No special procedures are required for the drawing of blood for these tests. The patient must fast for 12 hours before the test, eating nothing and drinking only water. The person should not have alcohol for 24 hours before the test. Afterward, the sample is packed with ice in an insulated container and shipped to the Testing Center. Ten days later, you have the results.  The bill is approximately $700, and is not usually covered by health insurance.  There should be a stable diet and no illnesses occurring in the preceding two weeks.  A lipoproteins test requires 5 mL (milliliters) of blood. A person's physical position while having blood collected affects the results. Values from blood drawn while a person is sitting may be different from those while the person is standing. If repeated testing is done, the person should be in same position each time. Discomfort or bruising may occur at the puncture site or the person may feel dizzy or faint. Pressure to the puncture site until the bleeding stops reduces bruising.  Warm packs to the puncture site relieve discomfort.

Lipoproteins are the "packages" in which cholesterol and triglycerides travel throughout the body. Measuring the amount of cholesterol carried by each type of lipoprotein helps determine a person's risk for cardiovascular disease (disease that affects the heart and blood vessels, also called CVD).

Cholesterol and triglycerides are fat-like substances called lipids. Cholesterol is used to build cell membranes and hormones. The body makes cholesterol and gets it from food. Triglycerides provide a major source of energy to the body tissues. Both cholesterol and triglycerides are vital to body function, but an excess of either one, especially cholesterol, puts a person at risk of        cardiovascular disease.

Because cholesterol and triglycerides can't dissolve in watery liquid, they must be transported by something that can dissolve in blood serum. Lipoproteins contain cholesterol and triglycerides at the core and an outer layer of protein, called apolipoprotein.

There are four major classes of lipoproteins: chylomicrons, very low-density lipoproteins (VLDL), low-density lipoproteins (LDL), and high-density lipoproteins (HDL). There are also less commonly measured classes such as lipoprotein(a) and subtypes of the main classes. Each lipoprotein has characteristics that make the cholesterol it carries a greater or lesser risk. Measuring each type of
lipoprotein helps determine a person's risk for cardiovascular disease more accurately than cholesterol measurement alone. When a person is discovered to be at risk, treatment by diet or medication can be started and his or her response to treatment monitored by repeated testing.

The Villains

Chylomicrons are made in the intestines from the triglycerides in food. They contain very little cholesterol. Chylomicrons circulate in the blood, getting smaller as they deposit the triglycerides in fatty tissue. Twelve hours after a meal, they are gone from circulation. Serum collected from a person directly after eating will form a creamy layer on the top if left undisturbed and refrigerated overnight. This creamy layer is the chylomicrons.

Very low-density lipoproteins (VLDL):  VLDL are formed in the liver by the combination of cholesterol, triglycerides formed from circulating fatty acids, and apolipoprotein. This lipoprotein particle is smaller than a chylomicron, and contains less triglyceride but more cholesterol (10-15% of a person's total cholesterol). As the VLDL circulates in the blood, triglycerides are deposited and the particle gets smaller, eventually becoming a low-density lipoprotein (LDL). Serum from a person with a large amount of VLDL will be cloudy.

Low-density lipoproteins(LDL):  LDL, often called "bad" cholesterol, is formed primarily by the breakdown of VLDL.  LDL contains little triglycerides and a large amount of cholesterol (60-70% of a person's total cholesterol). Although the particles are much smaller than chylomicrons and VLDL, LDL particles can vary in size and chemical structure. These variations represent subclasses within the LDL class. Serum from a person with a large amount of LDL will be clear.  LDL carries cholesterol in the blood and deposits it in body tissues and in the walls of blood vessels, a condition known as atherosclerosis. The amount of LDL in a person's blood is directly related to his or her risk of cardiovascular disease. The higher the LDL level, the greater the risk. LDL is the lipoprotein class most used to trigger and monitor cholesterol lowering therapy.

Apoliprotein B (107 mg/dl):  This is the protein cap that each LDL particle wears.  By counting these, you get a precise measure of the LDL particles in the bloodstream, a truer indication of your genetic predisposition to heart disease.  These particles may damage your arteries and cause blockages, so it helps to know how many you’ve got.

Lipoprotein(a), or Lp(a) (3 mg/dl).  It is recommended that Lp(a) be kept below 20.  This is a bastard form of LDL that’s so predictive of coronary disease that it’s been called “heart attack cholesterol.”  Researchers at Oxford University in England found that among 5,400 people with heart disease, those with the highest levels had a 70 percent greater chance of having a heart attack.  It accumulates around arterial lesions and promotes clotting.  Lp(a) alone can raise your risk of heart attack by as much as 70 percent.  Furthermore, it does not respond to diet and exercise.  Niacin is the best way to treat it – 4 to 5 grams of niacin daily is recommended.

Fibrinogen (324 mg/dl):  This is a protein molecule that promotes clotting and also thickens the blood.  The more there is, the greater the likelihood that your heart is struggling to pump sludge.  High levels seem to correlate with cigarette smoking, obesity, inactivity, aging, and diabetes.  Levels above 350 double the risk of coronary disease.  Currently, high fibrinogen levels cannot be treated.

