12/20/2023 0 Comments Ldl cholesterol range![]() ![]() Even among those in whom the clinician does not have pretreatment values, assessment of fasting lipids can allow for detection of changes related to adherence for statins and/or lifestyle factors. Providing patients with a review of the trends over time in their lipid profile allows for a discussion of the risk reduction afforded with lower LDL and non-HDL levels. Adherence to therapy is important for all treated patients.Prognostic value is also present with lower treated LDL with regard to acute coronary syndrome incidence. A fasting lipid profile among treated patients provides prognostic value with regard to risk for statin-induced diabetes, as a triglyceride level Comparision of LDL levels pre- and post-statin therapy can estimate the relative risk reduction obtained thus, a fasting measure can be recommended. Moderate- and high-intensity statin therapy generally results in a relative risk reduction of 20% per 1 mmol/L (39 mg/dl) of LDL lowering. For the patient currently treated with lipid-lowering therapies, assessment of factors including diet, physical activity, smoking status, blood pressure, and glucose are important modifiable components of CVD risk, beyond LDL levels.Patients at risk for hypertriglyceridemia include those with human immunodeficiency virus treated with antiretroviral therapy, patients treated with long-term steroids, patients with a family history of hypertriglyceridemia or visceral adiposity who are starting an oral contraceptive or hormone replacement therapy, and women who are planning to get pregnant. Patients with pancreatitis should have a fasting lipid profile checked to assess for a triglyceride level >500 mg/dl.In the cases when extreme levels are observed, for example approximately 1000 mg/dl, there is no need for repeat of fasting lipids prior to treatment. ![]() In most cases, when an elevated result is observed, then a repeat fasting triglyceride can be measured in 2-4 weeks. In a recent statement on hypertriglyceridemia, the American Heart Association suggested that providers could use nonfasting triglycerides >200 mg/dl to identify hypertriglyceridemic states.Thus, the authors of the commentary recommend that for the assessment of metabolic syndrome, nonfasting would be acceptable. However, nonfasting measures including triglycerides >200 mg/dl and a low HDL (40 mg/dl in men or 5.6% would be consistent with traditional metabolic criteria and thus allow for theraputic interventions to begin soon after results are measured. Ideally, measurement of lipids such as triglycerides (a criterion of the metabolic syndrome) is recommended to be measured in the fasting state. Assessment of metabolic parameters which define metabolic syndrome can assist the provider and patient to initiate changes, in particular lifestyle changes, which reduce risk of diabetes and CVD.An LDL cholesterol >190 mg/dl is the most common result suggestive of familial hyperlipidemia. The screening and follow-up of patients with a family history of genetic (familial) hyperlipidemia and/or premature atherosclerotic cardiovascular disease (ASCVD) is recommended.Therefore, in the estimation of initial risk among the primary prevention patients who are not on lipid-lowering therapy, nonfasting lipid measurements would be acceptable. ![]() For several risk estimators, LDL is not included, but rather total cholesterol and high-density lipoprotein (HDL) cholesterol, both of which vary little between the fasting and nonfasting state. With current guidelines, low-density lipoprotein (LDL) cholesterol values may not be needed for some clinical scenarios.
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