The Pros And Cons Of Total Cholesterol Hdl Ldl And Triglyceride Testing
Time to get your cholesterol checked. Okay, but which test should you get? Its not so simple anymore. Here is a rundown of some of the choices and their pros and cons:
Total cholesterol. This is the simplest and least expensive test. The test doesnt require any sophisticated lab work, either. The simple, do-it-yourself home cholesterol tests measure total cholesterol.
But total cholesterol includes both good high-density lipoprotein cholesterol, and the bad varieties, chiefly low-density lipoprotein and very-low-density lipoprotein . So, if your total cholesterol is in the desirable category, its possible that you may have unhealthy levels of HDL and LDL and VLDL . Think of total cholesterol as a first glimpse, a peek. Doctors are not supposed to make any treatment decisions based on this number alone.
Cholesterol levels can be lowered by stress or infection. An injury, cancer, stroke, or heart attack may have the same effect. So, if your cholesterol levels are unusually high or low, your doctor will probably want to repeat the test some weeks later. Abnormal readings may also lead to tests for other medical problems.
HDL cholesterol. HDL wins its laurels as the good cholesterol because it sponges up cholesterol from blood vessel walls and ferries it to the liver for disposal. In contrast, LDL deposits the harmful fat in vessel walls.
An HDL level of 60 or above is associated with a lower risk of heart disease, and below 40 is associated with a higher risk.
Performance Of Friedewald And Novel Estimates Of Ldl
In considering the implications to patient care, it is important to note that the current standard of practice is not the gold standard LDL-CQ, but rather LDL-CF. To account for this we performed a series of analyses in which the estimated value was considered the reference . LDL-CF was marginally more concordant compared to LDL-CN when LDL-C was > 100 mg/dL. Concordance was significantly higher for LDL-CN compared to LDL-CF when LDL-C was < 100 mg/dL . The greatest difference in concordance between the 2 estimations was observed in patients with LDL-CQ< 70 mg/dL. In this category, LDL-CF correctly classified 2306 patients and LDL-CN correctly classified 2089 patients. However, LDL-CF classified a total of 3239 patients with values < 70 mg/dL whereas LDL-CN classified only 2474 patients in this category, providing relative concordances of 71.2% and 84.4% for LDL-CF and LDL-CN, respectively, if the initial classification were defined by the estimated value .
Why Do I Need A Cholesterol Test
Cholesterol is a waxy, fat-like substance. Your liver makes all the cholesterol your body needs. But you take in more cholesterol from certain foods, such as those from animals. If you have too much cholesterol in your body, it can build up in the walls of your arteries and eventually harden. This process, called atherosclerosis, actually narrows the arteries, making it harder for blood to travel through the vessels.
Unfortunately, high cholesterol doesnât cause symptoms. In later stages of atherosclerosis, though, you may suffer anginaâ severe chest pain from lack of blood flow to the heart. If an artery gets totally blocked, a heart attack results. A routine blood cholesterol test is a far better way of finding out what your cholesterol level is.
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How To Calculate Cholesterol Ratios
There are three indicators that describe your heart disease risk with high accuracy. They are all built as ratios of the aforementioned blood results, and are therefore called cholesterol ratios.
Are you wondering what a good cholesterol ratio is? You can use this total cholesterol calculator to find the following values:
- ideal: below 2.0
- bad: over 5.0
Data Cleaning Query Resolution And Clinical Monitoring
Data in the central database were verified through logic and edit checking. Any answer in the database that was identified as physiologically unlikely or outside the entry criteria prompted an electronic query. The appropriate investigative site was contacted to resolve each query, and the database was changed to reflect the corrected information. Data collection procedures were verified by a 100% data field audit performed at 42 of the sites.
