Is there a more advanced lipid assay? Yes, there are. Some physicians may perform “advanced” lipid analysis because it provides more information about the individual patient’s lipid metabolism than conventional lipid analysis. Advanced lipid analysis is used to evaluate specific problems that may occur in the lipid metabolism pathway, such as whether there is an increase in the inflammatory marker C-reactive protein, and whether “normal” lipid metabolism results are masking serious abnormalities in specific lipid components such as LDL cholesterol or HDL cholesterol. Many laboratory techniques are available to determine the specific functional characteristics of lipid components in blood, including centrifugation, electrophoresis, and nuclear magnetic resonance. These techniques are used to detect one or more of the following features: LDL particle size: There are mixed LDL particles of different sizes in the human blood stream. LDL particle size is associated with coronary heart disease and is influenced by genetic factors, but this risk can be reduced with treatment. LDL particle number: LDL particle number is more closely associated with cardiovascular disease than LDL cholesterol levels and LDL particle size. Lipoprotein(a), Lp(a) is an LDL particle with abnormal protein attachment, and increased Lp(a) levels are associated with a 3-fold increase in cardiovascular disease. HDL subclasses: Like LDL lipoproteins, HDL particles come in different sizes and are associated with different levels of cardiovascular disease. Compared to LDL, HDL has more complex functions. These functions are not fully understood and are currently being studied in depth. Apo A-I. Apo A-I is one of several proteins that attach to each HDL particle, and the amount of Apo A-I may be a better predictor of risk for heart disease than HDL cholesterol levels. Apolipoprotein B. Apo B attaches to LDL particles. One Apo B is attached to one LDL cholesterol particle. Measuring Apo B provides a more accurate indication of the number of LDL particles than standard LDL cholesterol tests. Several studies have shown that Apo B is a better predictor of coronary heart disease risk than LDL cholesterol levels. Apolipoprotein E. Apo E is an under-understood apolipoprotein present in normal and abnormal genetic forms. Measuring this apolipoprotein can help identify certain inherited lipid abnormalities associated with an increased risk of cardiovascular disease. Current guidelines do not recommend these tests for all individual patients. However, in certain patients with a family history of early-onset cardiovascular disease or patients with well-controlled lipids who still have myocardial infarction or other cardiovascular events, these tests can be helpful in the assessment of cardiovascular disease risk levels.