Test Catalog

Test ID: CERAM    
MI-Heart Ceramides, Plasma

Useful For Suggests clinical disorders or settings where the test may be helpful

Evaluating for the risk of major adverse cardiovascular events within the next 1 to 5 years

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

MI-Heart Ceramides is a blood test that measures risk for adverse cardiovascular events and quantifies plasma ceramides. Plasma ceramides are predictors of adverse cardiovascular events resulting from unstable atherosclerotic plaque. Ceramides are complex lipids that play a central role in cell membrane integrity, cellular stress response, inflammatory signaling, and apoptosis. Synthesis of ceramides from saturated fats and sphingosine occurs in all tissues. Metabolic dysfunction and dyslipidemia results in accumulation of ceramides in tissues not suited for lipid storage. Elevated concentrations of circulating ceramides are associated with atherosclerotic plaque formation, ischemic heart disease, myocardial infarction, hypertension, stroke, type 2 diabetes mellitus, insulin resistance, and obesity.


Three specific ceramides have been identified as highly linked to cardiovascular disease and insulin resistance: Cer16:0, Cer18:0, and Cer24:1. Individuals with elevated plasma ceramides are at higher risk of major adverse cardiovascular events even after adjusting for age, gender, smoking status, and serum biomarkers such as low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, C-reactive protein (CRP) and lipoprotein-associated phospholipase A2 (Lp-PLA2). Ceramide concentrations are reduced by current cardiovascular therapies including diet, exercise, statins, and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

MI-Heart Ceramide Risk Score:

0-2 Lower risk

3-6 Moderate risk

7-9 Increased risk

10-12 Higher risk

Ceramide (16:0): 0.19-0.36 mcmol/L

Ceramide (18:0): 0.05-0.14 mcmol/L

Ceramide (24:1): 0.65-1.65 mcmol/L

Ceramide (16:0)/(24:0): <0.11

Ceramide (18:0)/(24:0): <0.05

Ceramide (24:1)/(24:0): <0.45


Reference values have not been established for patients who are <18 years of age.


Note: Ceramide (24:0) alone has not been independently associated with disease and will not be reported.

Interpretation Provides information to assist in interpretation of the test results

Elevated plasma ceramides are associated with increased risk of myocardial infarction, acute coronary syndromes, and mortality within 1 to 5 years.

Ceramide Score

Relative Risk

Risk Category













Score is based on trial data including >4000 subjects.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

No significant cautionary statements.

Clinical Reference Recommendations for in-depth reading of a clinical nature

1 Laaksonen R, Ekroos K, Sysi-Aho M, et al: Plasma ceramides predict cardiovascular death in patients with stable coronary artery disease and acute coronary syndromes beyond LDL-cholesterol. Eur Heart J. 2016;37:1967-1976

2. Havulinna AS, Sysi-Aho M, Hilvo M, et al: Circulating ceramides predict cardiovascular outcomes in the population-based FINRISK 2002 cohort. Arterioscler Thromb Vasc Biol. 2016;36:2424-2430.

3. Wang DD, Toledo E, Hruby A, et al: Plasma ceramides, Mediterranean diet, and incident cardiovascular disease in the PREDIMED trial (Prevenci on con Dieta Mediterranea). Circulation. 2017;135:2028-2040. doi: 10.1161/CIRCULATIONAHA.116.024261

4. Meeusen JW, Donato LJ, Bryant SC, et al: Plasma Ceramides. Arterioscler Thromb Vasc Biol. 2018; 38:1933-1939. doi: 10.1161/ATVBAHA.118.311199

5. Peterson LR, Xanthakis V, Duncan MS, et al: Ceramide remodeling and risk of cardiovascular events and mortality. J Am Heart Assoc. 2018;7(10). doi: 10.1161/JAHA.117.007931

6. Hilvo M, Meikle PJ, Pedersen ER, et al: Development and validation of a ceramide- and phospholipid-based cardiovascular risk estimation score for coronary artery disease patients. Eur Heart J. 2020;41:371-380. doi: 10.1093/eurheartj/ehz387

7. Alshehry ZH, Mundra PA, Barlow CK, et al: Plasma lipidomic profiles improve on traditional risk factors for the prediction of cardiovascular events in type 2 diabetes mellitus. Circulation. 2016;134:1637-1650.

8. Anroedh S, Hilvo M, Akkerhuis KM, et al: Plasma concentrations of molecular lipid species predict long-term clinical outcome in coronary artery disease patients. J Lipid Res. 2018;59:1729-1737. doi: 10.1194/jlr.P081281

9. Lemaitre RN, Jensen PN, Hoofnagle A, et al: Plasma ceramides and sphingomyelins in relation to heart failure risk. Circ Heart Fail. 2019;12(7):e005708. doi: 10.1161/CIRCHEARTFAILURE.118.005708