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Test ID: CERAM MI-Heart Ceramides, Plasma

Useful For

Evaluating for the risk of major adverse cardiovascular events within the next 1 to 5 years

Method Name

Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)

Reporting Name

MI-Heart Ceramides, P

Specimen Type

Plasma EDTA

Specimen Required

Patient Preparation: Patients should not be receiving Intralipid because it may cause false-elevations in measured ceramides

Collection Container/Tube: Lavender top (EDTA)

Submission Container/Tube: Plastic vial

Specimen Volume: 1 mL

Collection Instructions: Centrifuge, aliquot at least 1 mL of plasma into a plastic vial, and freeze within 8 hours.

Specimen Minimum Volume

0.5 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Plasma EDTA Frozen (preferred) 30 days
  Refrigerated  24 hours
  Ambient  8 hours

Clinical Information

MI-Heart Ceramides is a blood test that measures risk for adverse cardiovascular events and quantifies plasma ceramides. Plasma ceramides are predictors of adverse cardiovascular events resulting from unstable atherosclerotic plaque. Ceramides are complex lipids that play a central role in cell membrane integrity, cellular stress response, inflammatory signaling, and apoptosis. Synthesis of ceramides from saturated fats and sphingosine occurs in all tissues. Metabolic dysfunction and dyslipidemia results in accumulation of ceramides in tissues not suited for lipid storage. Elevated concentrations of circulating ceramides are associated with atherosclerotic plaque formation, ischemic heart disease, myocardial infarction, hypertension, stroke, type 2 diabetes mellitus, insulin resistance, and obesity.


Three specific ceramides have been identified as highly linked to cardiovascular disease and insulin resistance: Cer16:0, Cer18:0, and Cer24:1. Individuals with elevated plasma ceramides are at higher risk of major adverse cardiovascular events even after adjusting for age, gender, smoking status, and serum biomarkers such as low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, C-reactive protein (CRP) and lipoprotein-associated phospholipase A2 (Lp-PLA2). Ceramide concentrations are reduced by current cardiovascular therapies including diet, exercise, statins, and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors.

Reference Values

MI-Heart Ceramide Risk Score:

0-2 Lower risk

3-6 Moderate risk

7-9 Increased risk

10-12 Higher risk

Ceramide (16:0): 0.19-0.36 mcmol/L

Ceramide (18:0): 0.05-0.14 mcmol/L

Ceramide (24:1): 0.65-1.65 mcmol/L

Ceramide (16:0)/(24:0): <0.11

Ceramide (18:0)/(24:0): <0.05

Ceramide (24:1)/(24:0): <0.45


Reference values have not been established for patients who are <18 years of age.


Note: Ceramide (24:0) alone has not been independently associated with disease and will not be reported.


Elevated plasma ceramides are associated with increased risk of myocardial infarction, acute coronary syndromes, and mortality within 1 to 5 years.

Ceramide Score

Relative Risk

Risk Category













Score is based on trial data including >4000 subjects.

Clinical Reference

1 Laaksonen R, Ekroos K, Sysi-Aho M, et al: Plasma ceramides predict cardiovascular death in patients with stable coronary artery disease and acute coronary syndromes beyond LDL-cholesterol. Eur Heart J. 2016;37:1967-1976

2. Havulinna AS, Sysi-Aho M, Hilvo M, et al: Circulating ceramides predict cardiovascular outcomes in the population-based FINRISK 2002 cohort. Arterioscler Thromb Vasc Biol. 2016;36:2424-2430.

3. Wang DD, Toledo E, Hruby A, et al: Plasma ceramides, Mediterranean diet, and incident cardiovascular disease in the PREDIMED trial (Prevenci on con Dieta Mediterranea). Circulation. 2017;135:2028-2040. doi: 10.1161/CIRCULATIONAHA.116.024261

4. Meeusen JW, Donato LJ, Bryant SC, et al: Plasma Ceramides. Arterioscler Thromb Vasc Biol. 2018; 38:1933-1939. doi: 10.1161/ATVBAHA.118.311199

5. Peterson LR, Xanthakis V, Duncan MS, et al: Ceramide remodeling and risk of cardiovascular events and mortality. J Am Heart Assoc. 2018;7(10). doi: 10.1161/JAHA.117.007931

6. Hilvo M, Meikle PJ, Pedersen ER, et al: Development and validation of a ceramide- and phospholipid-based cardiovascular risk estimation score for coronary artery disease patients. Eur Heart J. 2020;41:371-380. doi: 10.1093/eurheartj/ehz387

7. Alshehry ZH, Mundra PA, Barlow CK, et al: Plasma lipidomic profiles improve on traditional risk factors for the prediction of cardiovascular events in type 2 diabetes mellitus. Circulation. 2016;134:1637-1650.

8. Anroedh S, Hilvo M, Akkerhuis KM, et al: Plasma concentrations of molecular lipid species predict long-term clinical outcome in coronary artery disease patients. J Lipid Res. 2018;59:1729-1737. doi: 10.1194/jlr.P081281

9. Lemaitre RN, Jensen PN, Hoofnagle A, et al: Plasma ceramides and sphingomyelins in relation to heart failure risk. Circ Heart Fail. 2019;12(7):e005708. doi: 10.1161/CIRCHEARTFAILURE.118.005708

Day(s) and Time(s) Performed

Tuesday, Friday; 7 a.m.

Analytic Time

2 days

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.

CPT Code Information


LOINC Code Information

Test ID Test Order Name Order LOINC Value
CERAM MI-Heart Ceramides, P 93883-7


Result ID Test Result Name Result LOINC Value
42434 MI-Heart Ceramide Risk Score 93876-1
42428 Ceramide (16:0) 93882-9
42429 Ceramide (18:0) 93881-1
42430 Ceramide (24:1) 93880-3
42431 Ceramide (16:0)/(24:0) ratio 93879-5
42432 Ceramide (18:0)/(24:0) ratio 93878-7
42433 Ceramide (24:1)/(24:0) ratio 93877-9


If not ordering electronically, complete, print, and send a Cardiovascular Test Request Form (T724) with the specimen.

Mayo Clinic Laboratories | Cardiology Catalog Additional Information: