these proteins, separate types of lipoprotein fractions are distinguished.
High-density lipoproteins (HDL) have the ability to bind “bad” cholesterol, removing it from the general bloodstream and transporting it to liver cells for subsequent excretion in bile. The action of HDL is called antiatherogenic because they prevent the formation of atherosclerotic “plaques”.
The normal value of this indicator indicates that HDL performs its useful function - it protects blood vessels from being blocked by “bad” cholesterol and reduces the risk of developing lipid metabolism disorders.
Low density lipoproteins
Low-density lipoproteins (LDL or LDL) consist of 70% cholesterol and perform the function of transporting it. Their unfavorable effect lies in their ability to penetrate the walls of vessels of any diameter due to their small size.
By changing the structure of the vessel wall, they interfere with normal blood flow. Elevated LDL levels indicate a high likelihood of atherogenic arterial damage and lipid imbalance, while total cholesterol may remain normal.
There is another lipid profile indicator that is used to interpret the results - very low density lipoproteins (VLDL). This type of lipoprotein mainly consists of triglycerides, their function is to transport fat particles to peripheral organs immune system. They have an atherogenic effect, as they promote the deposition of lipids on the inside of the vascular wall.
Triglycerides
Triglycerides (TG) come from foods containing large amounts of animal fat. They are the main energy storage for cells and are mostly localized in fatty tissue. Despite their energy function, an increase in TG adversely affects the activity of the heart and blood vessels.
The amount of incoming TG must be completely spent on energy production, otherwise their excess accumulates in adipose tissue or is involved in the production of additional cholesterol.
Atherogenic coefficient
The atherogenic coefficient (AC) is calculated based on the obtained values for the main parameters of the lipid profile. The formula for its calculation is as follows: KA = (X – HDL)/LDL.
The value of the coefficient (normally 3-3.5) represents the ratio of atherogenic to non-atherogenic fractions. Its growth indicates an imbalance in fat metabolism. The higher the CA value, the higher the risk pathological changes caused by atherosclerotic damage to blood and lymphatic vessels.
How to prepare?
The results of a lipid profile will be reliable if the influence of external factors is minimized.
When preparing for analysis, there are a number of mandatory restrictions that should not be neglected:
- 24 hours before the test, it is forbidden to consume fatty foods and alcoholic drinks, and 4 hours before the test, refrain from smoking. The last meal is allowed at least 12 hours before the procedure. Drinking clean water is allowed.
- The day before the test, limit physical activity and emotional stress; during the procedure, also try not to be nervous and relax.
- If you feel physically and emotionally tired, reschedule the procedure a couple of days ahead.
- You should not adhere to a special lean diet before the examination; eat as you are used to.
- It is not recommended to take the test after radiography, rectoscopy (examination of the rectum), or physical therapy. In this case, you should postpone the examination for several weeks. Data will be unreliable for three months after a heart attack, injury or surgery.
- Be sure to tell your nurse and doctor about the medications you are taking, as some may significantly affect your results.
The results of the lipid profile will be different during pregnancy, during acute infectious diseases, chronic pathologies of the urinary system, diseases of the endocrine glands.
How is the analysis itself carried out?
The patient's venous blood is used for analysis. Blood donation takes place in the morning, on an empty stomach. The resulting serum is subjected to a centrifugation procedure, after which it is sent to the laboratory for detailed study.
Studying the biomaterial and preparing a conclusion takes no more than 24 hours. There is a special device - an express lipid profile (status) analyzer, with which you can carry out a shortened diagnosis in just 5 minutes.
For persons with a confirmed diagnosis of atherosclerosis, doctors recommend examining the lipid spectrum of the blood every six months.
Tables of normal indicators
The following data is considered to be the general norms for an adult:
It is important to remember that reference values will depend on the technical equipment of the laboratory. Minor deviations of the results from generally established standards are allowed.
