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Test ID: NMRLP Nuclear Magnetic Resonance Lipoprotein Profile, Serum


Specimen Required


Patient Preparation:

1. Fasting overnight (12-14 hours) is required. On night before examination, evening meal should be eaten before 6 p.m. and should contain no fatty foods.

2. Patient must not consume any alcohol for 24 hours before the specimen is collected.

Collection Container/Tube: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 1.5 mL

Collection Instructions:

1. Allow isopropyl alcohol (from phlebotomy site prep) to dry thoroughly before venipuncture.

2. Centrifuge and aliquot serum.


Useful For

Assessment and management of a patient's risk for atherosclerotic cardiovascular disease

 

Identifying residual risk that may be present in some patients on cholesterol targeting treatment

Method Name

Nuclear Magnetic Resonance (NMR)

Reporting Name

NMR Lipoprotein Profile, S

Specimen Type

Serum Red

Specimen Minimum Volume

1 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Red Refrigerated (preferred) 7 days
  Frozen  14 days
  Ambient  8 hours

Clinical Information

Low-density lipoprotein particle (LDL-P) concentration is positively associated with increased risk of atherosclerotic cardiovascular disease (ASCVD). LDL-P is heterogeneous and contains many lipids and proteins including phospholipids, triglycerides and cholesterol. LDL cholesterol is a surrogate biomarker of LDL-P.

 

LDL cholesterol (LDL-C) is the historical measure of atherogenic lipid burden. There is a large variance in the relative amount of cholesterol carried by each LDL-P. Consequently, subjects with similar LDL cholesterol values can have markedly different serum concentrations of LDL-P. Multiple studies have shown that serum concentrations of LDL-P more accurately reflect actual risk of ASCVD when LDL cholesterol values are discrepant.

 

High-density lipoprotein particle (HDL-P) concentration is inversely associated with risk of ASCVD. HDL cholesterol is also inversely associated with ASCVD since it is a surrogate marker for HDL-P. Like other lipoproteins, HDL-P is heterogeneous and particles contain highly variable proportions of proteins and lipids including phospholipids, sphingolipids and cholesterol.

 

Several large clinical studies have shown that HDL-P is more significantly associated with ASCVD risk than HDL cholesterol. Furthermore, HDL-P remains significantly associated with ASCVD even among subjects taking cholesterol-lowering medications. HDL-P more accurately reflects actual risk of ASCVD when HDL cholesterol values are discrepant.

Reference Values

≥18 years:

 

LDL Particles:

Desirable: <1,000 nmol/L

Above Desirable: 1,000-1,299 nmol/L

Borderline high: 1,300-1,599 nmol/L

High: 1,600-2,000 nmol/L

Very high: ≥2,000 nmol/L

 

HDL Particles:

Male: >30 mcmol/L

Female: >35 mcmol/L

 

LDL Cholesterol (NMR):

Desirable: <100 mg/dL

Above Desirable: 100-129 mg/dL

Borderline high: 130-159 mg/dL

High: 160-189 mg/dL

Very high: ≥190 mg/dL

 

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

Interpretation

Elevated concentrations of low-density lipoprotein particle (LDL-P) are associated with increased risk of atherosclerotic cardiovascular disease.

 

LDL-P is a more accurate indicator of risk when LDL cholesterol (LDL-C) is discordantly low.

 

Lower concentrations of high-density lipoprotein particle (HDL-P) are associated with increased risk of atherosclerotic cardiovascular disease.

Clinical Reference

1. Mora S, Glynn RJ, Ridker PM: High-Density Lipoprotein Cholesterol, Size, Particle Number, and Residual Vascular Risk After Potent Statin Therapy. Circulation 2013;Sep 10;128(11):1189-1197. doi: 10.1161/CIRCULATIONAHA.113.002671

2. Lawler PR, Akinkuolie AO, Ridker PM, et al: Discordance between Circulating Atherogenic Cholesterol Mass and Lipoprotein Particle Concentration in Relation to Future Coronary Events in Women. Clin Chem 2017;Apr;63(4):870-879. doi: 10.1373/clinchem.2016.264515

3. Akinkuolie AO, Paynter NP, Padmanabhan L, Mora S: High-Density Lipoprotein Particle Subclass Heterogeneity and Incident Coronary Heart Disease. Circ Cardiovasc Qual Outcomes. 2014;Jan;7(1):55-63. doi: 10.1161/CIRCOUTCOMES.113.000675

4. Tehrani DM, Zhao Y, Blaha MJ, et al: Discordance of Low-Density Lipoprotein and High-Density Lipoprotein Cholesterol Particle Versus Cholesterol Concentration for the Prediction of Cardiovascular Disease in Patients with Metabolic Syndrome and Diabetes Mellitus. Am J Cardiol 2016;Jun 15;117(12):1921-1927. doi: 10.1016/j.amjcard.2016.03.040

5. Mackey RH, Greenland P, Goff DC, et. al: High-Density Lipoprotein Cholesterol and Particle Concentrations, Carotid Atherosclerosis, and Coronary Events. J Am Coll Cardiol 2012; Aug 7;60(6):508-516. doi: 10.1016/j.jacc.2012.03.060

6. Otvos JD, Shalaurova I, Freedman DS, Rosenson RS: Effects of pravastatin treatment on lipoprotein subclass profiles and particle size in the PLAC-I trial. Atherosclerosis. 2002;Jan;160:41-48

7. Khera AV, Demler OV, Adelman SJ, et al: Cholesterol Efflux Capacity, High-Density Lipoprotein Particle Number, and Incident Cardiovascular Events: An Analysis From the JUPITER Trial (Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin). Circulation 2017;Jun 20;135(25):2494-2504. doi: 10.1161/CIRCULATIONAHA.116.025678

Day(s) and Time(s) Performed

Tuesday and 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

83704

LOINC Code Information

Test ID Test Order Name Order LOINC Value
NMRLP NMR Lipoprotein Profile, S In Process

 

Result ID Test Result Name Result LOINC Value
606167 LDL Particles, S 54434-6
606168 HDL Particles, S 49748-7
606169 LDL Cholesterol (NMR), S 2089-1
Mayo Clinic Laboratories | Cardiology Catalog Additional Information:

mml-lipids-lipoproteins