Test Catalog

Test Id : LPALD

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Lipoprotein (a) and Low-Density Lipoprotein Cholesterol, Serum

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Overview

Test Catalog

Useful For
Suggests clinical disorders or settings where the test may be helpful

Evaluation of the contribution of lipoprotein (a) (Lp[a])-cholesterol within measured low-density lipoprotein cholesterol

 

Evaluation of increased risk for cardiovascular disease and events:

-Most appropriately measured in individuals at intermediate risk for cardiovascular disease

-Patients with early atherosclerosis or strong family history of early atherosclerosis without explanation by traditional risk factors should also be considered for testing

-Follow-up evaluation of patients with elevations in Lp(a) mass

Method Name
A short description of the method used to perform the test

Lipoprotein (a) Cholesterol: Electrophoresis/Enzyme Staining/Densitometry

Low-Density Lipoprotein Cholesterol: Ultracentrifugation/Selective Precipitation/Enzymatic Colorimetric (Beta-Quantification)

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Lp(a) and LDL Cholesterol, S

Aliases
Lists additional common names for a test, as an aid in searching

Lipoprotein

Lp(a) Cholesterol

LPA

LPAWS

LDLD

Specimen Type
Describes the specimen type validated for testing

Serum

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Patient Preparation:

1. Fasting: 8 hours

2. Patient must abstain from alcohol for 24 hours before collection.

Collection Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 4 mL

Collection Instructions: Centrifuge and aliquot serum into plastic vial. Send refrigerated.

Forms

If not ordering electronically, complete, print, and send a Cardiovascular Test Request Form (T724) with the specimen.

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory

2 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Gross hemolysis Reject
Gross lipemia OK
Gross icterus Reject
 

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 7 days
Frozen 60 days

Useful For
Suggests clinical disorders or settings where the test may be helpful

Evaluation of the contribution of lipoprotein (a) (Lp[a])-cholesterol within measured low-density lipoprotein cholesterol

 

Evaluation of increased risk for cardiovascular disease and events:

-Most appropriately measured in individuals at intermediate risk for cardiovascular disease

-Patients with early atherosclerosis or strong family history of early atherosclerosis without explanation by traditional risk factors should also be considered for testing

-Follow-up evaluation of patients with elevations in Lp(a) mass

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

The cholesterol within lipoprotein(a) (Lp[a]) is included in every method that measures low-density lipoprotein cholesterol (LDL-C). Therefore, in patients that express high concentrations of Lp(a) the interpretation of LDL-C and the resulting clinical diagnoses and treatment strategies may be inaccurate. This panel reports 3 values: 1) the cholesterol measured within LDL by beta quantitation (this result contains both LDL-C and Lp[a]), 2) the cholesterol within Lp(a), and 3) a calculated "true" LDL-C where Lp(a)-C is subtracted from the beta quantitation LDL-C.

 

The abnormal lipoprotein-X (LpX) is visible on lipoprotein electrophoresis. If LpX is present, the measurement of LDL-C is inaccurate and will not be reported.

Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

Lipoprotein (a) CHOLESTEROL: Normal: <5 mg/dL

Lipoprotein-X: Undetectable

Low-Density Lipoprotein Cholesterol (LDL-C):

The National Lipid Association and the National Cholesterol Education Program (NCEP) have set the following guidelines for LDL-C in adults (ages 18 years and up):

Desirable: <100 mg/dL

Above desirable: 100-129 mg/dL

Borderline high: 130-159 mg/dL

High: 160-189 mg/dL

Very high: > or =190 mg/dL

 

The Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents has set the following guidelines for LDL-C in children and adolescents (ages 2-17 years):

Acceptable: <110 mg/dL

Borderline high: 110-129 mg/dL

High: > or =130 mg/dL

Interpretation
Provides information to assist in interpretation of the test results

Results of this panel can be used to determine the cholesterol content of low-density lipoprotein (LDL) and lipoprotein (a) (Lp[a]) separately. Interpretations of lipoprotein disorders can be made within the other clinical context.

 

Lipoprotein-X (LpX) is an abnormal lipoprotein that appears in the sera of patients with obstructive jaundice and is an indicator of cholestasis. The presence of LpX will be reported if noted during Lp(a) cholesterol analysis. The other values (LDL-C and Lp(a)-C) will not be reported if LpX is present.

Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Lipoprotein (a) (Lp[a]) cholesterol values should not be confused with Lp(a) mass values, although they may be correlated in some individual cases. Lp(a) cholesterol values will be approximately 10 times lower than Lp(a) mass values, but the difference between the measures is not uniform. Lp(a) mass values are considered elevated when greater than 30 mg/dL. Lp(a) cholesterol is increased if greater or equal to 5 mg/dL.

