Test Code 98050
Test Details
LipoMap®
The LipoMap® test is a panel of 33 lipid and lipoprotein tests performed by our high resolution 600 MHz NMR instruments. This is the most complete assessment of lipid metabolism commercially available for use in clinical practice.
Methodology
Nuclear Magnetic Resonance (NMR)
Patient Preparation
None
Preferred Specimen
1 mL fasting (8 hr minimum) serum collected in Greiner Bio-one Vacuette Z-serum clot activator, red/yellow top tube; or approved alternatives: NMR LipoTube (manufactured by Greiner, Inc.), or S-Monovette® Serum (Sarstedt).
Alternate Specimen
None
Transport Temperature
Refrigerated (ship on frozen cold packs)
Stability
3 days at 2-8°C.
Lab Values
LipoMap®
| Test Name | Optimal | Borderline | Increased Risk |
|---|---|---|---|
| Lipid, Lipoprotein, and Apolipoprotein Tests | |||
| Total Cholesterol (TC) | <200 | 200 - 240 | >240 mg/dL |
| Direct LDL-cholesterol (LDL-C) | With CVD: <70 Without CVD:<100 | 70 - 100 100 - 160 | >100 mg/dL >160 mg/dL |
| HDL-cholesterol (HDL-C) | Male: >50 Female: >60 | 40 - 50 50 - 60 | <40 mg/dL <50 mg/dL |
| Non HDL-cholesterol (Non-HDL-C) | <130 | 130 - 190 | >190 mg/dL |
| Triglycerides (TG) | <150 | 150 - 200 | >200 mg/dL |
| IDL-cholesterol (IDL-C) | <7 | 7 - 12 | >12 mg/dL |
| VLDL-cholesterol (VLDL-C) | <30 | 30 - 40 | >40 mg/dL |
| Apolipoprotein-AI (ApoA-I) | Male: >160 Female: >180 | 120 - 160 140 - 180 | <120 mg/dL <180mg/dL |
| Apolipoprotein-AII (ApoA-II) | Male: >32 Female: >35 | 30 - 32 32 - 35 | <30 mg/dL <32 mg/dL |
| Apolipoprotein-B (ApoB) | <80 | 80 - 120 | >120 mg/dL |
| Lipid Ratios |
|||
| Total Cholesterol/HDL-cholesterol ratio (TC/HDL-C) | With CVD: <3 Without CVD: <4 | 3 - 5 4 - 6 | >5 >6 |
| Apolipoprotein-B/Apolipoprotein-A ratio (ApoB/ApoA-I) | With CVD: <0.5 Without CVD: <0.6 | 0.5 - 0.7 0.6 - 0.9 | >0.7 >0.9 |
| Atherogenic Lipoprotein Particles | |||
| Total ApoB carrying Particle Number (Total ApoB-P) | <1400 | 1400 - 2000 | >2000 nmol/L |
| LDL Particle Number (LDL-P) | <1200 | 1200 - 1800 | >1800 nmoles/L |
| IDL Particle Number (IDL-P) | <70 | 70 - 100 | >100 nmoles/L |
| VLDL Particle Number (VLDL-P) | <120 | 120 - 180 | >180 nmoles/L |
| LDL Particles | |||
| LDL-1 Particle Number (LDL1-P) | <140 | 140 - 190 | >190 nmol/L |
| LDL-2 Particle Number (LDL2-P) | <150 | 150 - 200 | >200 nmol/L |
| LDL-3 Particle Number (LDL3-P) | <190 | 190 - 260 | >260 nmol/L |
| LDL-4 Particle Number (LDL4-P) | <230 | 230 - 330 | >330 nmol/L |
| LDL-5 Particle Number (LDL5-P) | <290 | 290 - 400 | >400 nmol/L |
| LDL-6 Particle Number (LDL6-P) | <300 | 300 - 450 | >450 nmol/L |
| ApoB-100 and TG in Atherogenic Lipoproteins | |||
| LDL-apoB | <70 | 70 - 100 | >100 mg/dL |
| IDL-apoB | <4.0 | 4.0 - 6.0 | >6.0 mg/dL |
| VLDL-apoB | <6.0 | 6.0 - 10.0 | >10.0 mg/dL |
| LDL-TG | <24 | 24 - 28 | >28 mg/dL |
| IDL-TG | <6.0 | 6.0 - 10.0 | >10.0 mg/dL |
| VLDL-TG | <60 | 60 - 90 | >90 mg/dL |
| HDL Particles | |||
| HDL Particle Level (HDL-P) | Male: >38.0 Female: >42.0 | 33.0 - 38.0 37.0 - 42.0 | <33.0 μmol/L <37.0 μmol/L |
| Lipoprotein Cholesterol Esterification |
|||
| LDL-Free Cholesterol/LDL-cholesterol (LDL-FC/LDL-C) | <0.5 | ≥0.5 | |
| HDL-Free Cholesterol/HDL-cholesterol (HDL-FC/HDL-C) | <0.5 | ≥0.5 | |
Clinical Significance
LipoMap®
- 50% of people who suffer a heart attack or stroke have normal LDL cholesterol 1-2, hinting at hidden risk factors.
- Provides a thorough tool to measure and optimize the full spectrum of lipids lipoproteins and apolipoproteins.
- Studies show that LDL Particle Number (LDL-P) and HDL Particle Number (HDL-P) are superior to LDL-C, HDL-C, and cholesterol efflux capacity measurement in CVD risk assessment. 1-12
- Characterizes atherogenic dislipidemia associated with metabolic syndrome and improvements resulting from treatment.
- Hypocholesterolemia–where direct LDL-C is <10 mg/dL.
