Lipid Panel Reference Chart

Component	Age Group	Reference Range	Clinical Notes
Total Cholesterol mg/dL	Adults (≥19 years)	<200	Desirable: <200 mg/dL Borderline High: 200-239 mg/dL High: ≥240 mg/dL Total cholesterol alone is insufficient for cardiovascular risk assessment. HDL and LDL components provide better clinical insight.
Total Cholesterol mg/dL	Children/Adolescents (0-18 years)	<170
HDL Cholesterol mg/dL	Males	>40	Low (increased risk): Men <40, Women <50 High (protective): ≥60 mg/dL Clinical Pearl: HDL ≥60 mg/dL is considered a negative risk factor that removes one risk factor from the total count Exercise, moderate alcohol consumption, and weight loss can increase HDL levels. Smoking cessation prevents HDL reduction.
HDL Cholesterol mg/dL	Females	>50
LDL Cholesterol (Calculated) mg/dL	Adults	<130	Optimal: <100 mg/dL Near Optimal: 100-129 mg/dL Borderline High: 130-159 mg/dL High: 160-189 mg/dL Very High: ≥190 mg/dL Friedewald Equation: LDL = Total Cholesterol - HDL - (Triglycerides ÷ 5) Important: Calculated LDL becomes unreliable when triglycerides >400 mg/dL. Direct LDL measurement (DLDL) recommended above this threshold. Primary target for therapy. Goals vary by cardiovascular risk: Very high risk <70, High risk <100, Moderate risk <130
Direct LDL (DLDL) mg/dL	Adults	<130	Method: Spectrophotometry When to Order: Triglycerides >400 mg/dL, or by provider request CPT Code: 83721 Specimen: Gold (SST) tube or lithium heparinized plasma Stability: 5 days refrigerated More accurate than calculated LDL when triglycerides are elevated. May be reflexively ordered by laboratory when TG >400 mg/dL.
Triglycerides mg/dL	Adults	30-149	Normal: <150 mg/dL Borderline High: 150-199 mg/dL High: 200-499 mg/dL Very High: ≥500 mg/dL Requires 9-12 hour fast. Associated with metabolic syndrome, diabetes, and pancreatitis risk when very high (≥500 mg/dL).
Non-HDL Cholesterol mg/dL	Adults	<160	Formula: Total Cholesterol - HDL Cholesterol Target by Risk: • Very High Risk: <100 mg/dL • High Risk: <130 mg/dL • Moderate Risk: <160 mg/dL Useful when triglycerides ≥200 mg/dL make LDL calculation less reliable. Secondary target after LDL goal achieved.

NCEP ATP III Risk Categories and LDL Goals

Risk Category	LDL Goal (mg/dL)	Consider Drug Therapy	Patient Characteristics
Very High Risk	<70	≥70	Established CHD + diabetes, acute coronary syndrome, multiple major risk factors
High Risk	<100	≥100	CHD or CHD equivalent (diabetes, peripheral arterial disease)
Moderate Risk	<130	≥130	2+ risk factors, 10-year risk 10-20%
Lower Risk	<160	≥190	0-1 risk factors

Major Risk Factors for CHD (NCEP ATP III)

Positive Risk Factors

Age: Men ≥45 years, Women ≥55 years
Family history of premature CHD
Cigarette smoking
Hypertension (≥140/90 or on antihypertensive medication)
Low HDL cholesterol (<40 mg/dL)

Negative Risk Factor

High HDL cholesterol (≥60 mg/dL)

If HDL ≥60 mg/dL, subtract 1 from total risk factor count

ATP III Stepwise Risk Assessment and Treatment Algorithm

Step 1: Obtain Lipid Profile

Complete lipoprotein profile after 9-12 hour fast

Total cholesterol
LDL cholesterol (calculated or direct)
HDL cholesterol
Triglycerides

Step 2: Identify CHD Risk Equivalents

Clinical CHD
Diabetes mellitus
Symptomatic carotid artery disease
Peripheral arterial disease
Abdominal aortic aneurysm

Step 3: Count Major Risk Factors

Age: Men ≥45, Women ≥55 years
Family history of premature CHD
Cigarette smoking
Hypertension (≥140/90 or on medication)
Low HDL (<40 mg/dL)

Note: HDL ≥60 mg/dL removes one risk factor

LDL Goals and Treatment Thresholds by Risk Category

Risk Category	LDL Goal	Start TLC	Consider Drug Therapy
CHD or CHD Risk Equivalent (10-year risk >20%)	<100 mg/dL	≥100 mg/dL	≥130 mg/dL (100-129: optional)
2+ Risk Factors (10-year risk <20%)	<130 mg/dL	≥130 mg/dL	10-20% risk: ≥130 mg/dL <10% risk: ≥160 mg/dL
0-1 Risk Factor	<160 mg/dL	≥160 mg/dL	≥190 mg/dL (160-189: optional)