In adult women and men
| Lipidogram indicator | Age, number of years | Norm, mmol/l | |
| Men | Women | ||
| Total cholesterol (cholesterol) | Up to 65 | 2,8 - 5,9 | |
| Over 65 | 3,6 - 7,1 | ||
| HDL | Up to 40 | 0,88 - 2,12 | |
| 40-60 | 0,72 - 1,84 | 0,96 - 2,35 | |
| Over 60 | 0,98 - 1,94 | 0,98 - 2,48 | |
| LDL | Up to 40 | 1,71 - 4,45 | 1,94 - 4,45 |
| 40 - 60 | 2,25 - 5,26 | 2,31 - 5,44 | |
| Over 60 | 2,15 - 5,44 | 2,59 - 5,8 | |
| Triglycerides | 20 - 40 | 1,7 - 2,25 | |
When deciphering the results of a lipid profile, you should pay attention to the person’s age. During reproductive age, HDL levels in women will be higher than in men. Consequently, the risk of developing atherosclerosis for women in this age period is minimal.
After the onset of menopause, hormonal changes occur in a woman’s body, as a result of which the concentration of “bad” cholesterol increases and the risk of atherosclerotic vascular damage significantly increases.
In children
Value standards for children will differ from those established for adults.
Increased cholesterol levels in children under 14 years of age are less common than in adolescence, young adulthood, or adulthood. However, in cases where a child has constantly high cholesterol and has a family history (close relatives of the child are diagnosed with hypercholesterolemia, coronary atherosclerosis, heart attack, stroke, etc.) a lipid profile is required.
It should be taken into account that until the age of two, this analysis is not informative, because At this time, there is an active process of formation and growth of tissues that need large amounts of fats absorbed from food.
During pregnancy
During pregnancy, changes occur in hormonal metabolism: on the one hand, sex hormones are intensively produced in a woman’s body, on the other hand, the production of the enzyme responsible for the breakdown of fats and their processing decreases.
This leads to an increase in cholesterol and LDL, their concentration during this period increases by 1.5-2 times. At the same time, the level of HDL is the same as the values established as the norm for non-pregnant women, and virtually does not change throughout the entire period of pregnancy.
The standards established for pregnant women include the following values:
- the level of total cholesterol should not exceed 6.5 mmol/l;
- the LDL norm is 1.9 – 5.5 mmol/l;
- HDL norm is 0.8 – 2.1 mmol/l;
- TG norm is 1.7 – 2.7 5 mmol/l.
Decoding the results
The results of a lipid profile should only be deciphered together with a doctor, since any deviations in its values from the norm are signs of possible disorders.
Increased performance
An elevated level of total cholesterol or hypercholesterolemia most often indicates a high risk of developing atherosclerosis in a patient. The reasons for this may be external or internal.
External reasons:
- excess fatty foods in the diet;
- obesity caused by low mobility, lack of physical activity;
- bad habits.
Since most of the cholesterol is produced internal organs, and only a fifth comes with food, an increase in its content may be due to internal reasons: hereditary diseases, age-related changes, acquired pathologies (diabetes mellitus, renal failure, thyroid diseases, cholestasis, hepatitis and cirrhosis of the liver, pancreas diseases and others). In case of dysfunction of the pancreas, intestines, pathologies of the liver and gallbladder, a stool lipid profile is additionally indicated.
A pathological increase in HDL levels above 2.2 mmol/l, despite their positive role in the regulation of fat metabolism, can be caused by genetic pathologies of lipid metabolism, intestinal oncology, strong physical activity. In other cases, moderately elevated HDL levels indicate a low risk of developing vascular diseases.
High values of LDL and triglycerides, related to the upper limit of normal, warn of a high risk of atherosclerotic vascular damage. While a pronounced excess of the norm indicates an existing cardiovascular disease - atherosclerosis of the cerebral and peripheral arteries.
Triglyceride concentrations may also increase for the following reasons:
- ischemic disease heart disease (CHD), myocardial infarction, arterial hypertension;
- increased calcium levels;
- diabetes;
- obesity;
- chronic alcoholism;
- thrombosis of cerebral arteries;
- viral hepatitis;
- nephrotic syndrome.
