An Approach to Lipid Testing

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Mary E. Tang, M.D.
May 1998

Lipid Testing
Evaluation and Treatment
Recommendations

The approach to lipid testing involves review of the risk factors, a list of appropriate tests to be performed, and evaluation, treatment and follow up. The approach outlined below is based on the summary of the second report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel II). Reference: JAMA, June 16, 1993 - Vol 269, No. 23.

Dr. Mary Tang is a Clinical Pathologist at Fletcher Allen Health Care in Burlington, Vermont. Questions regarding this protocol may be directed to Dr. Tang at 802-847-5121 or 800-991-2799.

Lipid Testing

Risk Factors:

Male>/=45 years	_____________
Female>/=55 years(or premature menopause w/o Estrogen Tx	_____________
Family history of coronary artery disease in a male<55 or female<65	_____________
Smoker	_____________
Hypertension	_____________
Diabetes	_____________
HDL<35mg/dL.	_____________
HDL>/=60 - subtract one risk factor	_____________

Total # of risk factors	_____________

Tests: Cholesterol & HDL, on all patients over 18 yrs. old (does not need to be fasting)

Cholesterol	___________
HDL	___________

Patients with known Coronary Heart Disease require a lipid profile (fasting sample required)

Evaluation, Treatment & Follow Up Lipid Testing

All patients: General dietary, risk factor and physical activity recommendations.

Cholesterol mg/dl	HDL mg/dl	Risk Factors	Follow up
<200	>/=35		Recheck Cholesterol & HDL within 5 years
200-239	>/=35	0 or 1	Recheck Cholesterol & HDL in 1-2 years
200-239	>/=35	2 or more	Do Lipid profile
>/=240			Do Lipid profile
	<35		Do Lipid profile

Lipid profile = total cholesterol, HDL cholesterol, triglyceride, calculated LDL cholesterol - Fasting
Lipid Profile (Lipid Profile requires fasting sample)

*LDL mg/dl**	Risk Factors	Follow up	Goal
<130		Recheck total cholesterol & HDL within 5 years
130-159	0-1	Educate on diet, exercise. Recheck lipid profile yearly
130-159	2 or more	Dietary therapy, exercise. Recheck total cholesterol at 4-6 wks. until stable, then at 3, 6, 9, and 12 mo., then every 6 months thereafter	LDL<130 mg/dl (Approx. Cholesterol <200 mg/dl)
>/= 160	0 or 1	Dietary therapy, exercise. Recheck total cholesterol at 4-6 wks. until stable, then at 3, 6, 9, and 12 mo., then every 6 months thereafter	LDL<160 mg/dl (Approx. Cholesterol <240mg/dl)
>/= 160	2 or more	Dietary therapy, consider drug therapy. Recheck total cholesterol at 4-6 wks. until stable, then at 3, 6, 9, and 12 mo., then every 4 to 6 months thereafter Check LDL at least annually	LDL<160 mg/dl (Approx. Cholesterol <240mg/dl)
>/= 190	0 or 1		LDL<160 mg/dl (Approx. Cholesterol <240mg/dl)

*based on the average of two LDL determinations

Recommendations for Patients with Known CAD

LDL mg/dl	Follow up	Goal
<100	Recheck Lipid Profile annually	LDL<100 mg/dl
100-129	Dietary therapy, exercise. Recheck total cholesterol at 4-6 wks. until stable, then at 3,6,9, and 12 mo., then every 6 months thereafter.	LDL<100 mg/dl
>/= 130	Consider drug therapy. Recheck LDL at 4-6 wks. until stable, then at 3, 6, 9, and 12 mo., then every 4 to 6 months thereafter Check LDL at least annually	LDL<100 mg/dl

This protocol is a joint initiative of NECLA and the VSPS

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