Lipid Profile (Blood)

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Test Guide

Lipid Profile (Blood)

Testing Laboratory

Auckland Te Toka Tumai | Auckland Hospital

Department

Chemical Pathology

Delphic Registration Code (Alpha Code)

Serum/Plasma
Alpha Code: SCHO (Serum/plasma Cholesterol only), Numeric Code: 0140
Alpha Code: HDL (Serum/plasma GROUP code, full lipid profile, Numeric Code: 0163
Alpha Code: STRG (Serum/plasma Triglyceride only), Numeric Code: 0141,

Other Fluids
Alpha Code: OTRG (Other fluid Triglyceride only), Numeric Code: 0541
Alpha Code: OHDL (Other fluid HDL Cholesterol only), Numeric Code: 3871
Alpha Code: OLDL (Other fluid) (GROUP code, full lipid profile), Numeric Code: 3872

Laboratory Handling

Phlebotomy

The lipid profile includes the following tests:
- Total cholesterol
- HDL-cholesterol
- Triglycerides
- LDL-cholesterol (calculated)
- TC / HDL ratio (calculated)

Both fasting and non-fasting samples are acceptable.

Laboratory

Serum/Plasma: Register HDL for group registration of Total Cholesterol, HDL Cholesterol, Triglyceride and LDL Cholesterol.

Sample Stability

Cholesterol: 7 days at 15-25°C, 7days at 2-8°C, 3 months at -20°C.
HDL: 72 hours at 15-25°C, 7 days at 2-8°C, 12 months at -20°C.
Triglyceride: 2 days at 20-25°C, 10 days at 4°C, 3 months at -20°C.

Associated Tests

Other Fluids

Synonyms

Lipids, Total cholesterol, HDL cholesterol, LDL cholesterol, non-HDL cholesterol, HDL, LDL, Triglyceride, TRIG, TG

Turnaround Time

3 hours

Specimen Type

Plasma
Serum

Specimen Requirements

Tube/Container Type:

Preferred

Lithium Heparin PST- Gel (Light Green Cap)

Acceptable

Lithium Heparin - Non-gel (Green Cap)
Plain (Red Top)
SST II (Gold Cap)

Preferred Sample Volume (ml)

Minimum Sample Volume (ml)

3.5

No of Samples Required

Paediatric Specimen Requirements

Tube/Container Type:

Preferred

Lithium Heparin PST- Gel (Light Green Cap)

Acceptable

Lithium Heparin - Non-gel (Green Cap)
Plain (Red Top)

Preferred Sample Volume (ml)

0.5

Minimum Sample Volume (ml)

0.5

Pre-testing Requirements

Non-fasted samples are acceptable in most cases of lipid assessment. Triglycerides (TGs) can increase after a meal, but this is usually small (about 0.3 mmol/L) and therefore does not impact measures of LDL-, HDL- or non-HDL cholesterol except in extreme cases. In Auckland, there is a consensus from experts that non-fasting lipids can be used to assess absolute risk, using an algorithm such as PREDICT. In a minority of patients, a more significant increase in TGs may occur after a meal. In these cases, fasted testing may be clinically useful when the cholesterol concentration is of interest.

There is little difference in most lipid parameters between fasting and non-fasting specimens after a typical meal (1-3). Total cholesterol and LDL fall by about 0.2 mmol/L and HDL by about 0.1 mmol/L, for up to 3-4h. The TC/HDL ratio does not change. These changes mostly reflect the dilution effect of water in the ingested food and are well within physiological variation of lipids typically seen in individual patients.

Both fasted and non-fasted cholesterol measures show a similar predictive value for CVD risk (4-6).

Additional Specimen Information

0.5 mL Paediatric Microtainer PST Blood (Preferred)
0.5 mL Paediatric Microtainer Heparin Blood
0.5 mL Paediatric Microtainer Plain Blood

Diagnostic Use

Lipid testing is mostly performed to inform cardiovascular risk but can also be useful to determine the cause of acute pancreatitis and several metabolic conditions.

The lipid profile includes the following tests:

Triglycerides
Total cholesterol
HDL cholesterol
LDL cholesterol (calculated)
Non-HDL cholesterol (calculated)
Total/HDL ratio (calculated)

See ‘Specimen’ section of pre-testing requirements above for more information on fasted vs. non-fasted sampling.