Therapeutic Lifestyle Changes (TLC) Components

TLC Diet:

Saturated fat <7% of total calories
Dietary cholesterol <200 mg/day
Consider viscous fiber (10-25 g/day)
Plant stanols/sterols (2 g/day) as therapeutic option

Additional Components:

Weight management
Increased physical activity

Drug Therapy Options (ATP III)

Drug Class	LDL Reduction	HDL Effect	TG Effect	Major Side Effects
HMG-CoA reductase inhibitors (statins)	18-55%	↑5-15%	↓7-30%	Myopathy, increased liver enzymes
Bile acid sequestrants	15-30%	↑3-5%	No change/increase	GI distress, constipation
Nicotinic acid	5-25%	↑15-35%	↓20-50%	Flushing, hyperglycemia, hepatotoxicity
Fibric acids	5-20%	↑10-20%	↓20-50%	Dyspepsia, gallstones, myopathy

Metabolic Syndrome Criteria (NCEP ATP III)

Diagnosis requires 3 or more of the following:

Component	Men	Women
Waist Circumference	>102 cm (40 in)	>88 cm (35 in)
Triglycerides	≥150 mg/dL
HDL Cholesterol	<40 mg/dL	<50 mg/dL
Blood Pressure	≥130/85 mmHg or on medication
Fasting Glucose	≥100 mg/dL or on medication

Alternative Guideline Perspectives: ATP III vs. 2018 ACC/AHA

Clinical Context: While ATP III is widely used in psychiatric metabolic monitoring, clinicians may also consider the 2018 ACC/AHA guidelines for primary cardiovascular prevention.

Current Chart Emphasis: This tool primarily follows ATP III guidelines (2001), which remain widely used for risk stratification and LDL goal setting.

Alternative Approach: The 2018 ACC/AHA guidelines emphasize cardiovascular risk assessment using pooled cohort equations and focus on statin intensity rather than specific LDL targets. Consider consulting both approaches for comprehensive cardiovascular risk management.

Aspect	ATP III (2001)	2018 ACC/AHA
Primary Focus	LDL cholesterol targets	Statin intensity and cardiovascular risk reduction
Risk Assessment	Framingham Risk Score	Pooled Cohort Equations
Treatment Approach	Treat to target LDL goals	Fixed-dose statin therapy based on risk
Clinical Utility	Excellent for goal-setting and monitoring	Simplified prescribing decisions

Clinical Pearls for Lipid Interpretation

Fasting Requirements: Total cholesterol and HDL can be measured non-fasting. Triglycerides and calculated LDL require 9-12 hour fast for accuracy.

LDL Calculation Validity: Friedewald equation (LDL = Total Chol - HDL - TG/5) is inaccurate when triglycerides >400 mg/dL. Consider direct LDL measurement.

Secondary Causes of Dyslipidemia

Elevated LDL/Total Cholesterol

Hypothyroidism
Nephrotic syndrome
Obstructive liver disease
Medications: Thiazides, beta-blockers, oral contraceptives

Low HDL Cholesterol

Smoking
Obesity
Physical inactivity
Type 2 diabetes
Medications: Beta-blockers, anabolic steroids

Elevated Triglycerides

Diabetes mellitus
Obesity
Alcohol excess
Hypothyroidism
Kidney disease
Medications: Estrogens, corticosteroids, HIV protease inhibitors

🚨 Critical Clinical Flags

Triglycerides ≥500 mg/dL: Risk of acute pancreatitis - consider immediate therapy
LDL ≥190 mg/dL: Suggests familial hypercholesterolemia - family screening indicated
HDL <20 mg/dL: Investigate secondary causes and genetic disorders
Total cholesterol <120 mg/dL: May indicate malnutrition, liver disease, or hyperthyroidism

🧠 Psychiatric Medications and Lipid Effects

Many psychiatric medications significantly impact lipid metabolism. Regular monitoring enables early intervention and improved cardiovascular outcomes in patients with mental health conditions.

High Risk Medications

High Risk (RED):

Clozapine: Significant ↑ triglycerides, ↑ total cholesterol
Olanzapine: ↑ triglycerides, ↑ LDL, ↓ HDL
Quetiapine: ↑ triglycerides, variable cholesterol effects
Risperidone: Moderate ↑ triglycerides

Monitoring: Baseline, 12 weeks, then annually minimum

Moderate Risk Medications

Moderate Risk (ORANGE):

Lithium: May ↑ triglycerides and cholesterol
Valproate: ↑ triglycerides, weight gain-related effects

Some Antidepressants (ORANGE):

Mirtazapine: ↑ triglycerides, ↑ cholesterol
TCAs: Variable effects, often weight-related

Lower Risk Medications

Lower Risk (GREEN):

