Synonym
Tubes
- Red top tube
- 5-7 mL of venous blood
Additional information:
- 12-14 hours fasting before specimen is drawn
- Stable diet for 2 wks
- No alcohol for 24 hr before the test
Info
- Cholesterol is a lipid, obtained from the diet (exogenous cholesterol) or synthesized in the body (endogenous cholesterol), mainly by the liver and intestinal mucosa.
- Cholesterol is a component of the cell membrane, and materials that render the skin waterproof.
- An integral component in bile salts, adrenal corticosteroids, estrogen, androgens, and other hormones.
- Serum cholesterol measures the circulating levels of free cholesterol and cholesterol esters.
- The total cholesterol seems to be much less important than the fractions of LDL ("bad"), HDL ("good"), and VLDL
- Total cholesterol = LDL + HDL + VLDL
Clinical
Clinical Overview:
- Total cholesterol (TC) = LDL + HDL + Triglycerides/5 [Triglycerides/5 estimates VLDL]
- The total cholesterol seems to be much less important than the fractions of LDL ("bad"), HDL ("good"), and VLDL that make up the total cholesterol
- TC:HDL ratio seems predictive of cardiac risk (Framingham Heart Study)
- Males TC:HDL of 5=average risk, 3.4=half of average risk 9.6=double of average risk
- Females TC:HDL of 4.4=average risk, 3.3=half of average risk 7=double of average risk
- HDL>60 mg/dL offers cardiac protective, HDL<40 mg/dL increases cardiac risk
- LDL goals of <100 mg/dL are "optimal" for higher risk patients and <70 mg/dL may be sought for very high risk patients
Indications for testing total cholesterol levels include:
- To evaluate the risk of
- Atherosclerosis
- Cerebrovascular disease
- Coronary arterial disease
- Peripheral artery disease
- To evaluate fat metabolism
- To aid in the diagnosis of
- Hepatic disease
- Nephrotic syndrome
- Pancreatitis
- Thyroid disorders
- To assess efficacy of therapy to lower cholesterol
- Lifestyle changes such as exercise or diet
- Pharmacologic therapy
- To investigate hypercholesterolemia in patients with family history of cardiovascular disease
- In screening of patients with celiac disease. High to normal levels of total cholesterol rule out celiac disease with 100% sensitivity
- Low levels of cholesterol indicate poor prognosis in severe illness
Additional information
- A total blood cholesterol level is one of several important factors in determining risk of coronary artery disease
- African-American adults have lower cholesterol levels than Caucasian adults
- Cholesterol levels are 3-5% higher in fall and winter, and lowest in spring and summer
- Day to day variation is about 7%
- Related laboratory tests include:
- Apolipoprotein A
- Apolipoprotein B
- Aspartate aminotransferase
- Atrial natriuretic peptide
- Blood gases
- B-type natriuretic peptide
- C-reactive protein
- Creatine kinase and isoenzymes
- Glucose
- Glycated hemoglobin
- HDL
- Homocysteine, ketones
- Lactate dehydrogenase and isoenzymes
- Lipoprotein electrophoresis
- Magnesium
- Myoglobin
- Potassium
- Triglycerides
- Troponin
Nl Result
Consult your laboratory for their normal ranges as these may vary somewhat from the ones listed below.