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If A Patients Ldl Cholesterol Concentration Could Not Be Calculated Because The Triglycerides Were Too High What Options Do You Have For Getting An Ldl Cholesterol Concentration
If the LDL concentration could not be calculated because the triglyceride level was too high, direct LDL-C testing may be useful. At Quest Diagnostics, for example, direct LDL measurement provides a reliable result even when triglyceride levels are up to 1,000 mg/dL. It can be ordered as a stand-alone test, as a reflex if the patients triglyceride level is likely to exceed 400 mg/dL, or as part of one of several panels.
low-density lipoprotein-cholesterol
What Is Cholesterol And Why Is It Important For Our Health
Cholesterol is a fatty substance that is made mainly in the liver. Smaller quantities find their way into our bodies through the food we consume. Contrary to popular belief, cholesterol is not just a bad guy. It is a critical structural component of all our cells and essential for producing vital hormones and vitamin D.
Our body absorbs about half of the cholesterol from food. Then, cholesterol enters the blood, which already contains some quantities produced in the liver. The risk of atherosclerosis in our blood vessels increases when normal cholesterol levels are exceeded, especially if other risk factors are present.
Because cholesterol and other lipids are insoluble in water, they bind to unique proteins in the blood plasma. These unique molecules are called lipoproteins. By them, lipids can be transported to tissues and organs.
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Cholesterol: The Good And The Bad Of It
HDL High-density lipoprotein
- Moves cholesterol from arteries to the liver.
LDL Low-density lipoprotein
- Makes up 60%70% of total cholesterol
- Main form of âbadâ cholesterol
- Causes build-up of plaque inside arteries.
VLDL Very-low-density lipoprotein
- Makes up 10%15% of total cholesterol
- With LDL, the main form of âbadâ cholesterol
- A precursor of LDL.
LDL cholesterol. The LDL measurement is usually considered the most important for assessing risk and deciding on treatment. The definition of a healthy level keeps on getting lower. For people at low risk of heart disease, an LDL of less than 100 is desirable, However, people at higher risk of heart disease, an LDL of less than 70 or perhaps even lower is considered âoptimal.â Some experts say that an LDL of less than 70 would be a healthy LDL goal for all of us.
Your LDL is computed by plugging the measurements for total cholesterol, HDL, and triglycerides into a: LDL = Total cholesterol HDL . LDL can also be measured directly in a non-fasting blood sample.
You have to fast for about 10 hours before the test because triglyceride levels can shoot up 20%30% after a meal, which would throw off the equation. Alcohol also causes a triglyceride surge, so you shouldnât drink alcohol for 24 hours before a fasting cholesterol test.
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The numbers to know |
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How Total Cholesterol Is Measured
This is done using a blood test called a lipoprotein panel, which also measures your triglycerides. For this test, you provide a blood sample thats taken after youve fasted for 9 to 12 hours before your test.
Your total cholesterol score is calculated using the equation: HDL level + LDL level + 20% of your triglyceride level.
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Study Design And Patient Samples
Participants for the study were recruited from the National Institutes of Health or the Virginia Commonwealth University Medical Center , with approval of their respective institutional review boards. Data from a previous study on 145 participants with TG levels < 200 mg/dl, and 19 subjects with TG levels > 200 and < 400 mg/dl were used in the analysis. The study population contains 37 healthy control subjects, with the majority of the remaining subjects recruited from specialty clinics for dyslipidemia and cardiovascular disease and thus are representative of the population of patients for which accurate lipid testing is important for making clinical decisions on the use of lipid lowering drug. Approximately, one quarter of the subjects were not fasting for at least at 10 h. Details of the lipid profile, diagnosis and use of lipid-lowering medication of each participant in the study has been previously described .
Ldl Vs Hdl Good Vs Bad
If cholesterol is essential for overall health, why would one type be bad?
In simple terms, if there is too much LDL cholesterol running through your blood vessels, it can, over time, start to build up on the sides of those blood vessels. This buildup is typically referred to as plaque.
