Lipidogram decoding in adults is the norm of HDL. Lipid profile

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Cardiovascular diseases lead in the number of cases worldwide, and the main cause of them is considered to be a violation of fat metabolism with atherosclerosis that affects the vascular walls. Laboratory tests, including a lipid profile, help to objectively assess the degree of risk.

You can find out about the amount of total cholesterol from a biochemical blood test, but only this indicator does not make it possible to reliably judge the presence or absence of pathology. The study of the lipid spectrum involves determining the concentration of not only cholesterol, but also other fatty blood fractions. These indicators are very important in assessing the degree of risk of pathology of the heart and blood vessels, therefore, they are indicated for people predisposed to atherosclerosis, myocardial ischemia, and diabetes.

For analysis, venous blood is taken, and the patient must know some of the features of preparing for it and the conditions that may affect the result. The decoding of the lipidogram is carried out by a general practitioner, a cardiologist, an endocrinologist.

Lipidogram indicators

The pathology of fat metabolism plays a key role in the genesis of various diseases and, above all, vascular lesions. It is no longer in doubt that lipid metabolism disorders influence the development of atherosclerosis, and this disease is the path to dangerous lesions of the aorta, kidney vessels, and limbs.

Timely detection of deviations from cholesterol and lipid fractions is necessary not only for the early diagnosis of the pathology of the cardiovascular system, but also for the prevention of severe complications of atherosclerosis.

Many people know that the level is the most important indicator of fat metabolism, so its increase is always a concern. However, for correct conclusions, only this indicator is not enough, because cholesterol can also increase in absolutely healthy individuals without provoking atherosclerosis. To assess fat metabolism, it is important to establish the concentration of lipid fractions, the fluctuations of which characterize the pathology or the norm to a greater extent.

Lipidogram with the study of all fatty components of blood plasma makes it possible to more accurately assess the risk of atherosclerosis. The analysis may reveal abnormalities even when the total cholesterol concentration is within normal limits.

Cholesterol is an integral component of cell membranes, it is part of the bile necessary for proper digestion, it is the precursor of sex hormones, without which there is no development, puberty and functioning of an adult organism. In plasma, cholesterol is bound to lipoprotein proteins.

In addition to cholesterol (Cholesterol), lipidogram - a blood test for lipids includes indicators such as high, low and very low density - HDL, LDL, VLDL. It is they who make up the total cholesterol, but their role is different, therefore, the disease is not judged by total cholesterol. Based on the content of these components, plasma atherogenic coefficient, which serves as a prognostic factor for cardiovascular disease.

Cholesterol is formed by liver cells and enters the body from the outside with food, and its excess is excreted. VLDL are not saturated with cholesterol and are able to bind it, becoming LDL. High-density lipoproteins capture excess cholesterol from the blood and deliver it to hepatocytes, where cholesterol is converted into fatty acids or incorporated into very low density lipoproteins, thus “neutralizing”.

High-density lipoproteins are classified as anti-atherogenic fractions, that is, these components prevent atherosclerosis, removing "bad" cholesterol from the circulation. With their decrease, the likelihood of atherosclerosis increases.

The bulk of blood fats are LDL, which are endowed with the ability to "stick" to the walls of blood vessels and participate in the formation of fat-protein plaque. They account for up to 70% of total cholesterol. If these substances do not go beyond the limits of the norm, then the risk of pathology is minimal, because the exchange occurs in the right way. In cases where LDL is elevated and settles on the vascular walls, we can talk about a high probability of atherosclerosis, even if total cholesterol retains normal values.

Triglycerides are a normal component of the blood, they are considered natural metabolites that are part of VLDL, ingested and excreted by the liver. Their main volume is concentrated in adipose tissue, they are the main energy substrate in the body. Being an integral part of metabolic processes, they, at the same time, can cause serious harm when normal concentrations are exceeded.

It has been established that triglycerides increase in atherosclerosis, diabetes mellitus, excess weight, hypertension and play a significant role in the genesis of coronary heart disease and vascular changes in the brain.

So, the lipidogram consists of the definition:

• total cholesterol;
• triglycerides;
• HDL;
• LDL;
• VLDL.

The coefficient of atherogenicity, which allows to quantify the risk of atherosclerotic lesions of the vascular endothelium, is calculated according to these indicators: the sum of VLDL and LDL values ​​is divided by the HDL level. (Normal - up to 3.5).

For the correct interpretation of the lipidogram, some other conditions must be taken into account:

1. Age;
2. Heredity in relation to cardiovascular pathology;
3. The presence of carbohydrate metabolism disorders;
4. The presence and degree of obesity;
5. Blood pressure level;
6. Bad habits (smoking, alcohol).

Only an objective assessment of the lipid spectrum, taking into account these factors, gives the most accurate prognosis for atherosclerosis and diseases of the heart and blood vessels.

When should the lipid spectrum be examined?

The study of the lipid spectrum aims not only to determine the risk of heart and vascular diseases, but also to assess the effectiveness of treatment with an already established diagnosis,. It is important for the dynamic monitoring of patients who are on and taking drugs to reduce cholesterol.

Indications for a lipid profile are:

• Examination as part of preventive measures for people over 20 years old - once every five years;
• Increase in total cholesterol in a biochemical blood test;
• The presence of changes in the concentration of cholesterol in the past;
• Unfavorable heredity, when among close relatives there are patients with severe atherosclerosis, hereditary forms of fat metabolism disorders;
• The presence of risk factors - smoking, diabetes, overweight, arterial hypertension, age over 45 and 55 years for men and women, respectively;
• Ongoing treatment with lipid-lowering drugs, the appointment of a special diet (control effect).

How to pass the analysis correctly and what affects the result?

Heading for any study or analysis, we all want to get the correct and most reliable result, and in the case of a lipid profile, as with other analyzes, you need to know and follow some rules so as not to distort the indicators.

The lipid spectrum of the blood is very sensitive to external conditions. This doesn't just apply to eating. The result can be influenced by excitement, excessive physical effort, medication, recent other studies, infections, etc., so all these factors must be kept in mind.

Blood sampling for lipid spectrum is recommended in the morning, on an empty stomach, at least 12 hours after the last meal. Half an hour before the study, physical activity and psycho-emotional experiences, as well as smoking, should be excluded. The analysis should not be carried out in patients with acute myocardial infarction and during the first 3 months from the moment of its occurrence.

The result can change:

Many medications can cause an increase or decrease in both total cholesterol and its fractions, so if you are taking any medication, be sure to notify your doctor about this.

Total cholesterol rises in the treatment of beta-blockers, by the way, often prescribed for pathology of the heart and blood vessels, which at the same time serves as a reason for the lipid profile. Hormones, some diuretics and tranquilizers also increase total cholesterol.

Decrease in total cholesterol noted in persons taking lipid-lowering drugs (,), as well as when prescribing estrogen, androgen, allopurinol and others.

Corticosteroid and sex hormones cause an increase not only in total cholesterol, but also in HDL and LDL. Hormonal contraceptives increase cholesterol, LDL and lower HDL.

The ability of many drugs to influence lipid profile indicators makes it necessary not only to take it into account when interpreting the results, but also to closely monitor patients taking such drugs, because their risk of developing vascular and heart pathology may be increased.

Norm or pathology?

When deciphering the lipidogram in adults, the specialist first assesses whether there are deviations in the numbers of specific indicators. It is believed that the risk of atherosclerosis is increased if total cholesterol, LDL, VLDL and TG exceed normal values. The pathology is also evidenced by an atherogenic coefficient of more than three and a reduced content of high density lipoproteins.

