Lipid Profile

Presented by:
Dr. Md Razib Hasan
MBBS,BCS,DCP
Clinical Pathologist, MMC
Lipid Profile

Lipid profile is a group of different lipid fractions

used to assay the lipid status of an individual .
Lipid profile tests consists of
1).Triglyceride.
2).Total cholesterol .
3). Low density lipoprotein cholesterol (LDL-C)
4). High density lipoprotein cholesterol (HDL-C),
 Hyperlipidaemia is the term use to denote raised
serum levels of one or more of total cholesterol,
LDL-C, triglycerides or both total TC & TG.
(combined hyperlipidaemia).
 Dyslipidaemia is a wider term that also include
disorder of lipoprotein metabolism including
lipoprotein over production or deficiency
manifested by ↑ TC, LDL-C & TG & ↓ low level
of HDL – C.
Frederickson -WHO classification
Type I:
I incr. chylomicrons, reduced HDL, decreased of
lipoprotein lipase or altered of apo CII
(hyperchylomironemia)
Type II-A:
II-A raised LDL only; LDL receptor deficiency
( polygenic hypercholesterolaemia or FH)
Type II-B:
II-B raised VLDL + LDL; often reduced HDL;
increased production of VLDL + decreased LDL receptor
& increased Apo B.
Type III:
III raised IDL (F.dysbetalipoproteinemia); Defect in
Apo E synthesis. (formerly known as broad beta
disease)
Frederickson -WHO classification

Type IV:
IV raised VLDL; often reduced HDL;
increased VLDL production & decreased
elimination.(Endogenous hyperlipemia)
Type V:
V raised chylomicrons + VLDL;
reduced HDL; increased VLDL production
& decreased LPL (F.hypertriglyceridemia)
Fredrickson’s Classification
Type Electrophoretic Increased LP
I Increased Chyl. Chyl.
II a Increased β LP LDL
II b Increased β & LDL & VLDL
Pre- β LP
III Broad β LP IDL
IV Increased Pre- VLDL
β LP
V Increased Chyl. Chyl & VLDL
& Pre- β LP
Indications for estimation lipid profile:

1. Hypertension
2. Ischemic heart disease
3. Diabetes mellitus
4. Cerebrovascular diseases
5. Hyper and hypothyroidism
6. Dyslipidemia
7. A routine examination after age of 40.
Preparation for lipid profile test

 Certain kinds of physiologic variation and errors can

be introduced before or during venipucture.
 Ideally the patient is requested to fast for 12 hours
before venipuncture.
 Usual diet for a couple of weeks.
 Usual activities in previous 3 days.
 Individual must be free from trauma, surgery , acute
infection, pregnancy
Sample:
Either plasma or serum can be used

Anticoagulants:
 Na-Citrate
 EDTA:
 LDL cholesterol:
Method to measure LDL cholesterol assume that total cholesterol
is composed primarily of cholesterol in VLDL, LDL, and HDL. In
practice, LDL can be measured indirectly usually of the Fried Wald
equation.

 Fried Wald equation:

In the most widely used indirect method, cholesterol, triglyceride
and HDL cholesterol are measured and LDL cholesterol is
calculated from the primary measurements by use of the empirical
equation of Fried Wald:
 Fried Wald equation:
 LDL cholesterol = Total cholesterol - HDL cholesterol –
Triglyceride/5.
Where all concentration are given in milligrams per deciliter.
(Triglyceride /2.22 is used when LDL cholesterol is expressed
in millimoles per liter).
Limitation of this formula:

• When TG concentration is more then 400mg/dl,

• sample contain Chylomicron, chylomicron remnants or
VLDL remnants.
• pt. with type III hyperlipoproteinemia.
• For this method overestimate VLDL-Cholesterol and
underestimate LDL-Cholesterol.
Interpretation
 Normal range
 Total cholesterol : < 200mg/dl
 Triglyceride : < 150mg/dl
 LDL : < 130mg/dl
 HDL : > 40mg/dl
 Total cholesterol:
 Values increase with age and the rise is greater in men than in
women during the reproductive years. Thereafter, levels in
women increase to those in men levels are highest in the 6th or
7th decades.
Hypercholesterolaemia:
1. Nephrotic syndrome
2. Myxoedema
3. Obstructive jaundice (most commonly when there is
obstruction in the large bile duct)
4. Diabetes mellitus
5. Chronic glomerulonephritis
6. Primay (Xanthomatosis) biliary cirrhosis (very high)
7. Drug induced cholestasis
8. Hypopituitarism
Hypocholesterolaemia:

1. Hyperthyroidism
2. Pernicious anaemia and other anaemia
3. Haemolytic jaundice
4. Malabrosption syndrome
5. Sever malnutrition
6. Abetalipoproteinaemia
7. Familial hypobetalipoproteenemia
Triglyceride : Increases
1. Obesity
2. Diabetes mellitus
3. Type-I glycogen storage disease
4. Alcoholism
5. Hypothyroidism
6. Nephrotic syndrome
7. Hypoalbuminemia
8. Hyperuricaemia
Decreased value:

1. Large doses of ascorbic acid

2. Administration of halofenate
3. Administration of heparin
4. Oral hypoglycemic drug
5. Metformin
6. Phenformin
7. Clofibrate
8. Bezafibrate
Factors promoting elevated blood lipids

 age
 men >45 years of age; women > 55 years of
age
 family history of CAD
 smoking
 hypertension >140/90 mm Hg
 low HDL cholesterol
 obesity >30% overweight
 diabetes mellitus
 inactivity/ lack of exercise
Dyslipidemia(Dyslipoproteinemia)
 Group of disorders characterized by
abnormal ( High/low) plasma lipoprotein
and lipid concentration .
Classification:
 1. Hyperlipidemia
• Primary Hyperlipidemia
• Secondary Hyperlipidemia

 2. Hypolipidemia
• Primary Hypolipidemia
• Secondary Hypolipidemia
Primary Hyperlipidemia
Idopathic
 1. Familial Hyperchylomicronemia
 2. Familial hypercholesterolemia
 3. Familial combined hyperlipidemia
 4. Familial dysbetalipoproteinemia
 5. Familial Hypertriglyceridemia
Secondary hyperlipidemia

Due to
 Nutritional factor. Eg. Excess calories indiet, excess
consumption of saturated fat
 Hepatic diseases: Hepatitis, obstructive jaundice
 Obesity, alchoholism, Diabetes mellitus
 Renal diseses :CRF
 Endocrine diseases: Hypothyroidism, Cushing syndrome
 Drugs: Steroid, OCP
Primary Hypolipidemia

idopathic
 Primary hypoalpha lipoproteinemia
 Abetalipoproteinemia
 Hypobetalipoproteinemia
Secondary Hypolipidemia

Due to
 Chronic cachexia : malignancy
 Chronic malabsorbtion
Clinical importance of dyslipidemia

 Atherosclerotic dsorders. It occur mostly due to

hypercholesterolemia
- coronary artery disease
-Cerebrovascular disease
-Peripheral vascular disease
 Fatty liver disease
 Acute pancreatitis