- Helps identify dysbetalipoproteinemia, familial combined hyperlipidemia, and certain genetic HDL-C deficiencies by measuring a broader array of lipoproteins such as IDL-C and particle number, VLDL-C and particle number, and the LDL-FC/LDL-C and HDL-FC/HDL-C ratios.
References:
- Blake GJ, Otvos JD, Rifai N, Ridker PM. Low-density lipoprotein particle concentration and size as determined by nuclear magnetic resonance spectroscopy as predictors of cardiovascular disease in women. Circulation. 2002; 106:1930-7.
- Otvos JD, Collins D, Freedman DS, Shalaurova I, Schaefer EJ, McNamara JR, Bloomfield HE, Robins SJ. Low density and high-density lipoprotein particle subclasses predict coronary events and are favorably changed by gemfibrozil therapy in the Veteran Affairs High Density Lipoprotein Intervention Trial. Circulation 2006; 113:1556-1563.
- Cromwell WC, Otvos JD, Keyes MJ, Pencina MJ, Sullivan L, Vasan RS, Wilson PW, D’Agostino RB. LDL particle number and risk of future cardiovascular disease in the Framingham Offspring Study – implications for LDL management. J Clin Lipidol 2007; 1:583-592.
- Mora S, Otvos JD, Rifai N, Rosenson RS, Buring JE, Ridker PM. Lipoprotein particle profiles by nuclear magnetic resonance compared with standard lipid and apolipoproteins in predicting incident cardiovascular disease in women. Circulation 2009; 119:931-939.
- Mackey RH, Greenland P, Goff DC Jr, Lloyd-Jones D, Sibley CT, Mora S. High-density lipoprotein cholesterol and particle concentrations, carotid atherosclerosis, and coronary events: MESA (multi-ethnic study of atherosclerosis). J Am Coll Cardiol. 2012; 60:508-16.
- Khera AV, Demler OV, Adelman SJ, Collins HL, Glynn RJ, Ridker PM, Rader DJ, Mora S. Cholesterol efflux capacity, high-density lipoprotein particle number, and incident cardiovascular events: an analysis from the JUPITER Trial (Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin). Circulation. 2017; 135:2494-2504.
- Ikezaki H, Lim E, Cupples LA, Liu CT, Asztalos BF, Schaefer EJ. Small dense low-density lipoprotein cholesterol is the most atherogenic lipoprotein parameter in the prospective Framingham Offspring Study. J Am Heart Assoc. 2021; Feb 15:e019140.
- Schaefer EJ, Geller AS, Endress G. The biochemical and genetic diagnosis of lipid disorders. Curr. Opin. Lipidology 2019; 30:56-62.
- Schaefer EJ, Tsunoda F, Diffenderfer M, Polisecki E, Thai N, Asztalos B. The Measurement of Lipids, Lipoproteins, Apolipoproteins, Fatty Acids, and Sterols, and Next Generation Sequencing for the Diagnosis and Treatment of Lipid Disorders. In: De Groot LJ, Beck-Peccoz P, Chrousos G, Dungan K, Grossman A, Hershman JM, Koch C, McLachlan R, New M, Rebar R, Singer F, Vinik A, Weickert MO, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc;2016; Mar 29 p 1-69.
- Corral P, Geller AS, Polisecki EY, Lopez GI, Bañares VG, Cacciagiu L, Berg G, Hegele RA, Schaefer EJ, Schreier LE. Unusual genetic variants associated with hypercholesterolemia in Argentina. Atherosclerosis. 2018;277:256-261.
Chyzhyk V, Kozmic S, Brown AS, Hudgins LC, Starc TJ, Davila AD, Blevins TC, Diffenderfer MR, He L, Geller AS, Rush C, Hegele RA, Schaefer EJ. Extreme hypertriglyceridemia: Genetic diversity, pancreatitis, pregnancy, and prevalence. J Clin Lipidol. 2019;13:89-99. - Schaefer EJ, Anthanont P, Diffenderfer MR, Polisecki E, Asztalos BF. Diagnosis and treatment of high-density lipoprotein deficiency. Prog Cardiovasc Dis. 2016;59:97-106.
Tani M, Horvath KV, Lamarche B, Couture P, Burnett JR, Schaefer EJ, Asztalos BF. High-density lipoprotein subpopulation profiles in lipoprotein lipase and hepatic lipase deficiency. Atherosclerosis.2016;20;253:7-14. - Geller AS, Polisecki EY, Diffenderfer MR, Asztalos BF, Karathanasis SK, Hegele RA, Schaefer EJ. Genetic and secondary causes of severe HDL deficiency and cardiovascular disease. J Lipid Res. 2018;59:2421-2435.
Treatment Options
LipoMap®
- The majority of lipid abnormalities can be normalized by lifestyle changes and/or medications, which are complementary treatment modalities.
- Lifestyle can improve many parameters, including the size distribution of the LDL, and effectiveness of HDL particles.
- Prior to the use of lipid lowering agents, it is important to identify and treat secondary causes including obesity, diabetes, hypothyroidism, liver disease, and kidney disease if possible, and/or the use of oral estrogens, testosterone, or steroids.
- For high risk patients and those with established CVD, it is very important to optimize LDL particle number, LDL-C, sdLDL-C, and LDL6-P, which may require medications including statins, ezetimibe, and if necessary proprotein convertase subtilisin kexin 9 (PCSK9) inhibitors.
- In addition to the LipoMap, consider measuring Lp(a), Cholesterol Balance®, Fatty Acid Balance™ and inflammatory, metabolic and genetic markers as indicated to optimize diagnosis and treatment.
