HDL laboratory test

High Density Lipoprotein Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]

Overview

The association between HDL levels and cardiovascular outcomes, especially in statin treated high risk patient with residual cardiovascular risks, has triggered a large interest in conducting trials for the evaluation of HDL lowering drugs. HDL is one of the most complicated and heterogeneous among the different lipoproteins as HDL subfractions can largely vary in function, structure, size, cholesterol and triglyceride contents. The widely used method of measurement of HDL is through the chemical measurement of HDL-cholesterol ( HDL-c); however, recent evidence suggest that HDL-c might not be the best method to quantify HDL and study its relationship with cardiovascular outcomes in statin treated patients. Newer studies postulate that HAL-particles (HDL-p) might be a better measure for HDL's effect on residual cardiovascular risks.

HDL Measurement Modalities

Chemical Measurements

Chemical measurements can be used to estimate HDL concentrations present in a blood sample, though such measurements may not indicate how well the HDL particles are functioning to reverse transport cholesterol from tissues. HDL-cholesterol (HDL-C) is measured by first removing LDL particles by aggregation or precipitation with divalent ions (such as Mg++) and then coupling the products of a cholesterol oxidase reaction to an indicator reaction. The measurement of apo-A reactive capacity can be used to measure HDL cholesterol but is thought to be less accurate.

Electrophoresis Measurements

Since the HDL particles have a net negative charge and vary by size, electrophoresis measurements have been utilized since the 1960s to both indicate the number of HDL particles and additionally sort them by size. Larger HDL particles are carrying more cholesterol.

NMR Measurements

The newest methodology for measuring HDL particles, available clinically since the late 1990s uses nuclear magnetic resonance fingerprinting of the particles to measure both concentration and sizes. This methodology was pioneered by researcher Jim Otvos and the North Carolina State University academic research spinoff company and dramatically reduced the cost of HDL measurements.