Haloperidol: Minimal direct lipid effects
Fluphenazine: Generally neutral

Most Antidepressants (GREEN):

SSRIs: Generally neutral or beneficial
SNRIs: Minimal effects
Bupropion: May improve lipid profile

Clinical Management Strategies

Pre-treatment screening: Baseline lipid panel before starting high-risk medications
Regular monitoring: 12 weeks, 6 months, then annually for high-risk agents
Lifestyle interventions: Diet, exercise, smoking cessation counseling
Medication adjustment: Consider switching if significant dyslipidemia develops
Cardiology consultation: For complex cases or multiple cardiovascular risk factors

APA/ADA Consensus Guidelines for Metabolic Monitoring

Adult Monitoring Schedule

Parameter	Baseline	12 Weeks	Annually
Lipid Panel	✓	✓	✓
Weight/BMI	✓	✓	✓
Glucose/A1C	✓	✓	✓
Blood Pressure	✓	✓	✓

Pediatric Monitoring Schedule

Parameter	Baseline	3 Months	Every 6 Months
Lipid Panel	✓	✓	✓
Glucose Assessment	✓	✓	✓
Weight/BMI/Growth	✓	✓	✓
Blood Pressure	✓	✓	✓

🧒 Pediatric-Specific Monitoring Guidelines

Superior HealthPlan Medicaid/CHIP Requirements (2019):

Fasting glucose and lipid monitoring required every 6 months for youth on antipsychotics
Order one lab from each column: Glucose assessment (Basic/Comprehensive Metabolic Panel, A1C, or Glucose) AND Lipid assessment (Lipid Panel, Total Cholesterol, or individual components)
Youth may require more frequent monitoring than adults due to rapid growth and development
Consider point-of-care monitoring to reduce barriers to testing

Medicaid Monitoring Mandates: Providers should be aware that Medicaid plans actively monitor compliance with these guidelines and may reach out if members have not received appropriate monitoring within the required timeframe.

LDL Cholesterol Calculator (Friedewald Equation)

Formula: LDL = Total Cholesterol - HDL - (Triglycerides ÷ 5)

Total Cholesterol (mg/dL):

HDL Cholesterol (mg/dL):

Triglycerides (mg/dL):

Note: This calculation is invalid when triglycerides >400 mg/dL. Direct LDL measurement required.

Non-HDL Cholesterol Calculator

Formula: Non-HDL = Total Cholesterol - HDL Cholesterol

Total Cholesterol (mg/dL):

HDL Cholesterol (mg/dL):

Framingham Risk Score Calculator

Simplified version - Full assessment requires comprehensive evaluation

Age:

Total Cholesterol (mg/dL):

HDL Cholesterol (mg/dL):

Systolic BP (mmHg):

Gender:

Note: This is a simplified calculator. Use validated tools for clinical decision-making.

Reference Information

Primary Guidelines: National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III). (2001). 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. National Heart, Lung, and Blood Institute. NIH Publication No. 01-3305.

Laboratory Methods: Friedewald, W. T., Levy, R. I., & Frederickson, D. S. (1972). Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clinical Chemistry, 18(6), 499-502.

Direct LDL Methods: Martin, S. S., Blaha, M. J., Elshazly, M. B., Toth, P. P., Kwiterovich, P. O., Blumenthal, R. S., & Jones, S. R. (2013). Friedewald-estimated versus directly measured low-density lipoprotein cholesterol and treatment implications. Journal of the American College of Cardiology, 62(8), 732-739.

Pediatric Monitoring: Superior HealthPlan. (2019). Pediatric antipsychotic glucose and lipid monitoring. Superior HealthPlan Medicaid and CHIP guidelines. Referenced from Psychotropic Medication Utilization Parameters for Children and Youth in Texas Public Behavioral Health (6th Version).

Alternative Guidelines: Grundy, S. M., Stone, N. J., Bailey, A. L., Beam, C., Birtcher, K. K., Blumenthal, R. S., ... & Yeboah, J. (2019). 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol. Journal of the American College of Cardiology, 73(24), e285-e350.

Note: Reference intervals may vary by laboratory and should be interpreted within the context of individual patient risk factors and clinical presentation.

Disclaimer:

The information provided in this Lipid Panel Reference Tool is intended solely for educational and informational purposes. It does not constitute medical advice, diagnosis, or treatment, nor does it establish a provider-patient relationship. While efforts have been made to ensure the accuracy and clinical relevance of the content, PsychConcierge PLLC and PsychConcierge.com make no warranties, express or implied, regarding the completeness, reliability, or applicability of the information presented. Users are strongly encouraged to consult their licensed healthcare provider for interpretation of laboratory values and individualized medical decisions. Reference ranges may vary by laboratory and patient population. PsychConcierge PLLC assumes no responsibility for any outcomes arising from reliance on this tool.