Plaque buildup in your blood vessels can eventually cause those vessels to become narrower. The more narrow your blood vessels are, the harder it is for blood to reach your heart and other organs.
When blood flow becomes very blocked, it can cause chest pain and even a heart attack.
HDL cholesterol, on the other hand, returns cholesterol to the liver so it can be flushed from the body.
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Total Cholesterol Hdl Ldl And Triglycerides
Our cholesterol ratio calculator takes into account four basic blood test results. All recommended levels are according to the National Heart, Lung, and Blood Institute within the National Institutes of Health.
You only need to input three of your results they are dependent on each other according to the formula:
total cholesterol = HDL + LDL + 0.2 * triglycerides
- Desirable: Less than 200 mg/dL
- Borderline high: 200 239 mg/dL
- High: 240 mg/dL and above
- Optimal: 60 mg/dL and above
- Borderline: 40 59 mg/dL
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How Do You Calculate Ldl And Non
The sum of Very Low Density Lipoprotein +LDL cholesterol is called non-HDL cholesterol. It is calculated routinely as total cholesterol minus HDL cholesterol. In persons with elevated triglycerides , 200 – 499 mg/dL, most cholesterol occurring in the VLDL fraction is contained in the remnant VLDL, which is thought to be very atherogenic. The non-HDL-C level includes cholesterol carried in several atherogenic lipoproteins, such as LDL, very low-density lipoprotein , intermediate density lipoprotein , and lipoprotein ).
Therefore, in patients with elevated TG levels , treatment of the non-HDL-C level is a secondary target after the LDL-C target has been reached.
When triglycerides are 200 mg/dL, after LDL goal is reached, set secondary goal for non-HDL cholesterol for 30 mg/dL higher than LDL goal.
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Question 3 Why Does Quest No Longer Rely On The Friedewald Equation
Although the Friedewald equation it is still widely used and generally produces reliable results, it may underestimate LDL-C at the low LDL-C levels that modern treatment guidelines call for and therapies can achieve .3 PCSK-9 inhibitors can drive LDL-C levels even lower . Such low LDL-C concentrations are below the concentrations considered when the Friedewald equation was developed.2
This limitation relates to the fact that the Friedewald equation uses a fixed ratio of triglyceride to VLDL-C it does not allow for heterogeneity in the ratio of triglycerides to VLDL-C. This becomes a problem especially at lower LDL-C and higher triglyceride concentrations, when the Friedewald calculation tends to underestimate LDL-C. In a 2013 study, Martin and colleagues compared the results of direct LDL-C and calculated LDL-C using the Friedewald equation in more than 1.3 million U.S. adults.4 Friedewald-estimated LDL-C tended to be lower than directly measured LDL-C, especially in patients with calculated LDL-C levels below 100 mg/dL. At triglyceride levels 150 mg/dL, calculated LDL-C was often below < 70 mg/dL in patients with directly measured LDL-C in the 71-80 mg/dL range. These findings suggest that the tendency of the Friedewald equation to underestimate LDL-C at higher triglyceride and lower LDL-C levels could result in high-risk patients being undertreated.
How To Calculate Ldl Cholesterol
After having the lipid profile measured, you can start the calculation. Check what units are your lab test results expressed in its important for the calculation.
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Total Cholesterol Calculation In Mg/dl And Mmol/l
Here is the medical calculator to calculate the amount of total cholesterol in millimoles/liters , based on the given inputs of high-density lipoprotein , low-density lipoprotein and triglyceride. Total cholesterol is the total blood cholesterol. High cholesterol is a condition called as hypercholesterolemia, which is a cause for heart diseases. Enter the values of LDL, HDL, and Triglycerides in the total cholesterol calculator and click calculate.