Triglycerides – In healthy people triglycerides rise about 15-20%, or about 0.2-0.3 mmol/L (2,4), after a meal (for up to 6-8h)(1). Some patients have slow lipid particle clearance after food (so-called ‘post-prandial dyslipidaemia’). They typically have a high triglyceride and low HDL pattern even on fasting samples. However, non-fasting triglycerides may even better predictive value for future CVD events in such patients (9,10). Therefore an initial non-fasting sample is also reasonable. The disadvantage is that accurate ranges are less well documented than for fasting measurements, but non-fasting triglycerides above 2 mmol/L is suspicious for such ‘postprandial dyslipidaemia’ unless explained by some other factor, such as alcohol or oestrogens(11).

LDL-cholesterol calculation – In most labs, including LabPLUS, LDL-cholesterol is calculated from other lipid measures (7, 8). There is more than one equation used to calculate LDL in public labs. In most patients, the formulae agree well, but diverge when triglycerides are high. (LabPLUS uses the Sampson equation, which allows calculation of LDL even when triglycerides are as high as 9.0 mmol/L.

Non-HDL cholesterol – The total of all atherogenic (apoB containing) particles can be expressed together as non-HDL cholesterol. This includes LDL as well as VLDL, IDL, and lipoprotein (a). Non-HDL compares favourably with LDL as a CVD risk marker, especially in patients with poor lipid particle clearance where the proportion of non-LDL particles in increase. It does not require the patient to be fasting. Non-HDL cholesterol can be easily calculated by the formula: Non-HDL cholesterol = total cholesterol – HDL cholesterol.

Although the modern emphasis is not on strict cholesterol treatment targets, but rather a risk-based approach, historically non-HDL treatment targets were usually about 0.8 mmol/L higher than LDL targets. In a non-fasting patient, a non-HDL level of 5.7 mmol/L or more may indicate genetic hypercholesterolemia that requires further evaluation or a secondary cause (13) .

Interpretation

Note that the intervals provided below are not the typical 95% or 99% intervals that represent the ‘normal’ population nor ideal ranges, but should indicate what is acceptable if there are no other major risk factors present. In a patient at high risk of CVD, a lower LDL than the intervals below may be preferable.

Reference Intervals

Adults

total cholesterol	<5.0
HDL cholesterol	>1.0
LDL cholesterol	<3.4
Triglyceride (TG)	<2.0
total/HDL ratio	<4.5
Non-HDL cholesterol	<4.2

References

Patients <19 years old

Age	Total cholesterol	HDL cholesterol	Triglyceride
0 – 14 days	1.2 – 3.2	0.4 – 1.1	0.9 – 3.0
15 days – 1 year	1.6 – 6.2	0.3 – 1.9	0.6 – 3.0
1 to 19 years	2.9 – 5.4	0.8 – 1.9	0.5 – 2.3

Units : mmol/L

Conversion factors :

Cholesterol (total, HDL and LDL): mg/100 mL x 0.026 = mmol/L
mmol/L x 38.6 = mg/100 mL

Triglyceride: mg/100 mL x 0.0113 = mmol/L
mmol/L x 88.5 = mg/100 mL

Test Method

Total Cholesterol
Principle : Enzymatic/ Colorimetric
Reagents: Roche assay
Analyser: Roche Cobas

HDL Cholesterol
Principle: Enzymatic/ Colorimetric
Reagents: Roche assay
Analyser: Roche Cobas

Chol/HDL Chol Ratio:
Principle: This is calculated as follows:
Chol/HDL Chol Ratio = total cholesterol / HDL-cholesterol.

LDL Cholesterol
Principle: This is calculated using the Sampson equation as follows:
LDL Cholesterol = 1.055 x total cholesterol - 1.03 x HDL-cholesterol - [(triglycerides/3.735) + triglycerides((total cholesterol - HDL-cholesterol)/24.18) ((triglycerides2)/79.38] - 0.244.
This calculation is valid when serum triglycerides are less than 9.0 mmol/L.

Triglyceride
Principle : Enzymatic/ Colorimetric
Reagents: Roche assay
Analyser: Roche Cobas

Non-HDL Cholesterol
This is not reported, but can easily be calculated as follows:
Non-HDL Cholesterol = total cholesterol - HDL-cholesterol.

Limitations / Interference

Triglycerides: Can be impacted by recent meals or fasting. Falsely high results can occur with excess glycerol.

LDL Cholesterol: In the presence of very high triglycerides, this may be impossible to calculate and report.