The norm is considered the values ​​​​of lipid spectrum indicators:

• Atherogenic coefficient - 2.2-3.5;
• TG level up to 2.25 mmol/l;
• HDL - 1.03-1.55;
• LDL up to 3.3;
• VLDL - 0.13-1.63 mmol per liter;
• Total cholesterol - up to 5.2 mmol / l.

High-density lipoproteins have different normal values ​​for women and men. So, an increased likelihood of atherosclerotic lesions and cardiovascular pathology is indicated by HDL below 1 mmol per liter of blood in men and less than 1.3 in women. Low risk is defined for people of both sexes if HDL exceeds 1.55 mmol per liter.

The coefficient of atherogenicity can also serve as a prognostic indicator. If it is below three, then the risk of atherosclerosis and vascular lesions is minimized. The level of the coefficient in the range of 3-4 may indicate an increased risk of atherosclerosis, and with a value of 5 or more, patients usually already have certain manifestations of atherosclerosis - coronary heart disease, dyscirculatory encephalopathy, kidney pathology, impaired blood flow in the extremities. With such figures, vascular complications are quite likely.

A positive lipid profile result, i.e. an increase in its atherogenic indicators can be observed with a variety of pathologies:

1. Family, hereditary forms;
2. with atherosclerotic changes;
3. Hepatitis, cirrhosis of the liver;
4. Pathology of the urinary organs;
5. Decreased production of thyroid hormones;
6. Diseases of the pancreas (pancreatitis, diabetes);
7. Overweight.

A physiological increase in cholesterol is possible during pregnancy.

Reducing total cholesterol and its fractions is possible with:

• malignant tumors;
• Pulmonary pathology;
• thyrotoxicosis;
• Infectious diseases, sepsis;
• burn disease;
• Starvation.

High-density lipoproteins usually decrease with coronary heart disease, atherosclerosis, myocardial infarction, diabetes, and stomach ulcers.

The nature of the food consumed has a great influence on the indicators of fat metabolism. Even if there is no atherosclerosis yet, changes in the lipid spectrum already create a risk of heart and vascular diseases. Abuse of quickly digestible carbohydrates, animal fats, fatty and fried foods, alcohol creates an excessive load of cholesterol, which the body is not able to metabolize. Over time, increasing concentrations of its derivatives are deposited in the vascular endothelium.

If the doctor noticed elevated cholesterol in a biochemical blood test, then he will send for a lipid spectrum study to exclude metabolic disorders. Patients with normal cholesterol levels still need such a detailed analysis if they are exposed to risk factors. Persons who have an unfavorable heredity for dyslipidemia are examined regularly, at least once a year, regardless of age.

The price for the study of the lipid spectrum depends on the level of the clinic and the locality, varying between 500 and 1500 rubles. The analysis is quite common, so there is usually no difficulty in finding a clinic or laboratory where it can be performed.

Lipidogram - what is this blood test?

Lipidogram is a complex biochemical blood test that determines its lipid profile (status / spectrum). That is, all levels (amounts) of fats / lipids, in the composition of various blood fractions (in particular, in the structure of lipoproteins). As a rule, it is prescribed by treating specialists (cardiologists, therapists or general practitioners) to adequately assess the risks of developing CVD (cardiovascular diseases of atherosclerotic origin / origin). In addition, the lipidogram allows you to identify and evaluate atherogenicity, that is, the body's tendency to. For example, when there is a suspicion (for this disease), but the indicators of total cholesterol (respectively, in the general blood test / from a finger) are normal.

Foreign synonyms / names: Coronary Risk Panel, Lipid Profile, Fasting Lipid Panel, Non-fasting Lipid Panel, Cholesterol Panel, Lipid Test.

Lipid profile - key indicators

Some lipidogram indicators are determined directly (using special laboratory equipment), others - by the usual / calculated method (using medical formulas). Next, we will consider the main indicators of both our (domestic) laboratories and foreign ones (in case of treatment of cardiovascular diseases abroad).

Cholesterol Total (Total / Blood Cholesterol)– total amount of cholesterol (in all its fractions / lipoprotein particles: cholesterol + apoproteins). Determined directly.

HDL cholesterol (HDL-C)– quantity (High-density Lipoprotein Cholesterol). It is called “good” cholesterol, because it “collects” excess “bad” cholesterol in the blood, and transports it back to the liver (for processing or excretion through the gastrointestinal tract). Determined directly.

LDL-C (LDL-C)- concentration (Low-Density Lipoprotein Cholesterol). It is commonly referred to as "bad" cholesterol. Since, being in excess, it is able to be deposited in the walls of blood vessels ( see video below), forming "cholesterol/atherosclerotic plaques".

As a rule, (in many of our and foreign clinical laboratories) its amount is determined by the calculation method (using the Friedwald formula, developed in 1972). By the way, at the same time - and with the concentration of VLDL cholesterol in the blood. Using the indicators of the so-called "classic" lipid profile: total cholesterol, HDL cholesterol and triglycerides (TG).

• LDL cholesterol (mg/dl) = total cholesterol - HDL cholesterol - (TG/5)*
• LDL cholesterol (mmol / l) \u003d total cholesterol - HDL cholesterol - (TG / 2.2) *

* - this is, just the same, VLDL cholesterol.

IMPORTANT NOTE: this method of calculation is NOT (!) used by laboratories if the level of triglycerides is more than 4.5 mmol/l (400 mg/dl).

Triglycerides (Triglycerides / TG ​​/ TRIG)- the level in all lipoprotein particles, most of which are located precisely in VLDL particles.

VLDL-C (VLDL-C)- the amount of Cholesterol in Very Low Density Lipoproteins (Very Low-Density Lipoprotein Cholesterol). As a rule, it is almost always determined by the Friedwald formula (mentioned above): Triglycerides (TRIG) / 5 (or 2.2). That is, simply put, by dividing the total amount of TG (TG) by the number 5 (for results in mg / dl) or by 2.2 (for results in mmol / l).

Coefficient (index) of atherogenicity (KA / IA) is the ratio of "bad" to "good" cholesterol. It is used - both by our doctors and foreign ones, only calculating - according to (slightly) different formulas, although, in fact, they are the same:

• KA (IA) = (Total Cholesterol - HDL Cholesterol) / HDL Cholesterol
• KA (foreign) = Non-HDL-C / HDL-C

Foreign lipid profile

And now the indicators of foreign lipidograms. They have pretty much the exact same thing. With the exception of…

Non-HDL-C (non-HDL-C)- that is, everything that is NOT HDL cholesterol.

Non-HDL-C = Total Cholesterol - HDL-C or

Non-HDL Cholesterol = Total Cholesterol - HDL Cholesterol

Until 2013, it was used for the (familiar to us) calculation of the atherogenic coefficient, until new recommendations appeared (from the American Heart Academy). However, it is still used to decipher "planned" lipidograms (in healthy men and women) every 4-6 years. It is also indicated in the results of the lipid profile of adolescents / boys and girls, as a rule, donating blood without starvation / not on an empty stomach (9-12 hours before the analysis).

Cholesterol/HDL ratio- according to the new recommendations (American Heart Academy / American Heart Association), doctors now use - not the ratio of "bad" cholesterol to "good", but the ratio of "total/absolute" (all the same) "good". If expressed very simply and accessible. That is, total cholesterol: HDL cholesterol.

When is a lipid profile prescribed?

