Coronary risk profile

Answer 1

Definition

A coronary risk profile is a battery of blood tests to measure your cholesterol and triglyceride levels. The profile can help determine your risk for heart disease.

Alternative Names

Lipoprotein/cholesterol analysis; Lipid profile; Lipid panel; Hyperlipidemia - testing

How the test is performed

Blood is typically drawn from a vein, usually from the inside of the elbow or the back of the hand. The site is cleaned with germ-killing medicine (antiseptic). The health care provider wraps an elastic band around the upper arm to apply pressure to the area and make the vein swell with blood.

Next, the health care provider gently inserts a needle into the vein. The blood collects into an airtight vial or tube attached to the needle. The elastic band is removed from your arm.

Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding.

In infants or young children, a sharp tool called a lancet may be used to puncture the skin and make it bleed. The blood collects into a small glass tube called a pipette, or onto a slide or test strip. A bandage may be placed over the area if there is any bleeding.

The blood is sent to a laboratory, where the following are measured:

• Low density lipoprotein (LDL or "bad" cholesterol)
• High density lipoprotein (HDL or "good" cholesterol
• Total cholesterol
• Triglycerides
• Very low density lipoprotein (VLDL cholesterol, though this is often calculated from the triglyceride level)

Other blood tests, such as C-reactive protein (CRP), may be added to the profile in some laboratories.

How to prepare for the test

You should not eat or drink anything except water for 9 - 12 hours before having your blood drawn.

How the test will feel

When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.

Why the test is performed

A coronary risk profile may be done:

• To screen adults and children for high blood cholesterol and triglycerides
• To follow people who have had high cholesterol levels and are being treated

Screening for adults:

• The first screening test is performed between ages 20 - 35 in men, and ages 20 - 45 in women. (Note: Different national medical organizations recommend different starting ages.)
• Follow-up screening should be done every 5 years
• Screening is done for anyone who develops Diabetes, high blood pressure, Heart disease, or another illness caused by atherosclerosis.
• Follow-up testing is done to determine how well diet and medications are controlling high cholesterol.

Screening for children is less agreed upon:

• Some experts recommend only screening children with risk factors, such as a family history of high cholesterol or early heart disease (a history of heart attacks before age 55 in men, and before age 65 in women).
• Some experts recommend screening all children, but according to the U.S. Preventive Services Task Force, there is not enough evidence to recommend for or against cholesterol screening in children.

Normal Values

The ideal values are different for people without coronary artery disease or other risk factors than for those with known coronary artery disease, diabetes, or high blood pressure. The desired values in adults are:

• LDL: 70 - 130 mg/dL (lower numbers are desired)
• HDL: greater than 40 - 60 mg/dL (higher numbers are desired)
• Total cholesterol: less than 200 mg/dL (lower numbers are desired)
• Triglycerides: 10 - 150 mg/dL (lower numbers are desired)
• VLDL: 2 - 38 mg/dL

Talk to your health care provider about the ideal levels in children.

Note: mg/dL = milligrams per deciliter

Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

What abnormal results mean

Abnormal values may be a sign that you are at increased risk for atherosclerosis and related disorders, including:

• Heart disease
• Kidney disease
• Poor blood supply to the legs
• Stroke

What the risks are

Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.

Other risks associated with having blood drawn are slight but may include:

• Excessive bleeding
• Fainting or feeling light-headed
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)

References

Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001;285:2486-2497. Updated 2004.

Semenkovich CF. Disorders of lipid metabolism. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 217.

U.S. Preventive Services Task Force. Screening for lipid disorders in adults: U.S. Preventive Services Task Force recommendation statement. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ): 2008 Jun.

U.S. Preventive Services Task Force. Screening for Lipid Disorders in Children. U.S. Preventive Services Task Force recommendation statement. Pediatrics. 2007;120(1):e215-e219.

Daniels SR, Greer FR; Committee on Nutrition. Lipid screening and cardiovascular health in childhood. Pediatrics. 2008;122:198-208.