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Review
. 2023 Sep 4;120(35-36):582-588.
doi: 10.3238/arztebl.m2023.0150.

Lipid Profile and Lipoprotein(a) Testing

Klaus G Parhofer  1 , Ulrich Laufs
Affiliations
Review

Lipid Profile and Lipoprotein(a) Testing

Klaus G Parhofer et al. Dtsch Arztebl Int. .

Abstract

Background: The treatment of dyslipidemias plays a major role in the primary and secondary prevention of cardiovascular disease. Proper evaluation of the patient's lipid status is very important for risk assessment and as a guide to treatment.

Methods: This review is based on publications retrieved by a selective search of the literature, including current guidelines.

Results: Measurement of the plasma concentration of cholesterol, triglycerides, HDL- and LDL-cholesterol, calculation of the non-HDL cholesterol concentration, and-on a single occasion-determination of the lipoprotein (a) concentration enable the clinician to quantify the lipid-associated health risk and monitor the effects of treatment. These blood tests can be performed in a non-fasting state except in special situations (particularly, hypertriglyceridemia). The HDL quotient is an obsolete measure. The main goal of treatment is to achieve an LDL-cholesterol level adequate to the patient's cardiovascular risk through lifestyle modification and, if necessary, medication. A high lipoprotein (a) concentration cannot be lowered with orally administered drugs; above all, patients should lower their LDL-cholesterol levels while minimizing all other risk factors.

Conclusion: Measurement of the concentration of cholesterol, triglycerides, and HDL- and LDL-cholesterol and calculation of the non-HDL-C suffice as a guide to lipid-lowering treatment. The primary therapeutic goal is to lower LDL cholesterol.

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Figures

Figure 1
Figure 1
Allocation lipids – lipoprotein fractions ApoB, apolipoprotein B; -C, cholesterol; HDL, high-density lipoprotein; IDL, intermediate-density lipoprotein; LDL, low-density lipoprotein; Lp(a); lipoprotein (a); VLDL, very-low-density lipoprotein; TG, triglyceride
Figure 2
Figure 2
Possible treatment algorithm to achieve the LDL cholesterol target *1LDL targets according to ESC and EAS are listed in Table 2; *2In acute coronary syndrome, a significant decrease should be induced as soon as possible; re-evaluation after 4–6 weeks is useful; *3typically high-dose atorvastatin (40 mg/d) or rosuvastatin (20 mg/d or 40 mg/d); *4Only in case of very high risk and a marked gap to the target (prescription restriction must be considered); ESC, European Society of Cardiology; EAS, European Atherosclerosis Society; LSM, lifestyle modification
Figure 3
Figure 3
Recommended management of patients with elevated lipoprotein (a) levels LDL, low-density lipoprotein; Lp(a), lipoprotein (a)
See this image and copyright information in PMC

References

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