The atherogenicity coefficient shows the general picture of the state of fat metabolism. At increased rates key elements of the lipid profile, its level will be 3-4 units, a significant excess of the norm - 5 and above requires medical supervision and corrective measures, as it indicates the progression of serious pathologies, such as:
- atheromatosis and calcification (advanced forms of atherosclerosis);
- ischemia of the heart and internal organs;
- multifocal or diffuse brain damage;
- kidney diseases;
- circulatory disorders in the extremities.
Decreased performance
Hypocholesterolemia (lower cholesterol) is caused by fasting, following a lipid-lowering diet, or diseases such as:
- arthritis (rheumatoid form);
- increased thyroid function;
- infectious lesions of a generalized nature;
- malignant anemia;
- impaired absorption capacity of the small intestine;
- extensive burns (burn disease);
- heart failure.
A decrease in HDL concentration is a harbinger of atherosclerotic vascular damage. The cause of this may be infections of bacterial or viral etiology, endocrine pathologies, kidney and liver diseases, hepatic encephalopathy, hereditary disorders of lipoprotein metabolism.
A decrease in atherogenic lipoprotein fractions below normal limits is extremely rare. If all other indicators of the lipid profile are normal, then a moderate decrease in LDL has a positive effect on the condition of blood vessels and indicates that there is no risk of developing heart disease.
A decrease in triglycerides is observed in autoimmune neuromuscular disorders, chronic pulmonary obstruction, ischemic stroke, pathologies endocrine system, the use of some medical supplies(for example, progestins, heparin, vitamin C and others).
Average prices and where to buy?
In accordance with the price list of medical laboratories for 2019 located in Moscow, for example such popular ones as Invitro, Hemotest and Helix, the cost of a detailed study of lipid metabolism will vary from 1400 to 2500 rubles, the cost of a basic lipid profile will be 600 - 950 rubles.
Who is most susceptible to high cholesterol?
Elevated cholesterol levels are caused by the following factors:
- Lifestyle;
- nutrition;
- age;
- heredity;
- diseases.
The relevance of this problem does not lose its importance among people who lead a sedentary lifestyle, are overweight and have an unhealthy diet. Foods containing large amounts of animal fats contribute to the growth of cholesterol. These products include: egg yolk, butter, margarine, mayonnaise, lard, sausages, offal - liver, brains, kidneys. Smoking and drinking alcoholic beverages also have an adverse effect on the structure of the vascular walls, thinning them and promoting the formation of atherosclerotic deposits.
With age, metabolism slows down, which leads to a decrease in the rate of elimination of fat metabolism products and the deposition of cholesterol particles on the walls of blood vessels.
Elevated cholesterol levels are characteristic of some hereditary and acquired diseases, such as:
- hereditary hyperlipidemia;
- diabetes;
- rheumatoid arthritis;
- renal failure;
- gout;
- changes in the pancreas leading to pancreatitis, etc.
How to lower blood cholesterol?
The main recommendation of doctors is to reduce the amount of saturated fat in the diet and increase foods containing soluble fiber and polyunsaturated fatty acids. Whole grains, vegetables, and fruits are rich in fiber. Their daily consumption will help remove excess cholesterol from the body.
In order to maintain fat balance, consume more healthy fats - red fish (mackerel, salmon, trout, tuna), nuts, avocados. Replace butter and margarine vegetable oils first pressing – olive, flaxseed, peanut, rapeseed.
You also need to control the fat content of the dairy products you consume; try to keep it to no more than 1-2%, or even better, switch to low-fat analogues.
In addition to following the rules proper nutrition You should avoid drinking alcohol, stop smoking, and do simple exercises every day. physical exercise. Long walks, swimming, cycling and any other type of physical activity that brings pleasure will be beneficial.
The level of cholesterol and low-density lipoproteins can be normalized with the help of special lipid-lowering drugs. These include statins and fibric acid-based drugs. Treatment medications must be agreed with a doctor in accordance with existing individual contraindications. To prescribe statins, you will most likely need to take a test to detect the level of transaminases (ALT and AST).
Long-acting calcium antagonists can improve lipid metabolism. Among folk remedies Herbs that are very popular are Caucasian dioscorea, fragrant callisia, licorice root, Japanese sophora, linden and others.
A lipidogram is an analysis of the lipid spectrum, an extended blood test through which it is possible to track changes in the metabolic plan, disorders of the synthesis of certain fatty compounds; in addition to cholesterol, this also includes a group of substances that have no less potential to provoke diseases.
Any deviations from the norm must be assessed professionally, but doctors avoid overdiagnosis. Changes in indicators do not always indicate a pathological process. Not everything is so simple. Therefore, the patient is examined repeatedly, or even several times, over time.
Treatment is carried out under the supervision of an endocrinology specialist, as needed. If there are reasons to start therapy. The issue is resolved on an individual basis, after a thorough assessment of all factors.
The lipid profile is examined to detect pathological processes in metabolism; based on the results of the analysis, the following deviations from the norm can be found:
- Atherosclerosis. Classic diagnosis in the context of fat detection. Almost always, high cholesterol and other similar compounds indicate the development of this condition. Even if the diagnosis was not previously confirmed. In any case, it is necessary to re-examine the patient.
The essence of the change is the deposition of cholesterol and other substances on the walls of the arteries.
These plaques impede blood flow, do not allow normal nutrition of tissues and provide them with oxygen, and as the pathological process progresses, trophism decreases to a critical level, which can be fatal.
- Heart disorders. Among them, ischemic disease, a recent heart attack or, and a lot of other options. The need to assess lipid concentrations is dictated by the high probability of provoking these conditions by metabolic disorders.
- History of stroke. Often, ischemic damage is caused by atherosclerosis. Blockage of the artery leads to problems with nutrition, and then to the complete impossibility of trophism in the local area.
- Diseases of the endocrine system. Diabetes, thyroid dysfunction and other problems. This also includes excess weight. Excess body weight is almost always associated with high lipid concentrations.
- Disorders of the digestive tract.
Of course, jumps and smooth changes in the level of fatty compounds cannot unambiguously indicate one or another disease mentioned above. The sign is too general and nonspecific. However, assessment of the level can be a starting point for identifying the disorder.
Other diagnostic methods are also used to more clearly assess the condition; the question remains at the discretion of the specialist.
In what cases is examination indicated?
A blood lipidogram is a test designed to evaluate the concentration of fatty substances in fluid connective tissue.
There are several reasons for holding the event:
- Excess body weight. Weight gain is almost always associated with a change in fat concentration. It’s hard to say where the cause is and where the effect is. In any case, you can’t do without this technique.
- Age 45+. Over the years, the likelihood of developing one or several types at once increases significantly. It is necessary to conduct a thorough assessment of the blood lipid spectrum in order to detect the problem at an early stage.
Older people are at greater risk of complications, so treatment is required even if fat levels increase slightly.
- Preventive assessment of the patient's health status (screening).
- Burdened heredity. If there was one or several people in the family with pathologies caused by a violation of the concentration of lipid compounds. This is a factor increased risk.
- Deviations from the heart, central nervous system, digestive tract, endocrine structures. Those conditions that could potentially be associated with changes in the synthesis of fatty compounds.
The question is complex, you will need additional methods examinations. If a primary factor is detected, its urgent correction is required.
- Therapy control. During treatment, it is necessary to focus on the level of cholesterol and other compounds in order not to miss the ineffectiveness or excessive results from the use of drugs. The challenge is to respond urgently and quickly to changing conditions.
- Having bad habits. Smoking, drinking alcohol. These factors increase the risk of developing cholesterol plaques. Giving up harmful addictions requires a re-evaluation of fat concentration, since even lifestyle correction does not always immediately result in the restoration of metabolism. May be required health care.
- Physical inactivity. Insufficient physical activity. Risk factor for the development of pathologies based on metabolic changes and disorders. It is necessary to carry out the procedure after eliminating this provoking moment.
The list is approximate. The physician may order lipid testing at his own discretion when appropriate.
What indicators are included in the blood lipid spectrum?
