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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, low-density lipoprotein (LDL), high-density lipoproteins (HDL), and chylomicrons

 

Identification of LpX

 

Classifying hyperlipoproteinemias (lipoprotein phenotyping)

 

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

 

Quantifying lipoprotein 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, very-low-density lipoprotein, 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.

2-9 years

10-17 years

> or =18 years

Total cholesterol

*

Acceptable: <170 mg/dL

Borderline high: 170-199 mg/dL

High: > or =200 mg/dL

**

Desirable: <200 mg/dL

Borderline high: 200-239 mg/dL

High: > or = 240 mg/dL

Triglycerides

*

Acceptable: <75 mg/dL

Borderline high: 75-99 mg/dL

High: > or =100 mg/dL

*

Acceptable: <90 mg/dL

Borderline high: 90-129 mg/dL

High: > or =130 mg/dL

**

Normal: <150 mg/dL

Borderline high: 150-199 mg/dL

High: 200-499 mg/dL

Very high: > or =500 mg/dL

Low-density lipoprotein (LDL) cholesterol

*

Acceptable: <110 mg/dL

Borderline high: 110-129 mg/dL

High: > or =130 mg/dL

***

Desirable: <100 mg/dL

Above Desirable: 100-129 mg/dL

Borderline high: 130-159 mg/dL

High: 160-189 mg/dL

Very high: > or =190 mg/dL

LDL triglycerides

< or =50 mg/dL

< or =50 mg/dL

Apolipoprotein B

*

Acceptable: <90 mg/dL

Borderline high: 90-109 mg/dL

High: > or =110 mg/dL

***

Desirable: <90 mg/dL

Above Desirable: 90-99mg/dL

Borderline high: 100-119 mg/dL

High: 120-139 mg/dL

Very high: > or =140 mg/dL

High-density lipoprotein (HDL) cholesterol

*

Low: <40 mg/dL

Borderline low: 40-45 mg/dL

Acceptable: >45 mg/dL

***

Males: > or =40mg/dL

Females: > or =50mg/dL

 

Very low-density lipoprotein (VLDL) cholesterol

<30 mg/dL

<30 mg/dL

VLDL triglycerides

<90 mg/dL

<120 mg/dL

Beta VLDL cholesterol

<15 mg/dL

<15 mg/dL

Beta VLDL

triglycerides

<15 mg/dL

<15 mg/dL

Chylomicron cholesterol

Undetectable

Undetectable

Chylomicron triglycerides

Undetectable

Undetectable

Lp(a) cholesterol

<5 mg/dL

<5 mg/dL

LpX

Undetectable

Undetectable

 

Reference values have not been established for patients who are less than 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

Patients with increased lipoprotein a (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

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; National Heart, Lung, and Blood Institute: 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, et al: Diagnosis and management of type I and type V hyperlipoproteinemia. J Atheroscler Thromb. 2012;19(1):1-12

6. Gonzales KM, Donato LJ, Shah P, Simha V: Measurement of apolipoprotein B levels helps in the identification of patients at risk for hypertriglyceridemic pancreatitis. J Clin Lipidol. 2021 Jan-Feb;15(1):97-103. doi: 10.1016/j.jacl.2020.11.010

7. Fatica EM, Meeusen JW, Vasile VC, Jaffe AS, Donato LJ: Measuring the contribution of Lp(a) cholesterol towards LDL-C interpretation. Clin Biochem. 2020 Dec;86:45-51. doi: 10.1016/j.clinbiochem.2020.09.007

8. Arnett DK, Blumenthal RS, Albert MA, et al: 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019 Sep 10;140(11):e596-e646