For healthy / adult women and men (i.e. without any risk factors for cardiovascular disease) it is recommended to undergo a lipid profile (on an empty stomach) every 4-6 years (after reaching the age of 20). In addition, it is mandatory to be prescribed if, according to the results of the annual biochemical blood test (for health control purposes), a “high” Total Cholesterol was detected. That is, 6.22 mmol/L (240 mg/dL) and above. Or "borderline/high" (at the discretion of the physician) in the range: 5.18 to 6.18 mmol/L (200-239 mg/dL).

For adult women and men who already have RISK FACTORS for the development of atherogenic CVD ( they are listed below ), or elevated cholesterol levels (according to the results of a previous comprehensive study of the lipid profile / blood spectrum), the lipid profile may be prescribed more often (at the discretion of the attending specialist).

Seals in the walls of blood vessels, caused by the formation (and growth) of so-called "cholesterol plaques", seriously interfere with blood circulation. Thus, provoking - the development of vascular diseases ....

Atherogenic RISK FACTORS for CVD (cardio/vascular disease) according to the 2002 NCEP (National Cholesterol Research Program) guidelines include:

• smoking (interestingly, both active and excessive - passive);
• overweight / BMI of 25 or more (or obesity / BMI of 30 or more / );
• "unhealthy" diet (which is good and bad, see;
• physical inactivity (sedentary lifestyle / "sedentary" work);
• age (when men reach 45 years old or women 50-55 years old);
• hypertension (high blood pressure from 140/90 mm Hg and above);
• a family history of premature CVD cardiovascular disease (heart attacks/heart attacks in the father under the age of 55 or in the mother under the age of 65);
• heart failure syndrome (IHD), as well as previous myocardial infarction or stroke;
• diabetes or pre/diabetes.

NOTE: HDL cholesterol levels: 60 mg/dL (1.55 mmol/L) and above are considered a "negative risk factor" according to the same NCEP guidelines. That allows you to exclude from the total - one of the above / listed atherogenic factors.

• required - gender (male or female);
• race (Mongoloid, African American, etc.);
• and the so-called "Aspirin Therapy" (daily aspirin therapy), required for almost all men and women aged 50-60 years (depending on the state of health, and, of course, the absence of problems with blood clotting).

For children / teenagers, boys and girls , according to the recommendations of the AAP (American Academy of Pediatrics), a regular lipid profile (for prevention purposes) is prescribed:

• for the first time - for children in the transitional period of life: 9-11 years old (entry into adolescence);
• and one more time - for boys and girls aged from 17 to 21 years.

Early (between the ages of 2 and 8 years) or more frequent blood lipid profiles are recommended for children/adolescents/boys and girls at increased risk of developing heart disease. Some of which are similar to adult atherogenic factors: family history of CVD, diabetes, high blood pressure, overweight/obesity, etc. For children under 2 years of age, a lipidogram is NEVER prescribed!

A biochemical analysis for a blood lipid profile can be prescribed even for children aged 2 to 9 years ...

And, finally, one more case when doctors necessarily prescribe an extended / biochemical analysis for the lipid profile / blood spectrum - this is the control of the effectiveness of the treatment prescribed by them. Either a lifestyle change, a special diet and exercise therapy (physiotherapy exercises), or lipid-lowering drugs, for example,. If you use the last treatment option, you will be assigned a second lipid profile after 4-12 weeks(since the start of drug therapy). And then through every 3-12 months.

Proper preparation for a blood test

As a rule, a biochemical analysis for the lipid profile (spectrum) of the blood is taken on an empty stomach. However, at the discretion of the physician (especially for young adults without the cardiovascular risk factors listed above), this test may be performed without fasting. That is, without prior fasting 9-12 hours before donating venous blood. Immediately before the lipid profile (for 30-40 minutes) it is not recommended: to smoke and over / strain (both physically and emotionally). In most laboratories, before taking blood (from a vein), the person is allowed to sit in peace and quiet for at least 5 minutes.

What can negatively affect the results of a lipid profile, distorting it - truthfulness?

• taking medications (check them out), both lowering and increasing levels of Total Cholesterol, HDL, LDL and triglycerides (directly or indirectly);
• equally, taking dietary supplements, oral contraceptives or "sports" steroids, both lowering and increasing lipid levels;
• incorrect body position during venous blood sampling (for example, half / standing, half / sitting or lying down), the analysis is given - sitting;
• the presence of concomitant diseases (either still hidden, or advanced, or occurring without adequate treatment);
• "stormy holidays" the day before (with the use of excessive amounts of alcoholic beverages and / or fatty / fried foods);
• intense physical activity (most often, this happens to athletes during preparation for important competitions);
• adherence to a too “hard” diet (up to anorexia syndrome);
• prolonged stay in a stressful state (after a divorce, accidents, accidents / disasters, or other troubles in life);
• a study of the lipid profile / blood spectrum should never (!) be carried out - immediately after a myocardial infarction, and also for another 3 months after it;
• taking a lipid profile during pregnancy (this blood test is prescribed for women at least 6 weeks after the birth of the child).

Deciphering the results of the lipid profile (in tables)

Further, we suggest that you familiarize yourself with what the results of a biochemical analysis for a lipid profile / blood spectrum mean, separately (in tables) for all its indicators. At the same time, both ours / domestic (TC, HDL, LDL, Triglycerides, Coefficient / Index of Atherogenicity), and foreign (non-HDL-C / non-HDL-C).

LDL cholesterol (low density lipoprotein cholesterol / LDL-C)

Total cholesterol (ChS / Cholesterol total)

HDL cholesterol (high-density lipoprotein cholesterol / HDL-C)

Triglycerides (TG, TAG / TRIG) fasting blood test

For information on how , and what they mean for a person (or vice versa -) - click on the links. For women there is.

Coefficient (index) of atherogenicity (KA)

The reference values ​​of the atherogenic index (for adult men and women of age) according to the results of the lipid profile are in the range 2.0 to 3.5. High performance: over 3.0– for women (up to 55-60 years of age) or over 4.0- for men (up to 45-55 years of age) who do not suffer from coronary artery disease, they can indicate to the attending specialist (doctor) the presence of atherosclerosis. Although, for a more accurate assessment of the risks of developing atherosclerotic cardiovascular diseases, all other FACTORS (which we described above) must be taken into account.

non-HDL-C (not HDL-C)

It is used abroad and represents - the total amount of cholesterol in lipoproteins with the exception of - namely high-density lipoprotein cholesterol, i.e. HDL cholesterol. It is determined (according to the results of the lipid profile) by subtracting the HDL-C from the total cholesterol according to the formula:

non-HDL-C = Total cholesterol (TC) – HDL cholesterol (HDL-C)

What to do if lipid levels are above or below normal?

Condition number 1 for solving problems with lipids is a healthy lifestyle! And if you have it wrong, then this “case” needs to be urgently changed radically! First of all, stop smoking (if you like to “smoke”, for example, to think normally), and do not look for “truth in wine”. Avoid foods high in saturated (and trans) fats. Examine the heart and blood pressure, after which - take moderate physical activity. Just always start small - with regular walks in the fresh air and "simplified" morning exercises. Be sure to find a dietitian to make a diet specifically for your situation (according to lipid levels). Do not follow the "recipes" of diets described by dubious "experts".

And, finally, in the most extreme case, contact the clinic for one who can prescribe you drug therapy. As a rule, after assessing the risks of developing atherosclerotic CVD, as well as taking into account the borderline or high level of LDL cholesterol in the blood plasma. At the moment, there are already quite a few such drugs that normalize lipid levels (check them out). If any of the drugs (according to the results of a repeated lipid profile) does not sufficiently reduce the concentration of “bad” cholesterol or provokes side effects, then the attending specialist will replace it with another one. Just do not self-medicate! Most lipid-lowering drugs (for example,) have a lot of conditions for use!