 

Intravenous administration of heparin causes activation of lipoprotein lipase, which tends to increase the relative migration rate of the fractions, especially beta lipoproteins.

Supportive Data

Interpretation of low-density lipoprotein cholesterol (LDL-C) can be confounded in cases with elevated lipoprotein (a) (Lp[a]) expression because the cholesterol within Lp(a) is usually indistinguishable from the cholesterol within LDL. Accurate LDL-C measurements are critical for identifying genetic dyslipidemias such as familial hypercholesterolemia (FH). The interpretation of LDL-C, particularly in FH diagnostic algorithms may be affected by Lp(a)-C content.(1). Therefore, this panel reports the total measured LDL-C, the Lp(a)-C, and the LDL-C corrected for Lp(a)-C content.

Clinical Reference
Recommendations for in-depth reading of a clinical nature

1. Fatica EM, Meeusen JW, Vasile VC, Jaffe AS, Donato LJ. Measuring the contribution of Lp(a) cholesterol towards LDL-C interpretation. Clin Biochem. 2020 Dec;86:45-51. doi: 10.1016/j.clinbiochem.2020.09.007. Erratum in: Clin Biochem. 2021 Feb;88:56-57

2. Willeit P, Yeang C, Moriarty P, et al: Low-density lipoprotein cholesterol corrected for lipoprotein (a) cholesterol, risk thresholds, and cardiovascular events. J Am Heart Assoc. 2020 Dec;9(23):e016318

3. Yeang C, Witztum JL, Tsimikas S: 'LDL-C'?=?LDL-C?+?Lp(a)-C: implications of achieved ultra-low LDL-C levels in the proprotein convertase subtilisin/kexin type 9 era of potent LDL-C lowering. Curr Opin Lipidol. 2015 Jun;26(3):169-178. doi: 10.1097/MOL.0000000000000171

4. Kinpara K, Okada H, Yoneyama A, Okubo M, Murase T: Lipoprotein(a)-cholesterol: a significant component of serum cholesterol. Clin Chim Acta. 2011 Sep 18;412(19-20):1783-1787. doi: 10.1016/j.cca.2011.05.036

5. Yeang C, Willeit P, Tsimikas S: The interconnection between lipoprotein(a), lipoprotein(a) cholesterol and true LDL-cholesterol in the diagnosis of familial hypercholesterolemia. Curr Opin Lipidol. 2020 Dec;31(6):305-312. doi: 10.1097/MOL.0000000000000713

Method Description
Describes how the test is performed and provides a method-specific reference

Lipoprotein (a) Cholesterol:

Electrophoretic separation of lipoproteins followed by lipid staining and densitometry measurement.(Package insert: SPIFE Vis Cholesterol Reagent. Helena Laboratories; 09/2015)

 

Low-Density Lipoprotein Cholesterol:

Serum is combined with dextran sulfate and magnesium, ions precipitate the low-density lipoprotein and very low-density lipoprotein fractions, leaving the high-density lipoprotein (HDL) fraction in solution. The HDL cholesterol is then determined using an enzymatic cholesterol assay.(Package insert: HDL Cholesterol Precipitating Reagent Set (Dextran Sulfate). Pointe Scientific, INC; 12/2009)

 

Cholesterol esters are cleaved by the action of cholesterol esterase to yield free cholesterol and fatty acids. Cholesterol oxidase then catalyzes the oxidation of cholesterol to cholest-4-en-3-one and hydrogen peroxide. In the presence of peroxidase, the hydrogen peroxide formed effects the oxidative coupling of phenol and 4-aminophenazone to form a red quinone-imine dye. The color intensity of the dye formed is directly proportional to the cholesterol concentration. It is determined by measuring the increase in absorbance.(Package insert: Roche Cholesterol Gen 2 Reagent. Roche Diagnostics; V 13.0, 02/2019)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday through Friday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

3 to 4 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

7 days

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their account representative. For assistance, contact Customer Service.

Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

This test has been modified from the manufacturer's instructions. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

83700

83701

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
LPALD Lp(a) and LDL Cholesterol, S 100732-7
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
2849 Lp(a) Cholesterol 35388-8
23924 LpX 42178-4
614917 LDL Chol (Beta-Quantification), S 18261-8
610767 LDL-C Corrected for Lp(a)-C 100733-5

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | PHP Pdf | CMS Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports