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Test ID: CERAM Ceramides, Plasma

Useful For

Evaluation for risk of major adverse events due to cardiovascular disease within the next 1 to 5 years

Method Name

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

Reporting Name

Ceramides, P

Specimen Type

Plasma EDTA

Specimen Required

Collection Container/Tube: Lavender top (EDTA)

Submission Container/Tube: Plastic vial

Specimen Volume: 1 mL

Collection Instructions: Centrifuge, aliquot at least 1 mL plasma and freeze within 8 hours.

Specimen Minimum Volume

0.5 mL

Specimen Stability Information

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

Clinical Information

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,(1) ischemic heart disease, myocardial infarction,(2,3) hypertension,(4) stroke,(5) type 2 diabetes mellitus, insulin resistance and obesity.(6)


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). Direct interventional studies have not yet been reported; however, ceramide concentrations are reduced by current cardiovascular therapies including statins, ezetimibe, and Proprotein convertase subtilisin/kexin type 9 (PCSK9) activity.(3,7)

Reference Values

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

Ceramide Risk Score:

0-2 Lower risk

3-6 Moderate risk

7-9 Increased risk

10-12 Higher risk


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 >4,000 subjects.

Clinical Reference

1. Cheng JM, Suoniemi M, Kardys I, et al: Plasma concentrations of molecular lipid species in relation to coronary plaque characteristics and cardiovascular outcome: Results of the ATHEROREMO-IVUS study. Atherosclerosis 2015;243:560-566

2. Pan W, Yu J, Shi R, et al: Elevation of ceramide and activation of secretory acid sphingomyelinase in patients with acute coronary syndromes. Coron Artery Dis 2014;25:230-235

3. Tarasov K, Ekroos K, Suoniemi M, et al: Molecular lipids identify cardiovascular risk and are efficiently lowered by simvastatin and PCSK9 deficiency. J Clin Endocrinol Metab 2014;99:E45-52

4. Spijkers LJ, van den Akker RF, Janssen BJ, et al: Hypertension is associated with marked alterations in sphingolipid biology: a potential role for ceramide. PLoS One 2011;6:e21817

5. Yu RK, Tsai YT, Ariga T, Yanagisawa M: Structures, biosynthesis, and functions of gangliosides--an overview. J Oleo Sci 2011;60:537-544

6. Bergman BC, Brozinick JT, Strauss A, et al: Serum sphingolipids: relationships to insulin sensitivity and changes with exercise in humans. Am J Physiol Endocrinol Metab 2015;309:E398-408

7. Ng TW, Ooi EM, Watts GF, et al: Dose-dependent effects of rosuvastatin on the plasma sphingolipidome and phospholipidome in the metabolic syndrome. J Clin Endocrinol Metab 2014;99:E2335-2340

8. 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 [epub ahead of print] April 28th, 2016. DOI:10.1093/eurheartj/ehw148

Day(s) and Time(s) Performed

Tuesday; 9 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 Ceramides, P In Process


Result ID Test Result Name Result LOINC Value
42428 Ceramide (16:0) In Process
42429 Ceramide (18:0) In Process
42430 Ceramide (24:1) In Process
42431 Ceramide (16:0)/(24:0) ratio In Process
42432 Ceramide (18:0)/(24:0) ratio In Process
42433 Ceramide (24:1)/(24:0) ratio In Process
42434 Ceramide Score In Process


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

Mayo Medical Laboratories | Cardiology Catalog Additional Information: