Lipid Profile (Total Cholesterol, HDL, LDL, Triglycerides)
Definition
A group of tests that measures the types of fat (lipids) in the blood:
- Total Cholesterol, the total cholesterol in the blood
- LDL Cholesterol, "bad" cholesterol; it builds up in the vessel wall and leads to atherosclerosis
- HDL Cholesterol, "good" cholesterol; it carries cholesterol from the tissues to the liver
- Triglycerides, the main type of fat in the blood
Purpose
Used to assess the risk of atherosclerotic cardiovascular disease (ASCVD) and to monitor cholesterol-lowering treatment. LDL cholesterol is one of the most important causal factors for ASCVD.
Results
Target values are not a single threshold but are set according to the person's cardiovascular risk level. For this reason, "normal LDL" is not the same for everyone: in high-risk and very-high-risk patients the targets are markedly lower.
Important: The European (ESC/EAS 2019) and American (AHA/ACC 2018) guidelines take different approaches. While ESC/EAS recommends target LDL levels, AHA/ACC recommends adding non-statin drugs only in specific patient groups and at specific LDL thresholds. The main reason for this difference is that AHA/ACC takes cost-value assessment into account, whereas ESC/EAS assumes an ideal setting without resource constraints.
Normal Values
Laboratory-specific + risk-group-specific. No single universal "normal" value can be given; the target is set by the physician according to the person's total cardiovascular risk.
Risks and Limitations
The fasting requirement before measurement varies by test and by laboratory. Current discussions show that, beyond LDL, non-HDL cholesterol, apolipoprotein B and lipoprotein(a) values are becoming increasingly important in determining risk.