The lipid profile includes: total cholesterol, triglycerides and lipoproteins of varying densities. This results in only six indicators that are examined during the diagnostic process:
Total cholesterol
Total cholesterol (TC) or cholesterol (CH) is the most important indicator in the entire analysis. With an increase, there is almost guaranteed to be a deviation in the volume of other substances, however, not always. Decryption required. A special formula for calculating this is used, this is an integral indicator.
Low density lipoproteins
Also called bad cholesterol, abbreviated LDL or LDL. There is some confusion in terms.
These compounds are small in size and easily attach to the walls of blood vessels, large arteries. Therefore, they are considered one of the most atherogenic, capable of provoking the formation of plaques.
This indicator should be adjusted as quickly as possible, because there is a real danger of developing atherosclerosis.
High density lipoproteins
Good HDL cholesterol. Due to the significant size of individual particles of the substance, they are not only unable to settle on the walls of blood vessels, but also mechanically cleanse the arteries of layers of bad fatty compounds.
Most foods contain both forms of cholesterol. There is no need to fight this type of substance, even if it increases.
Triglycerides
Found in the bloodstream in minimal quantities. The lipid profile includes TG indicators because a change in these is always indicative and indicates an endocrine disease.
These substances need to be dealt with, since under the influence of third-party reactions, triglycerides are quickly converted into low-density lipoproteins. The consequences are clear.
Atherogenic index
AI is used as a generalized coefficient that takes into account all the above compounds for calculation. The value of the coefficient (AK) is normally 2.2-3.5. If the number is increased, we can talk about a varying degree of risk of developing or worsening atherosclerosis.
The use of the atherogenicity index is a mandatory item in laboratory assessment.
Very low density lipoproteins
VLDL is not always studied, as many doctors believe, there is no practical point in this. Therefore, such diagnostics are rarely carried out, depending on the laboratory. In some cases, including a layer in the protocol is mandatory. A question about a specific situation.
The lipid profile includes a spectrum of compounds: LDL, VLDL, HDL, TG, CA and TC. Low-density lipoproteins and triglycerides can provoke disturbances in the functioning of the central nervous and cardiovascular systems.
Preparing for the test
Preparatory activities to obtain accurate results do not differ from those when conducting a biochemical blood test.
- You should not consume food rich in animal fats within 24 hours. This can artificially increase the levels of lipid compounds, the result will be false. It’s clear what this entails.
- You shouldn’t physically overwork yourself during the day. Inadequate mechanical activity is almost guaranteed to affect the concentration of fats, and this in turn will lead to incorrect interpretation of the results of the lipid profile.
- Alcoholic drinks should not be taken the same day before the test.
- Within 8 hours, food is completely abandoned. You can drink water.
- Blood donation occurs on an empty stomach. This is a mandatory condition so that the body does not begin biochemical processes that distort the final picture.
- You can't smoke for about an hour. Emotionally overloaded. Both of these affect the concentration of the substances in question.
If the doctor has suspicions about the results, the test may be ordered again. The question remains at the discretion of the treating specialist.
Carrying out
Lipid spectrum is an advanced biochemical technique. Blood sampling occurs in the same way, from a vein, without visible differences. The tube is labeled and sent to the laboratory.
The patient receives results after 1-2 days, give or take. Depending on the specific institution.
Cost of the study
In accordance with the price list of medical laboratories in 2019 located in Moscow, for example - Invitro, Hemotest and Helix, the price of a detailed analysis of the lipid spectrum ranges from 1400 to 2500 rubles, and the cost of studying a basic lipid profile is 600 - 950 rubles.
Standard tables
Mainly the degree of deviation is studied by total cholesterol, other indicators are assessed within the framework of an extended interpretation.
In men
Among women
In children
During pregnancy
During gestation, cholesterol levels increase 1.5-2 times depending on the age norm (see above). This is not considered an anomaly.
The numbers given are approximate. Deviations in one direction or another are possible depending on health status and many other factors.
The question of interpretation is decided by the treating specialist.
Attention:
When assessing, it is also necessary to take into account the reference values (normal range) accepted in a particular laboratory. Some discrepancies are possible, everything is determined by the methodology for calculating indicators.
