Lipid Panel

Order Code

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173

Preferred Specimen

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2 mL of serum. Allow the serum separator tube (SST) to clot in an upright position for a minimum of 30 minutes. Centrifuge the specimen within 2 hours of collection. Keep refrigerated.
The patient must fast for 9–12 hours prior to specimen collection.
THSteps (Medicaid) samples must be submitted to the DSHS laboratory.

ContainerType

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serum separator tube

Alternate Specimen Requirements

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2 mL of serum obtained from a plain red top tube. Let the sample clot upright for at least 60 minutes. Centrifuge, then transfer the serum into a plastic transport tube within 2 hours of collection. Clearly indicate that the sample is from a plain red top tube. Refrigeration is required.
The patient should fast for 9–12 hours before specimen collection.

Minimum Volume

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2 mL

Transport Temperature

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refrigerated

Specimen Stability

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5 days room temperature; 1 week refrigerated

Methodology

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Roche COBAS enzymatic;colorimetric gen 2
Roche COBAS enzymatic colorimetric

Rejection Criteria

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• gross hemolysis

Overview

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A lipid panel evaluates the types and quantities of fats and fat-like substances circulating in the bloodstream. These lipids serve as energy sources for cells, contribute to membrane structure, and act as precursors in the formation of bile acids and steroid hormones. Cholesterol and triglycerides are examples of lipids that do not dissolve in blood unless incorporated into lipoproteins—complexes made up of proteins, cholesterol, triglycerides, and phospholipids. Lipoproteins are categorized by density into very low-density lipoproteins (VLDL), low-density lipoproteins (LDL), and high-density lipoproteins (HDL) (AACC, 2019).

A comprehensive lipid profile helps in evaluating cardiovascular disease (CVD) risk by quantifying total cholesterol, HDL cholesterol, and triglycerides. LDL cholesterol may be calculated from these measurements or directly tested. Additional parameters may include the cholesterol-to-HDL ratio, non-HDL cholesterol, and LDL particle count.

Clinical Significance

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• Evaluate CVD risk in individuals without established disease
• Periodically monitor lipid levels when risk factors are present (e.g., diabetes, hypertension, smoking)
• Assess treatment efficacy
• Identify potential hereditary lipid disorders

Additional Information

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CVD risk assessment tools help pinpoint individuals aged 40–79 who may benefit most from preventive interventions. These calculators incorporate evidence-based variables such as age, sex, race, total and HDL cholesterol, blood pressure, diabetes status, and tobacco use (AACC, 2019).

The role of LDL cholesterol in risk assessment has evolved. The 2013 AHA/ACC guidelines shifted away from fixed LDL targets for preventing coronary heart disease, instead focusing on the degree of LDL reduction required via statin therapy, based on clinical risk. A 2018 update partially reinstated LDL goals for higher-risk populations. Meanwhile, other guidelines, such as the AACE/ACE 2017 update, still advocate for LDL targets determined by individual risk profiles (Wu, 2016).

Interpretative Information

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Lipid measurements are essential in determining CVD risk. Online calculators for estimating 10-year risk include:

ACC ASCVD Risk Estimator Plus

2013 ACC/AHA Risk Calculator

Limitations

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Total Cholesterol:

• Falsely low readings: May occur due to elevated levels of N-acetylcysteine (NAC) or N-acetyl-p-benzoquinone imine (NAPQI, a metabolite of acetaminophen), particularly at concentrations found in overdose scenarios.
• Falsely elevated readings: Can be seen during pregnancy or with the use of certain medications (e.g., anabolic steroids, oral contraceptives, beta-blockers).

HDL Cholesterol:

• Falsely decreased levels: Can result from high concentrations of NAC, NAPQI, or metamizole (a pain reliever used in some countries but not approved in the U.S.).

LDL Cholesterol:

• Routine assays may also detect intermediate-density lipoprotein (IDL) and lipoprotein(a) [Lp(a)], though these typically have minimal influence on the overall LDL value. Complex cases should be referred to a specialized lipid center.
• Medications that may increase LDL: Thiazide diuretics, beta-blockers, amiodarone, SGLT2 inhibitors, protease inhibitors, cyclosporine, and anabolic steroids.
• Medications that may reduce LDL: Statins, niacin, and estrogen therapy.

LDL Particle Number (LDL-P):
As of 2018, there are no established guidelines for initiating therapy or setting treatment goals based on LDL particle count.

Triglycerides:

• Falsely high levels: May result from unesterified glycerol in the bloodstream or the presence of lipid-based intravenous solutions (e.g., total parenteral nutrition).
• Falsely low levels: May be seen with ascorbic acid, elevated NAC, NAPQI (in overdose situations), or calcium dobesilate (a vasoprotective agent not used in the U.S.).

References

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Diagnostic Role

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For adults, routine fasting lipid profile screening is advised every 5 years starting at age 20. More frequent testing is advised if initial results are abnormal, if risk factors are present (eg, strong family history, diabetes, hypertension, tobacco use), or if the presence of cardiovascular disease (CVD) is established (eg, prior myocardial infarction, stroke, peripheral vascular disease) (Jellinger 2017). For children and adolescents, the National Heart Lung and Blood Institute (NHLBI) recommends testing non-HDL cholesterol (which may be performed nonfasting) once in all children between 9 and 11 years old, and again between 17 and 21 years old. High-risk children should be tested between 2 and 8 years old with a fasting lipid profile.

A lipid panel may be followed at regular intervals to monitor effectiveness of lipid-lowering lifestyle changes such as diet and exercise, or to determine the effectiveness of drug therapy.

Alias

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• coronary risk
• lipid panel
• lipid panel w/calc LDL/HDL ratio

Test Setup Days

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Monday through Friday

CPT

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80061 AMA Defined Profile.
Limited Coverage Test For Medicare.
Advance Beneficiary Notice Of Non-Coverage (ABN)
Required If Diagnosis Not Covered.
Frequency Limit Test For Medicare.
Advance Beneficiary Notice Of Non-Coverage (ABN)
Always Required For Frequency.