Lipid spectrum (lipidogram) - a set of biochemical blood tests that allow you to assess the full state of fat metabolism in the body. The study includes the definition of:

• total cholesterol (OH);
• triglycerides (TG);
• (HDL);
• (VLDL);
• low density lipoproteins (LDL);
• coefficient of atherogenicity (KA).

In an extended lipid spectrum analysis, the lipid carrier proteins circulating in the blood, apoprotein A and apoprotein B, are also detected.

Compound

Cholesterol is the general name for fatty molecules that circulate in the blood. Cholesterol has several biological functions in the body. It is a structural component of the cytoplasmic membrane of all body cells. It is a precursor of the adrenal hormones corticosteroids, estrogen and testosterone. It is part of bile and fat-soluble vitamin D, which is responsible for the growth of bone and cartilage tissue and the immune defense of the body.

Since fat, and accordingly cholesterol, is hydrophobic in nature and cannot move independently in the blood, special transport proteins apoproteins join it. The protein + fat complex is called lipoprotein. According to their chemical and molecular structure, several types of lipoproteins are distinguished that perform their functions in the body.

- fraction of the lipid spectrum, which has anti-atherogenic properties. For the ability to bind excess fat in the body, transport it to the liver, where it is utilized and excreted through the digestive tract, HDL is called "good" or "useful" cholesterol.

Low and very low density lipoproteins- the main factor in the formation of atherosclerosis. Their main task is to transport cholesterol to all cells of the human body. In elevated concentrations, LDL and VLDL are able to "linger" in the vascular bed, deposited on the walls of the arteries and form cholesterol plaques.

Triglycerides are neutral fats circulating in the blood plasma, which are also. These lipids are the main fat reserve of the body, providing the energy needs of cells.

Atherogenic coefficient- this is the ratio of "useful" and "harmful" fats in the patient's blood, which is calculated by the formula: CA \u003d (OH - HDL) / HDL.

Apoproteins (apolipoproteins)- Carrier proteins of cholesterol fractions in the bloodstream. Apoprotein A1 is a component of HDL, apoprotein B is HDL.

Deviations from the norm in the lipid spectrum indicate violations of metabolic processes in the body and can lead to serious complications. Regular analysis and monitoring of its results will help prevent the development of diseases.

Indications for a lipid spectrum analysis

The study of the lipid spectrum is carried out for:

• diagnosing and monitoring the dynamics of atherosclerosis in patients with risk factors: smoking, alcohol abuse, cardiovascular pathology, arterial hypertension, diabetes mellitus, aggravated heredity;
• studying the state of fat metabolism in patients with coronary heart disease, after myocardial infarction;
• evaluation of fat metabolism in terms of management of patients with cerebrovascular diseases.

Recently, the analysis of all patients older than 50 years in most polyclinics is included in the scope of guaranteed screening (preventive) examination. This means that regardless of the reason for visiting a doctor, it should be carried out in the target age categories once a year (or every 2 years). If a deviation from the norm is detected at this stage, the patient may be assigned an extended blood test for the lipid spectrum.

In addition, it is recommended that all healthy young people undergo a lipid spectrum analysis once every 5 years. This will allow you to notice violations of fat metabolism in time and begin treatment.

Control of the treatment of atherosclerosis should also be carried out with the study of the lipid spectrum. A blood test is prescribed 1 time in 3 months during the period of selection of the drug and dose, and 1 time in 6 months in case of positive dynamics. Reducing cholesterol, LDL, VLDL and atherogenic coefficient indicates the correct selection of funds for the treatment of atherosclerosis.

How to prepare for the analysis?

Like any other biochemical test, lipid spectrum analysis requires a little preliminary preparation and adherence to the rules listed below:

• The study of the lipid spectrum is carried out in the morning on an empty stomach (fasting time should be at least 8 hours, but not more than 14). Drinking table water without gas is allowed. If there is no opportunity to donate blood in the morning, it is allowed to do this in the daytime. The interval between the last meal and blood sampling should be 6-7 hours.
• You should have dinner the day before, as usual, without adhering to a special diet: this way the results of the analysis on the lipid spectrum will be more reliable. Moreover, it is not necessary to break the habitual diet for a person within 1-2 weeks before the examination;
• It is recommended to stop smoking half an hour before blood sampling and from drinking alcohol - a day before;
• The study of the lipid spectrum should be carried out when the patient is calm and does not experience psychological discomfort;
• Before taking blood, you need to sit quietly for 5-10 minutes.

Blood for analysis is taken from a vein. Usually 5-10 ml is sufficient. The laboratory assistant then properly prepares the biological fluid and transports it to the laboratory. Then the blood is sent for decoding: the results of the lipid spectrum test, as a rule, are ready within a day.

Normal and pathological values ​​of the lipid spectrum

The norms of a blood test for the lipid spectrum vary depending on the age of the subject and the equipment of a particular laboratory. Average indicators are presented in the table below

As a rule, with violations of fat metabolism, all indicators deviate from the norm. This condition is called dyslipidemia.

What does dyslipidemia mean?

A decrease or increase in the lipid spectrum can lead to significant malfunctions in the body. When correcting fat metabolism, first of all, it is necessary to focus on the causes that caused the violations.

Cholesterol

Most often, the first in patients who applied to the clinic, an increase in cholesterol is diagnosed. This indicator in a newborn does not exceed 3 mmol / l, but begins to gradually increase with age. Despite the fact that the average cholesterol rate is in the range of 3.2-5.26 mmol/l, these values ​​in elderly patients can be extended to 7.1-7.2 mmol/l.

Up to 80% of the cholesterol circulating in the blood is formed in the liver (the so-called endogenous cholesterol). The remaining 20% ​​comes from food. Therefore, one of the main risk factors for the deviation of this analysis from the norm is nutritional errors: eating a large amount of food saturated with animal fats (, fatty meat, milk and dairy products).

Other risk factors for high cholesterol include:

• hereditary genetic diseases (familial hypercholesterolemia);
• ischemic heart disease, myocardial infarction;
• liver diseases (cholelithiasis, primary biliary cirrhosis);
• kidney disease (chronic pyelonephritis, chronic glomerulonephritis, chronic renal failure);
• diabetes;
• thyroid disease (hypothyroidism);
• obesity;
• taking medications (diuretics, beta-blockers, combined oral contraceptives, glucocorticoids);
• alcoholism;
• diseases with a violation of mineral metabolism, gout.

Since cholesterol is a collective concept that includes all fractions of fats circulating in the blood, it can most often be increased by increasing atherogenic lipids. An analysis of the lipid spectrum in this case may show an increase in the concentration of LDL and VLDL with normal or reduced values ​​of high density lipoproteins. The coefficient of atherogenicity and the risk of developing atherosclerosis in the subject, respectively, will be increased.

Cholesterol reduction is less common. The causes of these lipid disorders can be:

• starvation, up to complete exhaustion;
• malabsorption syndrome, other gastrointestinal problems that interfere with the absorption and assimilation of food;
• severe diseases, including infectious ones, sepsis;
• chronic pathology of the liver, kidneys, lungs in the terminal stage;
• taking certain medications (statins, fibrates, ketoconazole, thyroxine).

