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 LDL is the considered the primary lipid target. What effect does a 30 mg decrease in serum LDL have on CAD risk? ~30% reduction in risk for CAD True/False - Guidelines now suggest that >20 yo adults should have a fasting lipid profile every 5 years. True If a non fasting profile is performed with a total of 190 TC and 42 HDL, is a confirmatory fasting profile indicated? No, fasting is indicated when TC >200 OR HDL<40. Why are heparin tubes (green top) contraindicated in lipid sample collection? Heparin activates LpL and falsely lowers TG. True/False - Because of analytic variation, 2 specimens should be taken > 1 week apart for determing lipid profile status. False - biologic variation What is the Friedwald Equation? What must be true to use this equation? LDL = Cholesterol - [TG/5 + HDL]; TG must be < 400 to use this equation What are the optimal Targets for TC, HDL & TG? Why is LDL's optimal target different? TC <200; HDL >40; TG <150; LDL's target levels are risk based Give LDL's optimal target as determined by relative risk. Low Risk <160; Moderate & Moderate High Risk <130; High Risk <100 What % difference must be obtained between the 2 collected samples to have a true clinical significance? ~17% for lipid profile When do we screen children (2-19) for lipid disorder? What is considered High in this age group? Family History of early CHD OR a parent with TC >240; children's High is >200 TC and >130 for LDL. Describe the importance of C Reactive Protein as a diagnostic marker. C Reactive protein is an acute phase reactant that is increased (often >1000 fold) in response to stress, infection, trauma, inflammation, or neoplastic proliferation. Greater than 10 mg/L is considered high and acute infection. Between 3 - 6 is high risk for cardiovascular event. Discuss the usage of hsCRP as a marker. 1. Limit testing to patients whose estimated 10y risk of developing coronary heart disease is between 10-20%; 2.Monitor hsCRP twice, two weeks apart (expressed in mg/L); 3. Risk interpretation: <1.0mg/L = low risk, 1.0-3.0 = average risk, >3.0 = high risk; 4. Evaluate patients with values >10mg/L for specific sources of infection or inflammation; disregard value; retest in two weeks or when infection/inflammation resolved. high sensitivity CRP assay