Cardiac Markers Part I Lecture
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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.
- 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.