Blood test metrics explained briefly, with a summary of the conversion factors for US/European Cholesterol and Triglyceride units. See the presentation at https://www.youtube.com/watch?v=YRFRRqe0vrE

1. The Cholesterol Conundrum -
“Know Your Metrics”
www.thefatemperor.com

2. Metrics Content:
2013 Ivor Cummins BE(Chem) MIEI
1. Cholesterol Units 101
2. Standard Lipid Test
• Total Cholesterol Concentration
• LDL / HDL Cholesterol Concentration
• Serum Triglyceride
3. The All-Important Ratios
• Total Cholesterol / HDL
• Triglyceride / HDL
4. Introduction to some other Critical Metrics
• Fasting Insulin, Blood Glucose/HbA1c, 25 Hydroxy Vitamin D
5. Conclusion

3. 1. Cholesterol Units 101
2013 Ivor Cummins BE(Chem) MIEI

4. 1. Cholesterol Units 101
Cholesterol and Triglyceride can be measured in mg/dL (e.g. USA) or
mmol/L (e.g. Europe)
2013 Ivor Cummins BE(Chem) MIEI

5. 1. Cholesterol Units 101
Cholesterol and Triglyceride can be measured in mg/dL (e.g. USA) or
mmol/L (e.g. Europe)
Be careful converting – Cholesterol and Triglyceride both have DIFFERENT
conversion factors as you switch from one unit to another
2013 Ivor Cummins BE(Chem) MIEI

6. 1. Cholesterol Units 101
Cholesterol and Triglyceride can be measured in mg/dL (e.g. USA) or
mmol/L (e.g. Europe)
Be careful converting – Cholesterol and Triglyceride both have DIFFERENT
conversion factors as you switch from one unit to another
To convert CHOLESTEROL from mmol/L to mg/dL, multiply by 38.7
2013 Ivor Cummins BE(Chem) MIEI

7. 1. Cholesterol Units 101
Cholesterol and Triglyceride can be measured in mg/dL (e.g. USA) or
mmol/L (e.g. Europe)
Be careful converting – Cholesterol and Triglyceride both have DIFFERENT
conversion factors as you switch from one unit to another
To convert CHOLESTEROL from mmol/L to mg/dL, multiply by 38.7
To convert CHOLESTEROL from mg/dL to mmol/L, divide by 38.7
2013 Ivor Cummins BE(Chem) MIEI

8. 1. Cholesterol Units 101
Cholesterol and Triglyceride can be measured in mg/dL (e.g. USA) or
mmol/L (e.g. Europe)
Be careful converting – Cholesterol and Triglyceride both have DIFFERENT
conversion factors as you switch from one unit to another
To convert CHOLESTEROL from mmol/L to mg/dL, multiply by 38.7
To convert CHOLESTEROL from mg/dL to mmol/L, divide by 38.7
To convert TRIGLYCERIDE from mmol/L to mg/dL, multiply by 88.6
2013 Ivor Cummins BE(Chem) MIEI

9. 1. Cholesterol Units 101
Cholesterol and Triglyceride can be measured in mg/dL (e.g. USA) or
mmol/L (e.g. Europe)
Be careful converting – Cholesterol and Triglyceride both have DIFFERENT
conversion factors as you switch from one unit to another
To convert CHOLESTEROL from mmol/L to mg/dL, multiply by 38.7
To convert CHOLESTEROL from mg/dL to mmol/L, divide by 38.7
To convert TRIGLYCERIDE from mmol/L to mg/dL, multiply by 88.6
To convert TRIGLYCERIDE from mg/dL to mmol/L, divide by 88.6
2013 Ivor Cummins BE(Chem) MIEI

10. 1. Cholesterol Units 101
Metric Current Desired Action Result
Tot Chol 200 mg/dL mmol/L Divide by 38.7 5.16 mmol/L
LDL 100 mg/dL mmol/L Divide by 38.7 2.58 mmol/L
Tot Chol 6.8 mmol/L mg/dL Multiply by 38.7 263 mg/dL
HDL 1.7 mmol/L mg/dL Multiply by 38.7 66 mg/dL
2013 Ivor Cummins BE(Chem) MIEI

11. 1. Cholesterol Units 101
Metric Current Desired Action Result
Tot Chol 200 mg/dL mmol/L Divide by 38.7 5.16 mmol/L
LDL 100 mg/dL mmol/L Divide by 38.7 2.58 mmol/L
Tot Chol 6.8 mmol/L mg/dL Multiply by 38.7 263 mg/dL
HDL 1.7 mmol/L mg/dL Multiply by 38.7 66 mg/dL
Triglyceride 150 mg/dL mmol/L Divide by 88.6 1.69 mmol/L
Triglyceride 0.78 mmol/L Multiply by 88.6 69 mg/dL
2013 Ivor Cummins BE(Chem) MIEI

12. 1. Cholesterol Units 101
Metric Current Desired Action Result
Tot Chol 200 mg/dL mmol/L Divide by 38.7 5.16 mmol/L
LDL 100 mg/dL mmol/L Divide by 38.7 2.58 mmol/L
Tot Chol 6.8 mmol/L mg/dL Multiply by 38.7 263 mg/dL
HDL 1.7 mmol/L mg/dL Multiply by 38.7 66 mg/dL
Triglyceride 150 mg/dL mmol/L Divide by 88.6 1.69 mmol/L
Triglyceride 0.78 mmol/L Multiply by 88.6 69 mg/dL
2013 Ivor Cummins BE(Chem) MIEI
Ratio
Use mg/dL(!)
Ivor Guide My Target Result
Tot Chol/HDL 263 / 66 <4.5 <4.0 ~3.5
Trig/HDL 69 / 66 <2.0 <1.0 ~1.0

13. 2 Standard Lipid Test

14. 2.1 Total Cholesterol

15. 2.1 Total Cholesterol
<200 200-240 240-280 >280
Is the use of cholesterol in mortality risk algorithms in
clinical guidelines valid? Ten years prospective data from
the Norwegian HUNT 2 study (>58,000 Participants)
Halfdan Petursson MD,1 Johann A. Sigurdsson MD Dr med,2 Calle Bengtsson
MD Dr med,3
Tom I. L. Nilsen Dr Philos4 and Linn Getz MD PhD5

16. 2.1 Total Cholesterol
<200 200-240 240-280 >280
Is the use of cholesterol in mortality risk algorithms in
clinical guidelines valid? Ten years prospective data from
the Norwegian HUNT 2 study (>58,000 Participants)
Halfdan Petursson MD,1 Johann A. Sigurdsson MD Dr med,2 Calle Bengtsson
MD Dr med,3
Tom I. L. Nilsen Dr Philos4 and Linn Getz MD PhD5
Total Cholesterol:
•Hopelessly confounded
•Only useful for research
•But interesting interaction
with w6/w3 ratio…

17. 2.2 LDL & HDL Cholesterol

18. 2.2 LDL & HDL Cholesterol

19. 2.2 LDL & HDL Cholesterol
LDL
•Confounded
HDL
•Guide >40mg/dL
•Generally true…

20. 2.3 Serum Triglyceride

21. 2.3 Serum Triglyceride
(< 2.25 mmol/L)
(> 2.25 mmol/L)

22. 2.3 Serum Triglyceride
(< 2.25 mmol/L)
(> 2.25 mmol/L) Triglyceride:
•Guide <150mg/dL
•Ideally <100mg/dL

23. 3 All-Important Ratios

24. 3.1 – The Total Chol / HDL Ratio

25. 3.1 – The Total Chol / HDL Ratio
Ratio <5, LDL being low
or High is irrelevant
Ratio >5, LDL being low
or High is irrelevant
Efficacy of cholesterol levels and ratios in predicting future coronary…..
Am J Cardiol. 2001 Oct 1;88(7):737-43.

