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Test ID: LMPP    
Lipoprotein Metabolism Profile, Serum

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

Diagnosing dyslipoproteinemia

 

Quantitation of cholesterol and triglycerides in very-low-density lipoprotein (VLDL), LDL, HDL, and chylomicrons

 

Identification of LpX

 

Classifying hyperlipoproteinemias (lipoprotein phenotyping)

 

Evaluating patients with abnormal lipid values (cholesterol, triglyceride, HDL, LDL)

 

Quantifying lipoprotein a (Lp[a]) cholesterol

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

Lipoprotein metabolism profile analysis adds practical information about the etiology of cholesterol and/or triglyceride elevation. In some patients, increased serum lipids reflect elevated levels of intermediate-density lipoprotein (IDL), very-low-density lipoprotein (VLDL), lipoprotein a (Lp[a]), or even the abnormal lipoprotein complex-LpX. These elevations can be indicative of a genetic deficiency in lipid metabolism or transport, nephrotic syndrome, endocrine dysfunction or even cholestasis. Identification of the lipoprotein associated with lipid elevation is achieved using the gold-standard methods, which include ultracentrifugation, selective precipitation, electrophoresis, and direct measurement of cholesterol and triglycerides in isolated lipoprotein fractions. Proper characterization of a patient's dyslipidemic phenotype aids clinical decisions and guides appropriate therapy.

 

Classifying the hyperlipoproteinemias into phenotypes places disorders that affect plasma lipid and lipoprotein concentrations into convenient groups for evaluation and treatment. A clear distinction must be made between primary (inherited) and secondary (liver disease, alcoholism, metabolic diseases) causes of dyslipoproteinemia. Lipoprotein profiling will identify the presence of Lp(a) and LpX and distinguish between the following dyslipidemias:

-Exogenous hyperlipemia (Type I)

-Familial hypercholesterolemia (Type IIa)

-Familial combined hyperlipidemia (Type IIb)

-Familial dysbetalipoproteinemia (Type III)

-Endogenous hyperlipemia (Type IV)

-Mixed hyperlipemia (Type V)

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.

Age

2-9 years

10-17 years

>18 years

Total Cholesterol (mg/dL)

*

Acceptable: <170

Borderline high: 170-199

High: > or =200

**

Desirable: <200

Borderline high: 200-239

High: > or = 240

Triglycerides (mg/dL)

*

Acceptable: <75 

Borderline high: 75-99

High: > or =100

*

Acceptable: <90 

Borderline high: 90-129

High: > or =130

**

Normal: <150

Borderline high: 150-199

High: 200-499

Very high: > or =500

LDL Cholesterol (mg/dL)

*

Acceptable: <110

Borderline high: 110-129

High: > or =130

***

Desirable: <100

Above Desirable: 100-129

Borderline high: 130-159

High: 160-189

Very high: > or =190

LDL Triglycerides (mg/dL)

< or = 50

< or = 50

Apolipoprotein B (mg/dL)

*

Acceptable: <90

Borderline high: 90-109

High: > or =110

***

Desirable: <90

Above Desirable: 90-99

Borderline high: 100-119

High: 120-139

Very high: > or =140

HDL Cholesterol (mg/dL)

*

Low: <40

Borderline low: 40-45

Acceptable: > 45

***

Males: > or =40

Females: > or =50

 

VLDL Cholesterol (mg/dL)

<30

<30

VLDLTriglycerides (mg/dL)

<90

<120

Beta VLDL Cholesterol (mg/dL)

<15

<15

Beta VLDL

Triglycerides (mg/dL)

<15

<15

Chylomicron Cholesterol

Undetectable

Undetectable

Chylomicron Triglycerides

Undetectable

Undetectable

Lp(a) cholesterol

<5

<5

LpX

Undetectable

Undetectable

 

Reference values have not been established for patients that are <2 years of age.

* Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents

** National Cholesterol Education Program (NCEP)

***National Lipid Association

Interpretation Provides information to assist in interpretation of the test results

For discussion of primary disorders associated with dyslipidemias see Lipids and Lipoproteins in Blood Plasma (Serum) in Special Instructions.

 

Patients with increased Lp(a) cholesterol values have been associated with increased risk for the development of atherothrombotic disease. Aggressive LDL reduction is the recommended treatment approach in most patients with increased Lp(a).

 

Lipoprotein-X (LpX) is an abnormal lipoprotein that appears in the sera of patients with obstructive jaundice, and is an indicator of cholestasis. The presence of LpX will be reported if noted during Lp(a) cholesterol analysis.

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

Reference values are based on fasting collections; it is essential that the patient fasts for 12 to 14 hours before the specimen collection.

 

Cholesterol results can be falsely decreased in patients with elevated levels of N-acetyl-p-benzoquinone imine (NAPQI), a metabolite of acetaminophen, N-acetylcysteine (NAC), and metamizole.

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

1. Grundy SM, Stone NJ, Bailey AL, et al: 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019 Jun 18;139(25):e1082-e1143

2. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics. 2011 Dec;128 Suppl 5:S213-S256

3. Rosenson RS, Najera SD, Hegele RA: Heterozygous familial hypercholesterolemia presenting as chylomicronemia syndrome. J Clin Lipidol. 2017 Jan - Feb;11(1):294-296. doi: 10.1016/j.jacl.2016.12.005

4. Hopkins PN, Brinton EA, Nanjee MN: Hyperlipoproteinemia type 3: the forgotten phenotype. Curr Atheroscler Rep. 2014 Sep;16(9):440. doi: 10.1007/s11883-014-0440-2

5. Gotoda T, Shirai K, Ohta T, Kobayashi J, Yokoyama S, Oikawa S, et al: Diagnosis and management of type I and type V hyperlipoproteinemia. J Atheroscler J Atheroscler Thromb. 2012;19(1):1-12

Special Instructions Library of PDFs including pertinent information and forms related to the test