Cholesterol reduction usually occurs at the expense of all fractions of the lipid spectrum. When deciphering the analysis, a picture of hypolipoproteinemia will be observed: a decrease in the concentration of not only total cholesterol, but also HDL, LDL, VLDL, triglycerides and atherogenic coefficient. This condition is fraught with a violation of the construction of cell membranes in the body, which means pathology on the part of all organs and systems, loss of childbearing function by women of childbearing age, depression of the nervous system with the formation of depression and suicidal thoughts. The condition is corrected by eliminating the cause that caused it, by prescribing a diet rich in animal fats.

high density lipoproteins

Most often, when analyzing the lipid spectrum in patients with atherosclerosis and cardiovascular pathology, a decrease in this indicator is determined. HDL is the main anti-atherogenic factor, which should be maintained within the target values ​​(>1–1 mmol/l in women and >1 mmol/l in men). When deciphering the analyzes for the lipid spectrum, it was noted that a critical decrease in HDL is more often observed in men than in women. This is due to the "protective" effect on the vessels of estrogens - female sex hormones. That is why women aged 40-50 years (that is, before the onset of menopause, when the concentration of estrogen in the blood decreases) have a lower risk of coronary heart disease and myocardial infarction. In old age, the incidence of cardiovascular pathology becomes approximately the same in both sexes.

A decrease in HDL occurs when:

• atherosclerosis;
• cardiovascular diseases;
• smoking and alcohol abuse;
• overweight;
• chronic liver diseases accompanied by cholestasis;
• diabetes.

An increase in the indicator in lipid spectrum analyzes is rare.

Low and very low density lipoproteins

This form of lipids is considered a key link in the pathogenesis of atherosclerosis. The lower the density of the protein + fat complex, the easier it settles on the inner surface of the vessels, forming at first a soft and loose lipid spot, and then, gradually strengthening with connective tissue, it turns into a mature cholesterol plaque. An increase in the concentration of LDL and VLDL occurs for the same reasons as an increase in cholesterol.

With a significant excess of the norm of LDL and VLDL, the atherogenic coefficient can reach values ​​of 7-8 or more (with a norm of 2-3). Such indicators of the lipid spectrum indicate already formed atherosclerosis and a high risk of complications from the cardiovascular, nervous system.

Triglycerides

Scientists consider triglycerides as an additional factor of atherogenicity. In atherosclerosis, in addition to an increase in total cholesterol and low-density lipoprotein fractions, triglycerides are also likely to be elevated.

Atherogenic coefficient

The atherogenic coefficient is an integral value that can be used to determine the risk of developing atherosclerosis and its complications in each individual patient. An increase in its value indicates the predominance of lipoproteins of "harmful" fractions over "useful", which means an increasing risk of deposition of cholesterol plaques on the inner surface of the arteries.

Apolipoproteins

Usually, when deciphering the analysis for the lipid spectrum, the concentration of carrier proteins, apolipoproteins, is not calculated. This study will be useful in investigating the causes of the hereditary form of hypercholesterolemia. For example, with a genetically determined increase in apolipoprotein A, the concentration of low density lipoproteins naturally increases. As a rule, such conditions require a lifelong prescription of a therapeutic diet and medications.

Lipidogram target values: what indicators should you strive for

The older the patient, the harder it is for him to keep his cholesterol and other indicators of the lipid spectrum normal. According to statistics, every third inhabitant of the planet over 60 suffers from atherosclerosis, and cardiovascular diseases are in the first place among the causes of death.

Correction of disturbed fat metabolism is a long process and requires maximum control both on the part of the general practitioner who prescribes the treatment, and on the part of the patient himself. The higher the initial level of cholesterol, the longer should be the therapy of atherosclerosis. The target values ​​of the lipid spectrum, which should be strived for by all patients with cardiovascular pathology and cerebrovascular accidents:

• total cholesterol - less than 5.26 mmol / l;
• KA - less than 3.00 mmol / l;
• low density lipoproteins - below 3.00 mmol / l;
• high density lipoproteins - above 1 mmol / l;
• triglycerides - less than 2 mmol / l.

Upon reaching these values ​​of the lipid spectrum in the blood, the risk of developing myocardial infarction and stroke is reduced by 3.5 times.

Thus, the lipid spectrum is a comprehensive analysis that allows you to give a complete assessment of fat metabolism in the body. The sooner lipid profile disorders are detected, the sooner they can be corrected by changing the diet, lifestyle and prescribing medications.

Determination of blood lipid profile indicators is necessary for the diagnosis, treatment and prevention of cardiovascular diseases. The most important mechanism for the development of such a pathology is the formation of atherosclerotic plaques on the inner wall of the vessels. Plaques are accumulations of fat-containing compounds (cholesterol and triglycerides) and fibrin. The higher the concentration of lipids in the blood, the more likely the appearance of atherosclerosis. Therefore, it is necessary to systematically take a blood test for lipids (lipidogram), this will help to identify deviations of fat metabolism from the norm in a timely manner.

Lipidogram - a study that determines the level of lipids of various fractions

Atherosclerosis is dangerous with a high probability of developing complications - stroke, myocardial infarction, gangrene of the lower extremities. These diseases often end in disability of the patient, and in some cases, death.

Role of lipids

Lipid functions:

• Structural. Glycolipids, phospholipids, cholesterol are the most important components of cell membranes.
• Thermal insulation and protective. Excess fats are deposited in the subcutaneous fat, reducing heat loss and protecting internal organs. If necessary, the lipid reserve is used by the body for energy and simple compounds.
• Regulatory. Cholesterol is necessary for the synthesis of steroid hormones of the adrenal glands, sex hormones, vitamin D, bile acids, is part of the myelin sheaths of the brain, and is needed for the normal functioning of serotonin receptors.

Lipidogram

A lipidogram can be prescribed by a doctor both if an existing pathology is suspected, or for preventive purposes, for example, during a medical examination. It includes several indicators that allow you to fully assess the state of fat metabolism in the body.

Lipidogram indicators:

• Total cholesterol (OH). This is the most important indicator of the lipid spectrum of the blood, it includes free cholesterol, as well as cholesterol contained in lipoproteins and associated with fatty acids. A significant part of cholesterol is synthesized by the liver, intestines, gonads, only 1/5 of the OH comes from food. With normally functioning mechanisms of lipid metabolism, a small deficiency or excess of cholesterol from food is compensated by an increase or decrease in its synthesis in the body. Therefore, hypercholesterolemia is most often caused not by excessive intake of cholesterol from foods, but by a failure of the fat metabolism process.
• High density lipoproteins (HDL). This indicator has an inverse relationship with the likelihood of developing atherosclerosis - an elevated HDL level is considered an anti-atherogenic factor. HDL transport cholesterol to the liver, where it is utilized. Women have higher HDL levels than men.
• Low density lipoproteins (LDL). LDL carries cholesterol from the liver to the tissues, otherwise known as "bad" cholesterol. This is due to the fact that LDL can form atherosclerotic plaques that narrow the lumen of blood vessels.

This is what an LDL particle looks like

• Very low density lipoproteins (VLDL). The main function of this group of particles, heterogeneous in size and composition, is the transport of triglycerides from the liver to tissues. A high concentration of VLDL in the blood leads to clouding of the serum (chylosis), and the possibility of atherosclerotic plaques also increases, especially in patients with diabetes mellitus and kidney pathologies.
• Triglycerides (TG). Like cholesterol, triglycerides are transported through the bloodstream as part of lipoproteins. Therefore, an increase in the concentration of TG in the blood is always accompanied by an increase in cholesterol levels. Triglycerides are considered the main source of energy for cells.
• Atherogenic coefficient. It allows you to assess the risk of developing vascular pathology and is a kind of outcome of the lipid profile. To determine the indicator, you need to know the value of OH and HDL.

