Investigations
1st investigations to order
triglyceride level
Test
A 12- to 14-hour period of fasting is recommended to obtain optimal values.
Triglyceride (TG) level is obtained as part of a routine lipid panel that also includes total and HDL-cholesterol, along with a calculated LDL-cholesterol and calculated non-HDL-cholesterol. Non-HDL-cholesterol is a derived measurement that is stable irrespective of fasting status. Calculated LDL-cholesterol is not accurate if TG >4.6 mmol/L (>400 mg/dL).
Non-fasting TG has been proposed to be more convenient to measure and has been strongly associated with atherosclerosis risk.[53] However, if non-fasting TG is so high that LDL-cholesterol cannot be calculated, a repeat fasting lipid profile is recommended. Acute illnesses and physiological stress can transiently raise TG levels; values should be confirmed on repeat testing, especially if diagnosis is made during an acute illness.
Result
elevated TG, fasting or non-fasting ≥2 mmol/L (≥175 mg/dL)
Investigations to consider
apolipoprotein B
Test
This test is stable irrespective of fasting status and provides an integrated index of all atherogenic lipoproteins, including LDL, very low-density lipoprotein (VLDL), and triglyceride-rich remnant particles and lipoprotein(a).[24] Determination is not affected by fasting and can provide an indirect index of LDL particle size. While it is becoming more available and popular, there are no universal standards yet.
Result
an apolipoprotein B (apoB) >1.2 g/L (>120 mg/dL) indicates clearly increased atherosclerosis risk; target apoB level in patients being treated for dyslipidaemia is <0.7 g/L (<70 mg/dL) in some guidelines
fasting plasma glucose
Test
Because insulin resistance, metabolic syndrome, and diabetes often occur in patients with HTG, and are potentially modifiable, fasting plasma glucose should be part of laboratory assessment.
Normal is <5 mmol/L (<90 mg/dL), while impaired fasting glucose is >6 mmol/L (>110 mg/dL) and diabetes is >7 mmol/L (>126 mg/dL) on two occasions. Additional criteria for diabetes include HbA1c ≥48 mmol/mol (≥6.5%) or abnormal glucose tolerance test results.
Result
glucose is elevated in dysglycaemia, pre-diabetes, or diabetes mellitus
urea, creatinine
Test
A variety of renal disorders including renal failure, nephrotic syndrome, and end-stage renal disease with dialysis are associated with increased triglyceride levels.
Result
analytes are elevated in renal failure, nephrotic syndrome, and end-stage renal disease
urinary albumin/protein
Test
Because nephrotic-range proteinuria is associated with dyslipidaemia, urinary protein levels should be determined, initially by routine urinalysis screening and determining the urinary albumin-to-creatinine ratio. If this screening is concerning or suggestive, a 24-hour urinary collection for albumin or protein should be pursued.
Result
analytes are elevated in nephrotic syndrome
serum albumin
Test
Hypoalbuminaemia is associated with HTG, perhaps through indirect increase in hepatic very low-density lipoprotein (VLDL) production.
Result
analytes are low in nephrotic syndrome or liver disease
thyroid-stimulating hormone
Test
Hypothyroidism increases the risk for HTG, but more often high LDL-cholesterol and hypercholesterolaemia. Normal thyroid-stimulating hormone (TSH) range 0.4 to 4.0 milli-international units/L.
Result
TSH is elevated in primary hypothyroidism
liver function tests
Test
Transaminases and gamma-glutamyl transferase (GGT), but usually not bilirubin, may be elevated in metabolic dysfunction-associated steatotic liver disease (MASLD)/metabolic dysfunction-associated steatohepatitis (MASH) or other types of liver disease.
Result
transaminases and GGT may be abnormal: 2- to 3-fold elevated
C-reactive protein
Test
The high-sensitivity C-reactive protein (CRP) assay can detect elevations in the 2-5 mg/L (0.2 to 0.5 mg/dL) range, which may indicate associated risk of atherosclerotic cardiovascular disease (ASCVD). The routine CRP assay is sensitive to much higher levels (i.e., >8 mg/L [>0.8 mg/dL]) as seen in inflammatory disorders.
Result
if CRP is moderately elevated, this can signal increased risk of ASCVD; if it is markedly elevated, this may indicate an associated inflammatory or autoimmune condition such as systemic lupus erythematosis or rheumatoid arthritis
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