26. 3.1 – The Total Chol / HDL Ratio
Tot Chol /
HDL Ratio:
•Guide <4.5 or 5
•Ideally <4.0
Ratio <5, LDL being low
or High is irrelevant
Ratio >5, LDL being low
or High is irrelevant
Efficacy of cholesterol levels and ratios in predicting future coronary…..
Am J Cardiol. 2001 Oct 1;88(7):737-43.

27. 3.2 The Trig / HDL Ratio

28. 3.2 The Trig / HDL Ratio
Study: “High Ratio of Triglycerides to HDL-Cholesterol Predicts
Extensive Coronary Disease”

29. 3.2 The Trig / HDL Ratio
Triglyceride /
HDL Ratio:
•Guide <2.0
•Ideally <1.0
Study: “High Ratio of Triglycerides to HDL-Cholesterol Predicts
Extensive Coronary Disease”

30. 4 Other Key Metrics

31. 4.1 Fasting Insulin

32. 4.1 Fasting Insulin

33. 4.1 Fasting Insulin
Fasting Insulin:
•Guide: Unclear
•Ideally <10uU/mL
•Again, watch the
units!

34. 4.2 Fasting Glucose

35. 4.2 Fasting Glucose
“The apoB/apoA-I ratio: a strong, new risk factor for cardiovascular disease
and a target for lipid-lowering therapy – a review of the evidence”
. WALLDIUS1,2 & I . JUNGNER3 , 4 From the 1King Gustaf V Research Institute, Karolinska Institute, Stockholm;
2AstraZeneca, So¨derta¨lje; 3Department of Medicine, Karolinska Institute, Epidemiological Unit, Stockholm; and 4CALAB
Research, Stockholm; Sweden
Journal of Internal Medicine 2006; 259: 493–519

36. 4.2 Fasting Glucose
Blood
Glucose:
•Guide <6 mmol/L
•Ideally <5 mmol/L
Note 1: watch the
units(!) – mmol/L used
above, but multiply by
18 to get mg/dL
Note 2: HbA1c is a more
stable indication of long-term
blood glucose
levels
“The apoB/apoA-I ratio: a strong, new risk factor for cardiovascular disease
and a target for lipid-lowering therapy – a review of the evidence”
. WALLDIUS1,2 & I . JUNGNER3 , 4 From the 1King Gustaf V Research Institute, Karolinska Institute, Stockholm;
2AstraZeneca, So¨derta¨lje; 3Department of Medicine, Karolinska Institute, Epidemiological Unit, Stockholm; and 4CALAB
Research, Stockholm; Sweden
Journal of Internal Medicine 2006; 259: 493–519

37. 4.3 25 Hydroxy Vitamin D

38. 4.3 25 Hydroxy Vitamin D
Study: “Association of vitamin D deficiency and coronary artery disease with cardiovascular risk factors”

39. 4.3 25 Hydroxy Vitamin D
Study: “Association of vitamin D deficiency and coronary artery disease with cardiovascular risk factors”
25 Hydroxy Vit D:
•Should be >=75 nmol/L
Note: watch the units again(!) – 75nmol/L used above equates to 30ng/ml: so, divide by 2.5 to get from
nmol/L to ng/ml, and vice versa)

40. 5 – Conclusion

41. 5 – Conclusion
•Need to understand lipid unit conversion to avoid confusion
•Traditional Tot Chol and LDL are outdated predictors
•Tot Chol / HDL and Trig / HDL are powerful predictors
•Fasting Insulin, HbA1c and other metrics are underused
•25 Hydroxy Vitamin D level is critical and underemphasised

42. 5 – Conclusion
•Need to understand lipid unit conversion to avoid confusion
•Traditional Tot Chol and LDL are outdated predictors
•Tot Chol / HDL and Trig / HDL are powerful predictors
•Fasting Insulin, HbA1c and other metrics are underused
•25 Hydroxy Vitamin D level is critical and underemphasised
Watch “The Cholesterol Conundrum – Root Cause and Solution”
for engineering-level explanation of this arena.