Formula:
Concordance In Guideline Classification By Friedewald Vs Novel Estimates Of Ldl
Our final analysis assessed the changes that clinicians would expect to see in patient LDL-C values if the novel method were to be implemented in routine practice rather than the Friedewald. Overall, 19 541 patients would have been grouped in the same NCEP category, 330 patients would have been categorized in a lower NCEP category, and 3184 patients would have been categorized in a higher NCEP category . The largest changes would be seen in patients with LDL-CF< 100 mg/dL, for which > 20% of patients were grouped in a higher NCEP category by LDL-CN compared to LDL-CF.
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What Is A Healthy Cholesterol Level
This table is a general guide for ideal cholesterol and triglyceride levels for healthy adults in the UK. If you have a condition such as heart disease or diabetes, your target levels may be lower your doctor will be able to tell you your individual targets.
| Above 6 is considered high risk – the lower this figure is the better | Above 6 is considered high risk – the lower this figure is the better |
How Does This Ldl Calculator Work
This health tool computes the LDL cholesterol value from the total cholesterol, HDL, triglyceride levels according to the two formulas used in these cases: the Friedewald and Iranian study . The second formula is often recommended when the triglyceride levels are lower than average, as in the case of those with a low carbohydrate diet.
For your convenience, the LDL calculator allows you to enter the three values in either mg/dL or mmol/L . You will be given the two results in the corresponding measurement unit so that you can further on interpret the results easily.
In case of the 1st tab LDL in mg/dL these are the equations used:
The Friedewald formula: LDL = TC HDL TG / 5.0
The Iranian study formula: LDL = TC / 1.19 + TG / 1.9 HDL / 1.1 38
In case of the 2nd tab LDL in mmol/L these are the formulas behind the algorithm:
The Friedewald equation: LDL = TC HDL TG / 2.17
The Iranian study method: LDL = TC / 1.19 + TG / 0.81 HDL / 1.1 0.98
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Healthy cholesterol levels are a key component of cardiovascular wellness. The American Heart Association recommends getting tested every four to six years beginning at age 20a blood lipid panel includes your total cholesterol, high-density lipoprotein , low-density lipoprotein , and triglycerides. If you have cardiovascular disease or elevated risk, you may need more frequent testing. After age 40, your doctor would recommend testing based on your calculated risk of having a heart attack or stroke.
These regular check-ins can guide your doctorâs assessment of whether you need to make lifestyle adjustments or take medication to keep your blood cholesterol within a healthy range.
At-home testing kits can be handy for people diagnosed with high cholesterol who may want to test their blood more frequently.
While home cholesterol testing should not be used as a replacement for the comprehensive diagnostics provided by your physician, it can be an addition to a proactive health regimen.
Here are the best at-home cholesterol test kits that you can use in-between visits with your doctor.
Validation Of The Friedewald Formula In Patients With Metabolic Syndrome
Caio César Diniz Disserol
1PontifÃcia Universidade Católica do Paraná, Rua Imaculada Conceição, Prado Velho, 1155 Curitiba, PR, Brazil
Abstract
Currently, the Friedewald formula is the main method for evaluating low-density lipoprotein cholesterol . Recently, many limitations have emerged regarding its use, including patients with triglyceride levels 400mg/dL, diabetes mellitus, and kidney or hepatic chronic diseases. We analyzed the use of the FF in patients with metabolic syndrome. We selected patients with known metabolic syndrome that fulfilled the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults Final Report and excluded patients with triglyceride levels 400mg/dL and chronic liver and/or kidney disease. Using direct assays, we measured total cholesterol, high-density lipoprotein cholesterol, triglycerides, and LDL-c. Then, LDL-c was estimated using the FF and compared with the LDL-c by direct assay. The sample size was 135 patients. Using the FF, the mean LDL-c value was mg/dL it was mg/dL by direct assay. The correlation coefficient between these two methods was 0.89, with statistical significance . There were no significant differences between the patients with triglyceride levels > 150mg/dL . In conclusion, FF is a good method for estimating LDL-c in patients with metabolic syndrome.
1. Introduction
5. Conclusion
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