Note on total cholesterol:
The total cholesterol seems to be much less important than the fractions of LDL ("bad"), HDL ("good"), and VLDL that make up the total cholesterol
| Conv. Units (mg/dL) | SI Units (mmol/L) |
---|
Adults |
Desirable level | 140-199 | 3.63-5.15 |
Borderline high | 200-239 | 5.18-6.19 |
High | >240 | >6.2 |
Adolescents (12-18 yrs) |
Desirable | <170 | <4.39 |
Borderline high | 170-199 | 4.4-5.16 |
High | >200 | >5.18 |
Child <12 years |
Normal | 70-175 | 1.81-4.53 |
High Result
Conditions associated with elevated cholesterol levels, include:
- Acute intermittent porphyria (AIP)
- Alcoholism
- Anorexia nervosa
- Cholestasis
- Chronic renal failure
- Diet high in cholesterol and fats
- Familial type II hypercholesterolemia
- Glomerulonephritis
- Glycogen storage disease (von Gierke's disease)
- Gout
- Hemoconcentration
- Hepatocellular disease, biliary cirrhosis
- Hyperlipoproteinemia types I, IV, and V
- Hypothyroidism
- Mental stress
- Nephrotic syndrome
- Obesity
- Pancreatic and prostatic malignant neoplasms
- Poorly controlled diabetes mellitus
- Pregnancy
- Smoking
- Werner's syndrome
Drugs that increase the total cholesterol levels include:
*Note that some of these agents have variable affect and may decrease or increase cholesterol*
- Acetohexamide
- Acetophenazine
- ACE Inhibitors
- Aminoglutethimide
- Amiodarone
- Amphotericin B
- Amprenavir
- Anabolic steroids
- Anastrozole
- Ascorbic Acid
- Asparaginase
- Aspirin
- Azathioprine
- Basiliximab
- Beclomethasone
- Bicalutamide
- ß-Blockers
- Calcitriol
- Carbamazepine
- Chenodiol
- Chlorpromazine
- Chlorpropamide
- Chlorthalidone
- Clofibrate
- Clonidine
- Clopidogrel
- Conjugated estrogens
- Corticosteroids
- Cortisone
- Cyclophosphamide
- Cyclosporine
- Danazol
- Dantrolene
- Dapsone
- Disulfiram
- Ether
- Etretinate
- Fluoroquinolone antibiotics
- Fluoxymesterone
- Fluvoxamine
- Glucocorticoids
- Glyburide
- Gold
- Imipramine
- Indapamide
- Isotretinoin
- Lansoprazole
- L-Asparaginase
- Levarterenol
- Lithium
- Medroxyprogesterone
- Mepazine
- Meprobamate
- Methimazole
- Methyclothiazide
- Miconazole
- Mirtazapine
- Mycophenolate
- Nafarelin
- Nandrolone
- Nefazodone
- Norethandrolone
- Norplant
- NSAIDS
- Oral contraceptives
- Oxymetholone
- Paroxetine
- Penicillamine
- Pergolide
- Phenobarbital
- Phenothiazines
- Phenytoin
- Pindolol
- Polythiazide
- Prochlorperazine
- Promazine
- Radioactive iodine
- Retinoids
- Riluzole
- Rosiglitazone
- Salicylates
- Sargramostim
- Sirolimus
- Sotalol
- Spironolactone
- Sulfadiazine
- Tamoxifen
- Theophylline
- Thiabendazole
- Thiazide diuretics
- Thiouracil
- Ticlopidine
- Tolcapone
- Tretinoin
- Troglitazone
- Venlafaxine
- Vitamin D
- Zolpidem
Low Result
Conditions associated with decreased cholesterol levels include:
- Acute severe illnesses (trauma, infection, burns)
- Chronic obstructive lung disease
- Chronic myelocytic leukemia
- Hepatocellular disease (severe)
- Hyperthyroidism
- Hypo-alpha-lipoproteinemia
- Hypobetalipoproteinemia
- Inflammation
- Luteal phase of menstrual cycle: 10-20% lower
- Malabsorption syndromes
- Malnutrition
- Megaloblastic anemia
- Mental retardation
- Myeloma
- Myeloproliferative diseases
- Myocardial infarction (period 3-4 days post MI)
- Polycythemia vera
- Sideroblastic anemia
- Smith-Lemli-Opitz Syndrome
- Tangier's Disease
- Thalassemia
- Waldenström's macroglobulinemia