Atherogenic coefficient \u003d (OH - HDL) / HDL

Optimal blood lipid profile values

It should be borne in mind that the value of the measured indicators may vary depending on the units of measurement, the methodology for conducting the analysis. Normal values ​​also vary depending on the age of the patient, the above figures are averaged for persons 20-30 years old. The norm of cholesterol and LDL in men after 30 years tends to increase. In women, the indicators increase sharply with the onset of menopause, this is due to the cessation of the anti-atherogenic activity of the ovaries. Deciphering the lipidogram must be carried out by a specialist, taking into account the individual characteristics of a person.

The study of blood lipid levels can be prescribed by a doctor to diagnose dyslipidemia, assess the likelihood of developing atherosclerosis, in some chronic diseases (diabetes mellitus, kidney and liver diseases, thyroid gland), and also as a screening study for early detection of individuals with abnormal lipid profiles from the norm .

The doctor gives the patient a referral for a lipidogram

Study preparation

Lipidogram values ​​can fluctuate not only depending on the gender and age of the subject, but also on the impact on the body of various external and internal factors. To minimize the likelihood of an unreliable result, you must adhere to several rules:

1. Donate blood should be strictly in the morning on an empty stomach, in the evening of the previous day, a light dietary dinner is recommended.
2. Do not smoke or drink alcohol on the eve of the study.
3. 2-3 days before donating blood, avoid stressful situations and intense physical exertion.
4. Refuse to use all medications and dietary supplements, except for vital ones.

Methodology

There are several methods for laboratory assessment of the lipid profile. In medical laboratories, analysis can be carried out manually or using automatic analyzers. The advantage of an automated measurement system is the minimum risk of erroneous results, the speed of obtaining an analysis, and the high accuracy of the study.

The analysis requires the patient's venous blood serum. Blood is taken into a vacuum tube using a syringe or vacutainer. To avoid the formation of a clot, the blood tube should be inverted several times, then centrifuged to obtain serum. The sample can be stored in the refrigerator for 5 days.

Taking blood for lipid profile

Currently, blood lipids can be measured without leaving home. To do this, you need to purchase a portable biochemical analyzer that allows you to assess the level of total cholesterol in the blood or several indicators at once in a matter of minutes. For research, you need a drop of capillary blood, it is applied to the test strip. The test strip is impregnated with a special composition, for each indicator it has its own. The results are read automatically after inserting the strip into the device. Due to the small size of the analyzer, the ability to operate on batteries, it is convenient to use it at home and take it with you on a trip. Therefore, persons with a predisposition to cardiovascular diseases are advised to have it at home.

Interpretation of results

The most ideal result of the analysis for the patient will be a laboratory conclusion that there are no deviations from the norm. In this case, a person can not be afraid for the state of his circulatory system - the risk of atherosclerosis is practically absent.

Unfortunately, this is not always the case. Sometimes the doctor, after reviewing the laboratory data, makes a conclusion about the presence of hypercholesterolemia. What it is? Hypercholesterolemia - an increase in the concentration of total cholesterol in the blood above normal values, while there is a high risk of developing atherosclerosis and related diseases. This condition may be due to a number of reasons:

• Heredity. Science knows cases of familial hypercholesterolemia (FH), in such a situation, a defective gene responsible for lipid metabolism is inherited. In patients, a constantly elevated level of TC and LDL is observed, the disease is especially severe in the homozygous form of FH. In such patients, early onset of coronary artery disease (at the age of 5-10 years) is noted, in the absence of proper treatment, the prognosis is unfavorable and in most cases ends in death before reaching the age of 30 years.
• Chronic diseases. Elevated cholesterol levels are observed in diabetes mellitus, hypothyroidism, kidney and liver pathology, due to lipid metabolism disorders due to these diseases.

For patients with diabetes, it is important to constantly monitor cholesterol levels.

• Wrong nutrition. Prolonged abuse of fast food, fatty, salty foods leads to obesity, while, as a rule, there is a deviation in lipid levels from the norm.
• Bad habits. Alcoholism and smoking lead to malfunctions in the mechanism of fat metabolism, as a result of which the lipid profile increases.

With hypercholesterolemia, it is necessary to follow a diet with a restriction of fat and salt, but in no case should you completely refuse all foods rich in cholesterol. Only mayonnaise, fast food and all foods containing trans fats should be excluded from the diet. But eggs, cheese, meat, sour cream must be present on the table, you just need to choose products with a lower percentage of fat. Also in the diet it is important to have greens, vegetables, cereals, nuts, seafood. The vitamins and minerals contained in them perfectly help to stabilize lipid metabolism.

An important condition for the normalization of cholesterol is also the rejection of bad habits. Good for the body and constant physical activity.

In the event that a healthy lifestyle in combination with a diet has not led to a decrease in cholesterol, it is necessary to prescribe an appropriate drug treatment.

Drug treatment of hypercholesterolemia includes the appointment of statins

Sometimes specialists are faced with a decrease in cholesterol levels - hypocholesterolemia. Most often, this condition is due to insufficient intake of cholesterol from food. Fat deficiency is especially dangerous for children, in such a situation there will be a lag in physical and mental development, cholesterol is vital for a growing body. In adults, hypocholesteremia leads to a violation of the emotional state due to malfunctions of the nervous system, problems with reproductive function, decreased immunity, etc.

A change in the blood lipid profile inevitably affects the work of the whole organism as a whole, therefore it is important to systematically monitor the indicators of fat metabolism for timely treatment and prevention.

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The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

What is a lipid profile?

The lipid profile is based on both the processes of fat metabolism in the human body and the state of the body as a whole. So, acting together with food, fats are subject to digestion and assimilation. However, these processes already depend on the state of the mucous membrane, on the presence in the body of the necessary elements of vitamins and coenzymes.
Thus, the metabolism of fats consists of several interrelated processes occurring in the body.

There are the following stages of fat metabolism in the body:

• intake with food;
• splitting fats into smaller components;
• digestion of incoming fats, mainly with the help of bile acids;
• absorption of fats at the level of the intestinal mucosa;
• transport with blood to liver cells;
• fatty acid synthesis ( lipogenesis);
• exchange of triglycerides, phospholipids;
• breakdown of fat lipolysis).

What are lipids?

It is wrong to assume that fats and fatty acids pose a threat to humans. Lipids and their compounds ( esters, lipoproteins) are vital to the body. Along with other structural elements ( proteins and carbohydrates) they perform a number of structural and regulatory functions. The main one is structural, since fats are indispensable components of cell membranes. Lipids are also used for the synthesis of various biologically active substances - hormones, vitamins, bile acids, prostaglandins ( neurotransmitter involved in inflammation processes).