Uncertainty of Measurement

Total cholesterol: 4%
HDL-cholesterol: 6%
Triglyceride: 5%

1. Langsted A, Freiberg JJ and Nordesgaard BG.   Fasting and non-fasting lipid levels: influence of normal food intake on lipids, lipoproteins, apoproteins and cardiovascular risk prediction. Circulation 2008; 118: 2047-56.
2. Sidhu D, Naugler C. Fasting time and lipid levels in a community-based population: a cross-sectional study [published online November 12, 2012]. Arch Intern Med . 2012;172: 1707-1710.
3. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106: 3143?3421.
4. Mora S, Rifai N, Buring JE, and Ridker PM. Fasting compared with non-fasting lipids and apolipoproteins for predicting incident cardiovascular events. Circulation 2008; 118: 993-1001
5. Di Angelantonio E, Sarwar N, Perry P, et al.   Emerging Risk Factors Collaboration. Major lipids, apolipoproteins, and risk of vascular disease. JAMA . 2009; 302:1993-2000.
6. Khera AV, Mora S. Fasting for lipid testing.   Is it worth the trouble?   Arch. Int. Med. 2012; 172: 1710-2
7. Friedewald WT, Levy RI, and Fredrickson DS.   Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without the use of the preparative ultracentrifuge. Clin Chem 1972;18: 499 ? 502.
8. Mora S, Rifai N, Buring JE, Ridker PM. Comparison of LDL cholesterol concentrations by Friedewald calculation and direct measurement in relation to cardiovascular events in 27 331 women. Clin Chem 2009; 55: 888-94
9. Sampson M, Ling C, Sun Q et al., A New Equation for Calculation of Low-Density Lipoprotein Cholesterol in Patients With Normolipidemia and/or Hypertriglyceridemia. JAMA Cardiol. 2020 May 1;5(5):540-548.
10. Bansal S, Buring JE, Rifai N, et al. Fasting compared with non-fasting triglycerides and risk of cardiovascular events in women. JAMA 2007; 298: 309-16
11. Nordestgaard BG, Benn M, Schnohr P, Tybjaerg-Hansen A. Nonfasting triglycerides and risk of myocardial infarction, ischemic heart disease, and death in men and women. JAMA . 2007;298:299 ?308.
12. Watts GF and Kohn JS. Whither the lipid profile? Feast, famine, or no free lunch?   Clin. Chem. 57:363-5
13. www.ifcc.org (keyword ?non-HDL cholesterol?)
14. Stone, NJ, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.    J. Am. Coll. Cardiol. 2014 Jul 1;63 (25 Pt B): 2889-934.
15. Su X, Kong Y, Peng D (2019). Evidence for changing lipid management strategy to focus on non-high density lipoprotein cholesterol. Lipids in Health and Disease 18, number 134.
16. Visseren FLJ, Mach, F, et al (2021). ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC). Euro Heart J 42(34):3227-37
17. Williams E, Round T, Jones NR (2024). Cardiovascular disease - risk assessment and reduction: NICE 2023 update for GPs. Br J Gen Pract 74(748):523

Last updated: 18/09/2026

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Testing Laboratory

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Delphic Registration Code (Alpha Code)

Laboratory Handling

Phlebotomy

Laboratory

Sample Stability

Associated Tests

Synonyms

Turnaround Time

Specimen Type

Specimen Requirements

Tube/Container Type:

Preferred

Acceptable

Preferred Sample Volume (ml)

Minimum Sample Volume (ml)

No of Samples Required

Paediatric Specimen Requirements

Tube/Container Type:

Preferred

Acceptable

Preferred Sample Volume (ml)

Minimum Sample Volume (ml)

Pre-testing Requirements

Additional Specimen Information

Diagnostic Use

Interpretation

Reference Intervals

Adults

References

Patients <19 years old

Test Method

Limitations / Interference

Uncertainty of Measurement

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Lipid Profile (Blood)

Overview

Testing Laboratory

Department

Delphic Registration Code (Alpha Code)

Laboratory Handling

Phlebotomy

Laboratory

Sample Stability

Associated Tests

Synonyms

Turnaround Time

Specimen

Specimen Type

Specimen Requirements

Tube/Container Type:

Preferred

Acceptable

Preferred Sample Volume (ml)

Minimum Sample Volume (ml)

No of Samples Required

Paediatric Specimen Requirements

Tube/Container Type:

Preferred

Acceptable

Preferred Sample Volume (ml)

Minimum Sample Volume (ml)

Pre-testing Requirements

Additional Specimen Information

Referral

Clinical Information/Test Method

Diagnostic Use

Interpretation

Reference Intervals

Adults

References

Patients <19 years old

Test Method

Limitations / Interference

Uncertainty of Measurement

Additional Information

Contact Information

Contact Information

Enquiry Form

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