Drugs that decrease total cholesterol level include:
*Note that some of these agents have variable affect and may decrease or increase cholesterol*
- Acarbose
- Acebutolol
- ACE-Inhibitors
- Albuterol
- Aldesleukin
- Allopurinol
- Aluminum hydroxide
- Aminoglycoside antibiotics
- Amiloride
- Amiodarone
- Amlodipine
- Ampicillin
- Ascorbic acid
- Asparaginase
- Aspirin
- Atorvastatin
- Azathioprine
blockers- Calcium channel blockers
- Chlorambucil
- Chloroform
- Chlorpropamide
- Chlorthalidone
- Cholestyramine
- Cilazapril
- Clofibrate
- Clomiphene
- Clonidine
- Coenzyme q10
- Colchicine
- Colestipol
- Conjugated estrogens
- Doxazosin
- Erythromycin
- Estrogens
- Fenofibrate
- Fluoxymesterone
- Gemfibrozil
- Glyburide
- Granulocyte colony-stimulating factor
- Guanabenz
- Haloperidol
- HMG CoA-reductase inhibitors (Statins)
- Indomethacin
- Insulin
- Isoniazid
- Isotretinoin
- Isradipine
- Ketoconazole
- Lansoprazole
- Levonorgestrel
- Levothyroxine
- Lincomycin
- LMW heparin
- Losartan
- MAO inhibitors
- Medroxyprogesterone
- Metformin
- Methyldopa
- Metronidazole
- Nandrolone
- Neomycin
- Niacin
- Nicotinic acid
- Norplant
- Oral contraceptives
- Oxandrolone
- Oxymetholone
- Perindopril
- Phenytoin
- Prazosin
- Prednisolone
- Probucol
- Progesterone
- Psyllium
- Raloxifene
- Spironolactone
- Statins
- Streptokinase
- Tacrolimus
- Tamoxifen
- Terazosin
- Tetracycline
- Thiazide diuretics
- Thyroid hormones
- Tolbutamide
- Trazodone
- Ursodiol
- Valproic acid
References
- Allison MA et al. The effect of novel cardiovascular risk factors on the ethnic-specific odds for peripheral arterial disease in the Multi-Ethnic Study of Atherosclerosis (MESA). J Am Coll Cardiol. 2006 Sep 19;48(6):1190-7. Epub 2006 Aug 28
- Brar P et al. Change in lipid profile in celiac disease: beneficial effect of gluten-free diet. Am J Med 2006 Sep;119(9):786-90
- Cui R et al. Serum total cholesterol levels and risk of mortality from stroke and coronary heart disease in Japanese: The JACC study. Atherosclerosis 2006 Sep 11; [Epub ahead of print]
- Gabriel A. Changes in plasma cholesterol in mood disorder patients: Does treatment make a difference? J Affect Disord. 2006 Sep 14; [Epub ahead of print]
- LabTestsOnline®. Cholesterol Total. [Homepage on the Internet] ©2001-2006. Last reviewed on December 10, 2004. Last accessed on October 20, 2006. Available at URL: http://www.labtestsonline.org/understanding/analytes/cholesterol/glance.html
- Nobili V et al. NAFLD in children: a prospective clinical-pathological study and effect of lifestyle advice. Hepatology 2006 Aug;44(2):458-65
- Rodondi N et al. Subclinical hypothyroidism and the risk of coronary heart disease: a meta-analysis. Am J Med 2006 Jul;119(7):541-51
- Rudichenko EV et al. Disturbances of lipid exchange and peroxidation system in patients with chronic pyelonephritis. Klin Med (Mosk) 2006;84(5):54-8
- The Third Report of the National Cholesterol Education Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Available at http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3xsum.pdf and update with 2004 changes at http://www.nhlbi.nih.gov/guidelines/cholesterol/upd-info_prof.htm
- Ushioda M et al. Serum Lipoprotein(a) Dynamics before/after Menopause and Long-term Effects of Hormone Replacement Therapy on Lipoprotein(a) Levels in Middle-aged and Older Japanese Women. Horm Metab Res. 2006 Sep;38(9):581-6