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ISSN: 1734-1922
Archives of Medical Science
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vol. 16

2020 Guidelines of the Polish Society of Laboratory Diagnostics (PSLD) and the Polish Lipid Association (PoLA) on laboratory diagnostics of lipid metabolism disorders

Bogdan Solnica
Grażyna Sygitowicz
Dariusz Sitkiewicz
Barbara Cybulska
Jacek Jóźwiak
Grażyna Odrowąż-Sypniewska
Maciej Banach

Arch Med Sci 2020; 16 (2): 237–252
Online publish date: 2020/03/02
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1. Introduction

The lipid profile, which is routinely done to assess a cardiovascular risk, involves the measurement/calculation of serum/plasma levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and non-HDL cholesterol (non-HDL-C), although LDL-C measurement still plays a key role in the diagnosis, prediction and the monitoring of both the course and treatment of lipid disorders [1–3]. The results of the measurements indirectly and approximately reflect the blood content of individual lipoproteins. Quantitative measurement of atherogenic lipoproteins, i.e. LDL, lipoprotein(a) [Lp(a)], chylomicron (CM) remnants and very low-density lipoprotein (VLDL) remnants, is of special importance in laboratory assessment of lipid metabolism and the risk of atherosclerosis progression [2, 3]. This is why lipid profile, which usually applies only to the LDL level, should be supplemented with the measurement of Lp(a) as well as CM and VLDL remnants, if possible.
Lipoproteins are a family of large particles composed of an “envelope”, which contains phospholipids and free cholesterol, and a core containing TG and cholesterol esters. The lipid part is bound to specific proteins – apolipoproteins (apo), which determine the physical and biological properties of lipoproteins [3]. Lipids are not covalently attached to proteins. The structure of lipoproteins is maintained primarily by hydrophobic interactions between nonpolar components of lipids and proteins. Lipoprotein classification reflects the particle size and density in the aqueous plasma environment as well as the content of apolipoproteins (Figure 1). Triglyceride-rich CM and VLDL as well as CM and VLDL remnants have a density of less than 1.006 g/ml. LDL, HDL and Lp(a) are lipoproteins with a density of over 1.006 g/ml [3].
The system of lipid transport with the involvement of lipoproteins has two main functions:
• Transport of triglycerides from the intestine and liver to the adipose tissue and muscles (intestinal pathway);
• Supply of cholesterol to the peripheral tissues, where it is essential for the formation of cell membranes and biosynthesis of steroid hormones, and to the liver, where it is used for the synthesis of bile acids (hepatic pathway) (Figure 2).
Dietary TG are hydrolysed in the intestine into free fatty acids (FFA), mono- and diglycerides, absorbed with the...

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