Reasons for the increase
An increase in lipid concentration occurs in several cases. If we talk about the most common triggers:
- Excess body weight. Significant weight does not always provoke changes in the lipid profile, but this is the most likely scenario.
- Hereditary forms of pathological processes. Usually these are not accompanied by any symptoms.
- Disorders of the coronary arteries. Up to a heart attack or at least a temporary one.
- Diabetes. A classic pathology, which is characterized by disorders of lipid metabolism: concentration, synthesis, deposition and excretion of fatty compounds.
Accompanied by a lot of changes, not only an increase in cholesterol and other lipids. If a deviation is detected, urgent medical attention is required to avoid dangerous complications.
- Pancreatitis. Inflammatory process from the pancreas. Usually does not have an infectious origin.
- Hepatitis. Liver damage. Occurs against the background of viral invasion. We are talking about a whole group of strains that can provoke a disorder.
In some cases, a toxic form occurs. Including abuse of alcohol and drugs. Since fatty compounds are processed precisely in this organ, one should not be surprised at the critical increase in indicators.
- Cirrhosis of the liver. Acute tissue necrosis, cell death.
- Disorders of the urinary tract.
- Hormonal imbalances.
We are not talking about changes as a result of natural factors. That is, about pregnancy, excess nutrition the day before.
Reasons for the downgrade
A drop in level indicates several possible violations.
- Malignant processes. Tumors of any location. Mainly when located in the digestive tract, organs reproductive system. Kidneys.
- Starvation. A long-term lack of adequate nutrition leads to an understandable result. Lipids simply do not enter the body in sufficient quantities. If there is a fat layer, this phenomenon can be delayed.
- Infectious lesions. Up to sepsis.
- High concentration of thyroid hormones. Accompanied by poisoning of one's own systems.
- Pulmonary diseases of different types.
- Burns. The larger the affected area, the more significant the problem.
A blood test for the lipid spectrum shows changes in organs and systems indirectly; in any case, auxiliary techniques will be required for clarification.
Additional examinations
Among the activities that may be needed:
- Ultrasound of organs abdominal cavity. Depending on the specific diagnosis, the results reveal certain deviations. The structures of the digestive tract are examined first.
- Study of kidney tissue. Through the same ultrasound or using endoscopic methods, depending on the case. Also practiced general analysis urine.
- Dopplerography of blood vessels, duplex scanning. Usually the structures of the heart, brain, neck, and also limbs are subject to evaluation if there is a suspicion of.
- If necessary, MRI diagnostics of individual areas of the body that are susceptible to the main lesion is carried out.
- ECHO-CG to detect heart problems through tissue imaging.
These methods are aimed at identifying the consequences of elevated lipids. It is also necessary to discover the root cause of the pathological process. For this purpose, additional diagnostic methods may be prescribed.
Treatment methods
Therapy is carried out with medications. When deciphering a lipid profile, all possible indicators are taken into account; an increase in even one, as well as a decrease, requires in-depth analysis.
If there is reason to suspect a disease, extensive diagnostics are performed. Then a course of therapy is prescribed.
What medications are used:
- . Atorvastatin, Atoris and similar. To eliminate excess concentration of fatty compounds. Prescribed in short courses, as it can provoke negative effects. Risk side effects high, which is considered a reason to use them as carefully as possible.
- Fibrates. They are used in combination with statins, especially when they are insufficiently effective. The doctor selects the names.
- A nicotinic acid. Effectively reduces some types of lipids, used with great caution.
In addition, correction of body weight, changes in diet, and cessation of bad habits are indicated: smoking, drinking alcohol.
Possible consequences
Among these: heart attack, stroke, plaque formation in structures lower limbs with the prospect of gangrene, necrosis. As a result, there is a high probability of death from complications.
A lipidogram is a necessary and non-alternative method for diagnosing pathologies associated with disorders of the synthesis, storage and excretion of fats.
The method is simple, but highly informative and accurate. Prescribed by endocrinology specialists to obtain more detailed data.
