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Unstable plaque in atherosclerosis, the target of biomarkers for cardiac risk |
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Lipids & Cardiovascular Risk
Lipid testing
At Stanford, we offer a number of different lipid panels. All may be ordered with either the calculated or direct assay for cholesterol found in low-density lipoprotein (LDL) particles.
In 2003, the National Cholesterol Education Program (NCEP) recommended <100 mg/dl as the optimal LDL cholesterol for everyone. Most physicians continued to target <130 mg/dl if the patient did not have coronary artery disease (CHD) but did have moderate risk, and reserved <100 mg/dl as the treatment goal for their patients with CHD (or diabetes). In 2004, the NCEP stressed that patients with moderate risk should try to reach <100 mg/dl and that patients with CHD should try to reach 70 mg/dl or lower. In our report, the reference range for LDL cholesterol is <130 mg/dl but a comment advises that “Patients with coronary heart disease or diabetes should target <100 mg/dl (or lower) as the desirable level.”
Cardiovascular risk
Cardiovascular disease continues to represent a significant problem. We do not know what causes the changes associated with atherosclerosis, but a number of risk factors have been identified. Much of the focus has been on inflammation and elevated serum lipids, and the most commonly employed schemes for risk calculation combine these two types of markers. But many patients who experience an acute coronary event do not have elevated LDL cholesterol. Also, CRP may be elevated in many types of inflammatory disorders.
There has been a search for more sensitive markers of atherogenic lipids as well as more atherosclerosis-specific markers of inflammation. Stanford Clinical Laboratory will be adding two of these to our menu of cardiovascular tests in the fall of 2006: small dense LDL (more sensitive test for atherogenic lipid) and lipoprotein-associated phospholipase-A2 or Lp-PLA2 (a more specific marker of vascular inflammation).
