Advances in Lipid Testing: A Practical Step Forward

[摘要] Measuring lipids and lipoproteins has been an important focus for both clinical chemistry and clinical medicine for over 75 years. Measurements from analytical ultracentrifugation (1) to preparative ultracentrifugation (2) provided invaluable insights, but were not suited for day-to-day clinical practice. Fredrickson, Levy, and Lees (3) used paper electrophoresis to stimulate clinical recognition in five major patterns of plasma lipoprotein excess. Known as type I, II (IIa and IIb), III, IV, and V, they represented distinctive phenotypes, not genotypes. The shorthand notations, however, provided insight into an individual patient's lipoprotein disorder, whether due to acquired and/or genetic causes.Yet a non–ultracentrifuge-based methodology was needed to quantify LDL cholesterol (LDL-C) concentrations in clinical practice (1). The Friedewald formula allowed LDL-C determination by using a fasting total cholesterol, HDL-C, and triglycerides/5 (when triglyceride concentration was expressed in mg/dL) with the caveats that it could not be used if triglycerides were ≥400 mg/dL (4.5 mmol/L) or the rare type III abnormality was present (4). This formula continues in widespread use today, but up until the recent guidance from this consensus panel has required a fasting lipid sample.In this issue of Clinical Chemistry , a prominent international panel argues persuasively that fasting is not routinely required for lipid determinations (5). The panel notes that nonfasting lipid …

[学科分类] 过敏症与临床免疫学