Since the trigs are high, probably neither answer is correct as the
amount of HDL-c is only a guide to the functioning of the cholesterol
recycling system.
Since HDL assays do not measure the HDL particle size they cannot really
tell us what is going on - Any result needs to be taken in conjuction
with body shape & life style details to decide whether the fibrate
therapy the patient is already on is adequate / whether they need to be
given a fibrate etc...
TIM
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Prof. Tim Reynolds,
Queen's Hospital,
Belvedere Rd,
Burton-on-Trent,
Staffordshire,
DE13 0RB
work tel: 01283 511511 ext. 4035
work fax: 01283 593064
work email: [log in to unmask]
home email: [log in to unmask]
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-----Original Message-----
From: Clinical biochemistry discussion list
[mailto:[log in to unmask]] On Behalf Of Sharpe, Peter
Sent: 22 April 2008 09:47
To: [log in to unmask]
Subject: HDL-C
Dear Colleagues,
I have great concerns regarding measurement of HDL-C in samples with
raised triglycerides. The recent NEQAS for Lipid Investigations report
(Distribution 84) demonstrated marked differences between methods.
Specimen 84B had triglycerides approx 5 mmol/l; we use the Roche
generation 3 HDL-C method and obtained an HDL-C result of 0.94 mmol/l.
The ALTM value was 1.18 mmol/l and I note that some labs were getting
results > 1.5 mmol/l. In specimen 84C, trigs were approx 7.1 mmol/l. We
obtained an HDL-C of 0.68 mmol/l, the ALTM value was 0.96 mmol/l and
many labs obtained HDL-Cs over 1.1 mmol/l.
The question is which method is obtaining the correct result for the
HDL-C in the presence of raised trigs. The Roche generation 3 method is
markedly negatively biased compared to the others. Don't forget we are
using the HDL-C to calculate the 10 year risk of Cardio-Vascular disease
and with the profound method-dependency of the HDL-C result, should we
be continuing to do so? We could be either seriously under- or
over-estimating the risk.
Furthermore, since we moved to Roche generation 3 HDL-C, we are now
getting up to 10 profoundly low HDL-C concentrations (< 0.6 mmol/l) out
of the 600 lipid profiles we analyse each day. Can I believe these
results?
Any thoughts or comments would be welcomed.
Best wishes
Peter
Dr Peter C Sharpe
Consultant Chemical Pathologist
Southern Health & Social Care Trust
Tel 028 38612657
Fax 028 38334582
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