C-reactive protein (0.07 mg/dl):  This substance is produced in the liver when arteries become inflamed.  The more of it there is, the greater the chance of arterial plaque rupturing and causing a heart attack.  Levels above 2.5 mg/dl convey a two-to fourfold increase in risk and are capable of predicting first heart attacks 6 to 8 years in advance.  As with fibrinogen, high CRP levels cannot be treated at the present time.  Regarding CRP levels, it is not the CRP level itself that is thought to be the problem, but the presumed inflammation in the coronary arteries that is reflected by the high CRP level.  So the real question is whether the inflammation (and not the CRP) can be treated.  There is some evidence that infection with an organism called Chlamydia pneumoniae may be a factor in the development of coronary artery disease.  If so, then antibiotics might be effective in eliminating the infection and reducing the risk of heart attacks (and, dentally, in reducing CRP levels).

Homocysteine (7 micromoles per liter):  This is a non-essential amino acid that promotes clotting and it appears to work in conjunction with fibrinogen and Lp(a).  Levels above 7 can increase your risk of  heart attack and stroke by two to four times.  Fortunately, it’s one of the easiest of the new blood components to control.  The most important and easiest treatment is taking dietary supplements of Vitamin B12, Vitamin B6, folic acid and TMG (betadine), in addition to eating a balanced diet including fruits and green leafy vegetables.  Excessive homocysteine levels can be caused by a deficiency of folate and/or vitamin B12.  The only way of knowing exactly how many B vitamins you need to reduce your homocysteine to a safe range (below 7 micro mol per liter of blood) is to take a homocysteine blood test. If your homocysteine levels are above 7, despite the vitamin supplement regimen you are following, this means you should consider taking more folic acid, vitamins B12 and B6 and adding trimethylglycine (TMG).  Deficiencies of folate can arise because a person is not eating enough fruits and leafy green vegetables. Vitamin B12 deficiency can occur in vegetarians (since this vitamin is not found in plant sources), but deficiencies are more commonly caused by poor absorption, which can result from HIV disease, aging, and other causes.  The FDA has approved TMG as a drug to lower homocysteine in those who have a genetic defect that causes the excess accumulation of homocysteine. You should also consider reducing your dietary intake of methionine-rich foods such as meat to facilitate a lower homocysteine level.

Insulin (4 micrograms per mililiter – 12 mcg/ml):  This is a hormone secreted by the pancreas to regulate blood sugar and it is important in regulating diabetes.  However, when combined with high triglycerides, low HDL, high fibrinogen, and high levels of small, dense lipoprotein, high insulin levels strongly predispose you to atherosclerosis.  Keep this under 12 mcg/ml.  Testing for insulin isn’t new, but it’s important.

LDL IIIa and IIIb (15.6 percent):  Dense lipoprotein.  Overall, LDL is bad cholesterol, but IIIa and IIIb are the most destructive types.  There are seven subclasses of LDL particles, with such catchy names as I, Iia, Iib, IIIa, IIIb, Iva, and Ivb. They are the most dangerous because they are the smallest, densest particles – the ones most likely to work their way into artery walls and form plaques. This creates arterial lesions, contributes to the growth of existing ones, and may make plaque less stable and more susceptible to rupture. They are the worst of the seven types of LDL cholesterol that can now be measured.  People with lots of small, dense lipoprotein are classified as pattern B and have a threefold greater risk of developing heart disease.

Triglycerides:  Triglycerides are the primary form of fat and comprise the bulk of fat in foods, stored fat in the body, and are a
primary form of fat in the blood. Triglycerides are the lipids that provide calories or energy to the body. Triglycerides exist in many shapes and sizes, but they all exhibit a similar structure which is glycerol molecule with three fatty acids attached. The physical characteristics of a given fat are determined by the degree of saturation of its fatty acids.  Keeping it below 150 appears to be the new consensus for safety.  The Rush Medical College in Chicago has shown that levels of triglycerides above 190mg/100 ml significantly increases the thickness of blood. Viscous blood is more prone to produce blood clots, which can result in cardiac and/or cerebrovascular problems. (Remember, an aspirin a day helps thin blood.)  As with cholesterol, most cases of extremely high triglycerides are the result of genetics as opposed to diet. A mildly overweight individual could have levels in the range of 18,000 mg/dL (milligrams per deciliter) and above.

The Heroes

HDL is often called "good" cholesterol. HDL removes excess cholesterol from tissues and vessel walls and carries it to the liver, where it is removed from the blood and discarded. The amount of HDL in a person's blood is inversely related to his or her risk of cardiovascular disease. The lower the HDL level, the greater the risk; the higher the level, the lower the risk. The smallest lipoprotein, it contains 20-30% of a person's total cholesterol and can be separated into two major subclasses.

Several studies have suggested that low levels of HDL-C without high levels of low-density lipoprotein cholesterol (LDL-C) characterizes between 20 and 30% of the population with coronary artery disease (CAD).  From this research, it appears that increased HDL-C levels are not only protective against CAD but also lead to a reduced risk of ischemic stroke in the elderly and among different racial and ethnic groups. HDL-C is an important modifiable stroke risk factor.

HDL2b (21 percent):  Overall, HDL is good cholesterol, but 2b is the most beneficial.  The more you have it, the less likely you are to suffer a heart attack. There are five subclasses of HDL particles, labelled 2a, 2b, 3a, 3b, and 3c.