The main functions of lipids are:

• Structural. Fats ( namely cholesterol.) are an integral part of cell membranes. The highest concentration of cholesterol is found in nerve cells, that is, in neurons. Thus, cholesterol is a basic element of nerve endings ( myelin sheath). Deficiency of cholesterol and other fats in the nervous tissue leads to various neurological diseases, since neurons are not able to perform their full functions without fats.
• Regulatory. Fats and fat complexes are part of steroid hormones and most vitamins. They also take an active part in the transmission of nerve impulses.
• Transport. Fats in combination with proteins form compounds called lipoproteins, which, in turn, carry out the transport of various substances throughout the body.
• Protective. Virtually every organ in the body most of the kidney) surrounded by adipose tissue. Forming a kind of fat pad, fats protect the internal organs from external negative influences.
• Supportive. Adipose tissue forms the support of those organs that it surrounds, as well as the nerve and vascular plexuses.
• Energy. Fats are the source of energy in the body. In terms of the amount of energy generated, fats exceed carbohydrates by two, and proteins by three times.
• Thermoregulatory. Body fats also form subcutaneous adipose tissue, which prevents the body from hypothermia.
• Trophic. Lipids are involved in the absorption and assimilation of vitamins and other active substances.
• Reproductive. Fats play one of the main roles in human reproductive function. So, they take part in the synthesis of sex hormones, in the absorption of vitamins and minerals, in the regulation of hormonal levels.
• Aesthetic. Lipids take an active part in ensuring the elasticity of the skin, thus protecting the skin from excessive moisture loss.

The human body is most adapted to seasonal rhythms. In areas with a cold climate, the body uses fat reserves for more economical energy consumption in cold winters. In some nationalities, the accumulation of fats in winter has become an important protective device. Therefore, it is in winter that a person has the most pronounced fat anabolism ( more body fat), while catabolism predominates in summer ( minimum body fat).

Violation of fat metabolism underlies many pathologies. In turn, these violations can be of a different nature.

The main causes of lipid metabolism disorders include:

• Alimentary ( food) deficit. In this case, initially there is a lack of lipids coming from food. Alimentary lipid deficiency can be both for rational reasons ( fasting, fasting), and due to the lack of essential fats in a particular region.
• Pathology of the pancreas and liver. It is these two organs that are actively involved in the absorption of fats. When they are affected, insufficient absorption of lipids is observed, despite the fact that they are supplied with enough food.
• Alimentary excess. Excessive intake of fats leads to excessive accumulation of fats in the organs and subcutaneous adipose tissue.
• Nutritional imbalance. It is observed when there is insufficient intake of carbohydrates with food. In this case, fatty acids take over the energy function of carbohydrates. As a result, the production of keto acids increases. At the same time, with an excess of carbohydrates in the diet, lipids begin to be intensively deposited in the depot ( adipose tissue).
• Violation of intermediate lipid metabolism. From the moment fats enter the body with food to the synthesis of structural elements from them, a chain of complex reactions occurs. Violation at one of these stages ( e.g. during transport) leads to disruption at the level of the entire metabolism. The most significant violations are observed in the absence of bile acids, which are actively involved in the absorption of fats. Such violations are most often recorded in diseases of the liver.

Deciphering the lipid profile

• cholesterol;
• LDL);
• very low density lipoproteins ( VLDL);
• HDL);
• triglycerides;
• atherogenic index.

Cholesterol in the lipid profile

Cholesterol is found in almost every cell in the human body. It is part of cell membranes. Combining with phospholipids and proteins, it gives them selective permeability, and also has a regulatory effect on the activity of cellular enzymes. In addition, cholesterol is present in the cytoplasm of the cell, where it is predominantly in a free state with fatty acids, forming small droplets - vacuoles. In blood plasma, cholesterol can be both in the free state ( unesterified), and in the composition of lipoproteins ( esterified).

At the macroorganism level, cholesterol also performs several important functions. So, it is a source of synthesis of bile acids and steroid hormones ( androgens, estrogens, adrenal hormones). An intermediate product of the oxidation of cholesterol under the influence of sunlight in the skin turns into vitamin D3. Thus, cholesterol plays an important role in metabolism. In general, the physiological functions of cholesterol are very diverse. However, it is worth knowing that cholesterol is present only in animals, but not in vegetable fats.

The problem of high cholesterol levels is acute in modern society. This is explained, first of all, by active urbanization - the dominance of fast food, a sedentary lifestyle, an unbalanced diet, the presence of concomitant metabolic pathologies. Given these factors, the World Health Organization ( WHO) a scale was developed for each lipidogram indicator, reflecting the danger of each level.

WHO reference values ​​for total cholesterol include:

• optimal value- no more than 5.15 millimoles per liter;
• marginal value- from 5.15 to 6.18 millimoles per liter;
• high value- more than 6.2 millimoles per liter.

Lipoproteins

The components of lipoprotein acids include:

• myristic fatty acid;
• palmitic fatty acid;
• stearic fatty acid;
• oleic fatty acid;
• linoleic fatty acid;
• linolenic fatty acid.

Low density lipoproteins ( LDL)

Synthesis ( education) low and very low density lipoprotein occurs in the liver. Then they are secreted into the bloodstream, already, from where they reach organs and tissues. Specifically binding to receptors, lipoproteins release cholesterol, which subsequently goes to the synthesis of membranes and other cellular structures.

Low and very low density lipoproteins are conditionally called "bad" lipoproteins. Being small in size, they easily penetrate the vascular endothelium, where they can subsequently be deposited. It is low density lipoproteins that are a risk factor for the development of vascular atherosclerosis. Also, the level of lipoproteins directly affects the concentration of cholesterol in the blood.

Very low density lipoproteins ( VLDL)

High density lipoproteins ( HDL)

Triglycerides

The concentration of triglycerides per liter of blood plasma usually correlates with total cholesterol levels. This means that with various pathologies, these indicators increase almost simultaneously. This is explained by the fact that both triglycerides and cholesterol are carried by the same lipoproteins. If there is an isolated increase in triglycerides, then this may indicate that the person has recently consumed a large amount of fat with food.

WHO reference values ​​for triglycerides include:

• optimal value- no more than 1.7 millimoles per liter;
• marginal value- from 1.7 to 2.2 millimoles per liter;
• high value- from 2.3 to 5.6 millimoles per liter;
• extremely high value- more than 5.6 millimoles per liter.

Alanine aminotransferase ( ALAT)

High numbers of alanine aminotransferase are predominantly characteristic of liver pathologies, while an increase in the level of aspartate aminotransferase is more characteristic of heart muscle damage.

Drugs that cause an increase in alanine aminotransferase activity include:

• monoamine oxidase inhibitor antidepressants ( moclobemide);
• steroids;

Aspartate aminotransferase ( ASAT)

Pathologies that are accompanied by an increase in the level of aspartate aminotransferase include:

• tumor processes in the body;
• viral hepatitis;
• tuberculosis of the lungs and lymph nodes;
• acute period of myocardial infarction.

Coefficient ( index) atherogenicity

In other words, the index is calculated using the following formula:
Atherogenic coefficient = (total cholesterol - high density lipoproteins) / high density lipoproteins.
Or,
Atherogenic coefficient = (low density lipoprotein + very low density lipoprotein) / high density lipoprotein.

Normally, the atherogenic index varies from 2.2 to 3.5. As can be seen from the formula, the coefficient reflects the ratio between harmful and beneficial cholesterol. The calculation of this parameter helps to summarize the lipid profile and objectively assess the risk factors. Just the level of total cholesterol does not give a complete assessment of lipid metabolism. This is explained by the fact that cholesterol itself is part of various compounds and is the same everywhere. Therefore, only the type of lipoprotein determines where the cholesterol will go.

Lipidogram control

Lipidogram norm in men and women

Numerous metabolic disorders are characterized by an increase in “bad” blood lipoproteins and an atherogenic index, as well as a decrease in “good” ones. In order to diagnose lipid metabolism disorders, clear biochemical criteria are needed. It is also important to know that hyperlipidemia is hereditary in more than 90 percent of individuals.
Therefore, the analysis of the lipid profile should take place in parallel with the analysis of risk factors - heredity, the presence of bad habits ( smoking) and comorbidities ( arterial hypertension).

Lipidogram norms by age

Deviations in the lipid profile

The main deviations in the lipid profile include:

• hyperlipidemia;
• hypolipemia;
• hypercholesterolemia;
• hypocholesteremia.

Pathologies that are accompanied by a constant high content of lipids include:

• acute and chronic kidney disease;
• cirrhosis;
• hepatitis in the acute period;
• pathology of the pancreas.

Hypercholesterolemia is a phenomenon characterized by high levels of cholesterol ( more than 6.1 millimoles per liter). As well as the previous deviations, it can have a different nature. Cholesterol is chemically a secondary monohydric aromatic alcohol. According to its functions, it is an indispensable component of cell membranes. Lack of cholesterol in the nervous tissue leads to serious neurological and mental disorders.

In the blood, cholesterol is present in several forms - in the form of lipoproteins ( mainly low and very low density), as well as in the free state.
Hypercholesterolemia can also be of nutritional origin and occur after meals. However, the most common pathological increase in cholesterol.

Conditions associated with high blood cholesterol include:

• cholestasis - stagnation of bile;
• kidney pathology - chronic renal failure, glomerulonephritis, nephrotic syndrome;
• malignant tumors of the pancreas;
• endocrine disorders, especially diabetes mellitus, hypothyroidism, vitamin B deficiency, obesity.

Pathologies characterized by a decrease in the concentration of cholesterol in the blood are:

• malabsorption syndrome ( malabsorption);
• damage to the central nervous system;
• chronic cardiovascular insufficiency;
• hyperthyroidism ( increased thyroid function);
• acute infectious and purulent-inflammatory diseases;
• acute pancreatitis;
• prolonged fever;
• tuberculosis of the lungs and lymph nodes;
• sarcoidosis of the pulmonary system;
• anemia ( low hemoglobin and red blood cells);
• hemolytic jaundice;
• oncological diseases ( more common in bowel cancer);

Why is a lipid profile done?

Situations when it is necessary to pass a lipid profile include:

• Preventive examination of healthy people. World Health Organization ( WHO) recommends checking lipid levels in people over 20 years of age at least every 5 years.

• Raising the level of total cholesterol. The upper limit of the norm of total cholesterol is an indication for a detailed analysis of lipid metabolism ( i.e. for lipidogram).
• A history of elevated cholesterol levels. If an elevated level of total cholesterol was previously detected, then it is recommended to take a lipidogram once every three months.
• A burdened family history. It is the main indication for the active identification of risk factors for cardiovascular disease. So, if at least one family member suffers from diabetes mellitus or arterial hypertension, or he suffered a stroke, then it is recommended that all family members take a lipid profile once a quarter.
• Presence of risk factors. If the patient has identified risk factors for cardiovascular diseases, as well as metabolic pathologies, then this is an indication for regular monitoring of the lipid spectrum.
• Monitoring treatment with statins. High concentrations of cholesterol and low-density lipoprotein are an indication for drug treatment. For this purpose, drugs called statins are prescribed. To assess the effect of statins, a lipidogram is done before and after treatment.
• Monitoring the effectiveness of a lipid-lowering diet. At high lipid levels, a special lipid-lowering diet is also recommended. Its effectiveness is also assessed using a lipidogram.

When is a lipid profile prescribed?

Risk factors for cardiovascular disease are:

• age over 45 for men;
• age 55 for women;
• smoking;
• overweight;
• carbohydrate metabolism disorders - type 1 or type 2 diabetes mellitus;
• arterial hypertension - an increase in blood pressure of more than 140 millimeters of mercury;
• the presence of strokes in the history of the disease;
• previous myocardial infarction.

Preparing for a lipid profile

The conditions for preparing for a lipidogram are:

• refusal of food within 12 hours before the analysis;
• quitting smoking 30 minutes before the test;
• exclusion of physical and emotional stress on the day of analysis.

So, in diabetes mellitus, due to impaired metabolism, a large amount of ketone bodies and cholesterol are synthesized. Therefore, this disease is most often characterized by hypercholesterolemia ( cholesterol level more than 6 millimoles per liter). Large titers of endogenous cholesterol are fixed in glomerulonephritis. This is explained by the fact that with this pathology there is an accelerated excretion of plasma protein. As a result, the viscosity and osmotic pressure of the blood are disturbed, which is reflected in the relative indicators of cholesterol.

The amount of triglycerides is highly dependent on this indicator, their increase in various diseases occurs simultaneously. This is due to the fact that these compounds are carried by the same lipoproteins. The triglyceride level helps to determine whether the lipid spectrum study has been performed correctly. If an increase in the amount of these substances is detected at a normal cholesterol level, the analysis is considered unreliable. This is observed when eating fatty foods before donating blood.

Lipidogram in myocardial infarction ( THEM)

The assessment of the risk of myocardial infarction and its lethal outcome is carried out according to the SCORE system. The SCORE score is a questionnaire specifically designed to assess the risk of fatal cardiovascular disease ( myocardial infarction) for 10 years. This takes into account the lipid profile, age, gender, smoking and systolic blood pressure. Data ( systolic blood pressure, cholesterol) are entered into a calculator specially designed for this purpose. The figure obtained during the calculation is the probability of death from myocardial infarction in percent. Further, if the amount received was less than 5 percent, then the patient belongs to the low-risk group. If the figure is 5 or more, then the patient is included in the high-risk group. However, the risk group is also influenced by other signs. These include low levels of good lipoproteins, high cholesterol, associated obesity, and a sedentary lifestyle.

Lipidogram parameters can be divided into three main risk groups. This interpretation is in line with international recommendations.

Lipidogram of feces

However, the presence of fats in the lipid profile does not always indicate pathology. Sometimes they may be present due to increased intestinal motility. At the same time, the food bolus quickly passes through the intestinal loops, as a result of which fats simply do not have time to be completely absorbed.

Norm lipidogram feces

Deviations from the above norms, as a rule, indicate a deficiency of certain enzymes and pathology of the pancreas. The main reason for the increase in lipids in the stool is a deficiency of the enzyme lipase. This is the main enzyme produced by the pancreas, the function of which is the breakdown of fats in the large intestine. Insufficient content of this enzyme is a consequence of acute or chronic damage to the organ. These can be acute and chronic pancreatitis, cysts, tumors, as well as the consequences of removing part of the pancreas ( resection). Separately, cystic fibrosis should be mentioned, which is accompanied by significant changes in the fecal lipid profile. Cystic fibrosis is a hereditary disease in which all organs that secrete mucus are affected, but to a greater extent the pancreas.

In addition to the pathology of the pancreas, the cause of an increased content of lipids in the feces can be pathologies of the liver and gallbladder. Lack of bile supply to the intestines is one of the most common causes of indigestion of fats. This is explained by the fact that normally bile is involved in the breakdown of fats. So, it activates the lipase necessary for this, which breaks down a complex fat molecule into an emulsion. In the state of emulsion, fats are maximally absorbed at the level of the intestinal mucosa. Thus, the lack or complete absence of bile leads to incomplete breakdown of fats, and this, in turn, to their appearance in the feces.
Similar situations are observed in cholelithiasis, gallbladder dyskinesia.

The appearance of fats in the feces can also be affected by the state of the lymphatic tract. violation of the patency of these paths ( which, fortunately, is rare.) also leads to malabsorption. The same is observed with tumors of the lymph nodes, Whipple's disease, with intestinal tuberculosis, as well as with other pathologies that are accompanied by damage to the lymph nodes.