What is an Advanced Lipid Profile?

An advanced lipid profile is a test used for the identification of additional risk factors for coronary artery disease that may not be detected on a standard lipid profile, despite a normal result.

Early detection of elevated lipid levels can easily be reversed with diet modification and medications. An advanced lipid profile is a successful tool in the detection and management of high cholesterol that can cause serious heart problems.

Early risk factor identification and modification can drastically reduce the morbidity and mortality of heart disease.

Why do I need it?

An advanced lipid profile is usually recommended at your initial visit to our clinic in addition to a standard lipid profile and is intermittently checked throughout treatment.

Standard cholesterol tests may not completely represent the risk for heart attack and strokes. This test is especially useful in patients with diabetes, insulin resistance, or cardiovascular disease who continue to have progression of cardiovascular disease even when their LDL (Lousy cholesterol) and total cholesterol is at their target goal.

This test helps determine the most accurate target number which is best for you, based on your risk factors.

What is advanced lipid profile?

An advanced lipid profile measures a variety of markers for cholesterol.

The two tests commonly done are:

    • Apolipoprotein B (ApoB)
    • LDL particle number (LDL-P)

Other tests include:

    • Apolipoprotein A1 (ApoA1)
    • HDL particle number (HDL-P)
    • Small dense LDL (sdLDL)
    • HDL-2
    • Lipoprotein (a) Mass (Lp (a))
    • Lipoprotein-associated phospholipase (Lp-PLA2)
    • Apolipoprotein E (Apo E) Genotype
    • Omega 3 fatty acid
    • Omega 6 fatty acid

An accurate advanced lipid profile is achieved after a 12 hour fast.*

Medications are to be taken as normally the morning of your test. If you are taking diabetic medications, do not take your medications the morning of your test. We will schedule an early appointment in these patients.

You may drink plenty of water during this fast; it will not affect the results of the test.

Apolipoprotein B (ApoB) and LDL particle number (LDL-P)

Since cholesterol can not dissolve in blood, it needs to attach to a lipoprotein to transport cholesterol in blood. HDL particles are known as Apo A and the particles causing atherosclerosis (fatty plaque build up in arteries) are known as Apo B. The majority of circulating Apo B particles are LDL-P.

If there is an increased amount of triglycerides and cholesterol in the blood, an increased amount of Apo B will be driven into the walls of the arteries. A type of white blood cell known as a macrophage comes to the area of Apo B deposition and ingests this foreign material. This process is the hallmark of atherosclerosis.

LDL-P is the most significant predictor of cardiovascular morbidity and mortality. This gives the most accurate number of Apo B particles in circulation; therefore assess the true risk factor for atherosclerosis.

A standard lipid profile shows the overall outlook of cholesterol, it may even be normal, but an advanced lipid profile measures the most accurate LDL levels that can lead to atherosclerosis.

This shows the accurate target number that is required for the management of your cholesterol.

Your physician may advise a combination of diet and drug therapy to prevent the onset and progression of cardiovascular disease.

Apolipoprotein A1 (ApoA1)

HDL particles (Healthy cholesterol) are known as Apolipoprotein A1. Apo A1 helps to clear out cholesterol from your arteries.

High levels of Apo A is associated with decreased risk of cardiovascular disease.

HDL particle number (HDL-P)

An increased amount of HDL-P decreases the risk of cardiovascular disease.

To further increase HDL, diet modification, exercise, and medications can be tried.


HDL-2 is the best type of HDL which removes cholesterol build up in the arteries.

An increased amount of HDL-2 decreases the risk of cardiovascular disease.

Small dense LDL (sdLDL)

Small dense LDL can produce more damage to the arterial wall than just regular LDL.

An LDL level in a standard lipid panel may be normal, but the sdLDL in an advanced lipid will assess your risk.

To lower your risk, diet, and exercise can help reduce sdLDL.

Lipoprotein (a) Mass (Lp (a))

Lipoprotein A is a genetic marker for cardiovascular disease.

An increased level of Lp (a) can increase the risk of cardiovascular risk at an early age.

Lipoprotein-associated phospholipase (Lp-PLA2)

Lp-PLA2 is a specific marker for vascular inflammation which can make fatty plaque build up within the artery prone to rupture.

Elevated Lp-PLA2 is a powerful predictor of heart attack and stroke.

Apolipoprotein E (Apo E) Genotype

Apolipoprotein E is a genetic marker for those who are more prone to high cholesterol levels.

Apo E comes in different forms including Apo E2, Apo E3, and Apo E4.

Apo E2 and Apo E3 patients respond well to statin drugs.

Fish oil is known to benefit Apo E2 and Apo E3 patients.

Apo E4 patients typically do not respond well to statin drugs but respond well with diet modification.

Elevated Apo E levels increase the risk of cardiovascular disease, especially in Apo E4 patients, as well as early-onset Alzhemers.

Patients with Down Syndrome are likely to have increased Apo E4

This is also useful in the prediction of a patient’s responsiveness to cardiac-related environmental factors, diet, and drug therapy.

Omega 3 fatty acid

Omega 3 fatty acids reduce the risk of cardiovascular disease.

A good source of omega 3 fatty acids come from oily fish and fish oils.

Omega 6 fatty acid

Omega 6 fatty acid reduces the risk of cardiovascular disease.

Oily fish and fish oil are a good source of omega 6 fatty acid.


The results of your test will return within 7 days.

Your test results will be discussed with you during your next scheduled visit. Diet or drug therapy may be advised or altered.

Your test results will be reflected in a chart form similar to the one below.

Your test result may fall under an optimal range, intermediate risk range, or high-risk range.


Optimal Range



Apo B (mg/dL)


60 – 79

≥ 80

LDL-P (nmol/L)

< 1000

1000 – 1299

≥ 1300

Apo A1 (mg/dL)

≥ 151

130 – 150

< 130

HDL-P (µmol/L)

≥ 35

28 – 34


sdLDL (mg/dL)

< 20

21 – 30

≥ 31

HDL-2 (mg/dL)

≥ 17

13 – 16

≤ 12

Lp (a) Mass (mg/dL)

< 30


≥ 30


< 200

200 – 234

≥ 235

Apo E Genotype

2/2 – 2/3


3/4 – 4/4


Omega- 3 Total

0.1% – 14.1%

Omega- 6 Total

28.6% – 44.5%