Total saturated fatty acids	1.06
14:0, Myristic	0.96
15:0, Pentadecanoic	0.94
16:0, Palmitic	1.15
17:0, Margaric	0.77
18:0, Stearic	1.23
Total monounsaturated fatty acids	1.06
16:1n-7, Palmitoleic	0.96
18:1cis-9, Oleic	1.09
ω-3 polyunsaturated fatty acids	unknown
18:3n-3, α-Linolenic	0.93
Total long-chain ω-3	0.84
20:5n-3, Eicosapentaenoic	0.78
22:6n-3, Docosahexaenoic	0.79
22:5n-3, Doscosapentaenoic	0.64
Total ω-6 polyunsaturated fatty acids	0.94
18:2n-6, Linoleic	0.99
18:3n-6, γ-Linolenic	1.03
20:2n-6, Eicosadienoic	1.18
20:3n-6, Dihomo-γ-linolenic	1.11
20:4n-6, Arachidonic	0.83
22:4n-6, Docosatetraenoic	1.20
22:5n-6, Docosapentaenoic	0.97
Total trans fatty acids	1.05
18:1, Trans-oleic	1.2
18:2, Trans-linoleic	1.36

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2014","type":"text","marks":[{"type":"link","attrs":{"href":"https://sci-hub.st/10.7326/M13-1788"}}]},{"text":")","type":"text"}]}]}]},{"type":"tableRow","content":[{"type":"tableCell","attrs":{"colspan":1,"background":"#eae6ff","rowspan":1,"colwidth":[278.0]},"content":[{"type":"paragraph","content":[{"text":"Error","type":"text","marks":[{"type":"textColor","attrs":{"color":"#000000"}}]}]}]},{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[683.0]},"content":[{"type":"paragraph","content":[{"text":"10% precision + unknown accuracy","type":"text"}]}]}]}]},{"type":"heading","attrs":{"level":3},"content":[{"text":" ","type":"text","marks":[{"type":"textColor","attrs":{"color":"#000000"}}]},{"type":"hardBreak"},{"text":"Lipidomics","type":"text","marks":[{"type":"textColor","attrs":{"color":"#000000"}}]}]},{"type":"paragraph","content":[{"type":"hardBreak"}]},{"type":"paragraph","content":[{"text":"Shotgun lipidomics using mass spectrometry detects 135 lipid species in 8 classes - triacylglycerols (TAGs) of low carbon number and double-bond content show the strongest and most consistent associations with CVD - molecular lipid profiling by MS results in a significant improvement in CVD risk prediction beyond classic lipid markers (","type":"text"},{"text":"Stegemann et al., 2014","type":"text","marks":[{"type":"link","attrs":{"href":"https://sci-hub.se/10.1161/CIRCULATIONAHA.113.002500"}}]},{"text":"). ","type":"text"}]},{"type":"paragraph","content":[{"text":"Certain TAGs rather than total TG confer increased CVD risk and saturated and MUFAs chains were most consistently associated with CVD.","type":"text"}]},{"type":"paragraph","content":[{"text":"Some of the identified risk markers that were only detectable within advanced plaques include cholesterol esters: CE (16:1) cholesteryl palmitoleate, PC (38.3), TAG (54:2), PE (36.5) (","type":"text"},{"text":"Stegemann et al., 2014","type":"text","marks":[{"type":"link","attrs":{"href":"https://sci-hub.se/10.1161/CIRCULATIONAHA.113.002500"}}]},{"text":").","type":"text"}]},{"type":"paragraph","content":[{"type":"hardBreak"}]},{"type":"heading","attrs":{"level":4},"content":[{"text":"Test type","type":"text"}]},{"type":"paragraph","content":[{"text":"Mass spectrometry","type":"text"}]},{"type":"paragraph","content":[{"type":"hardBreak"}]},{"type":"heading","attrs":{"level":4},"content":[{"text":"Standardization & error","type":"text"}]},{"type":"paragraph","content":[{"text":"Study results are not very consistent and in some cases, in fact, quite contradictory. However, many of these inconsistent findings can be explained by obvious differences in disease phenotypes and analytical approaches (","type":"text"},{"text":"Laaksonen, 2016","type":"text","marks":[{"type":"link","attrs":{"href":"https://sci-hub.se/10.1007/s10557-016-6651-8"}}]},{"text":"). ","type":"text"}]},{"type":"paragraph","content":[{"type":"hardBreak"}]},{"type":"heading","attrs":{"level":4},"content":[{"text":"Reference range","type":"text"}]},{"type":"paragraph","content":[{"text":"unknown","type":"text"}]},{"type":"paragraph","content":[{"type":"hardBreak"}]},{"type":"heading","attrs":{"level":4},"content":[{"text":"Lipidomics Summary Table","type":"text"}]},{"type":"table","attrs":{"layout":"wide","width":898.0,"localId":"525dac4a-387f-474a-b2c0-eb9c07c68db1"},"content":[{"type":"tableRow","content":[{"type":"tableCell","attrs":{"colspan":1,"background":"#eae6ff","rowspan":1,"colwidth":[251.0]},"content":[{"type":"paragraph","content":[{"text":"Summary","type":"text"}]}]},{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[647.0]},"content":[{"type":"paragraph","content":[{"text":"Lipidomics is new and not yet standardized. Not currently recommended.","type":"text"}]}]}]},{"type":"tableRow","content":[{"type":"tableCell","attrs":{"colspan":1,"background":"#eae6ff","rowspan":1,"colwidth":[251.0]},"content":[{"type":"paragraph","content":[{"text":"Hazard ratio for CVD events","type":"text"}]}]},{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[647.0]},"content":[{"type":"paragraph","content":[{"text":"unknown","type":"text"}]}]}]},{"type":"tableRow","content":[{"type":"tableCell","attrs":{"colspan":1,"background":"#eae6ff","rowspan":1,"colwidth":[251.0]},"content":[{"type":"paragraph","content":[{"text":"Error","type":"text"}]}]},{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[647.0]},"content":[{"type":"paragraph","content":[{"text":"unknown","type":"text"}]}]}]}]},{"type":"paragraph","content":[{"type":"hardBreak"}]},{"type":"heading","attrs":{"level":2},"content":[{"type":"hardBreak"},{"text":"Presentation of results ","type":"text"},{"type":"inlineExtension","attrs":{"extensionType":"com.atlassian.confluence.macro.core","extensionKey":"anchor","parameters":{"macroParams":{"":{"value":"Presentation"}},"macroMetadata":{"macroId":{"value":"1870828f-3a2f-4809-b1ca-e9af0a6da4d6"},"schemaVersion":{"value":"1"},"title":"Anchor"}},"localId":"85a38636-8df2-4211-be2a-cb4da155280e"}}]},{"type":"paragraph","content":[{"type":"hardBreak"}]},{"type":"paragraph","content":[{"text":"This chart compares lipid biomarkers in terms of their association with CVD and the total error of the analytical technique used to measure them. Arbitrary \"acceptable\" thresholds of 15% for error and a 1.2 CVD hazard ratio were assigned. Only two of the biomarkers, total cholesterol, and ApoB, currently satisfy these criteria. ","type":"text"}]},{"type":"paragraph","content":[{"type":"hardBreak"}]},{"type":"mediaSingle","attrs":{"layout":"wide","width":100.0},"content":[{"type":"media","attrs":{"width":1280,"id":"f7cc0d34-736f-452c-891f-a9007ad56536","collection":"contentId-2561538","type":"file","height":720}}]},{"type":"paragraph","content":[{"type":"hardBreak"}]},{"type":"heading","attrs":{"level":2},"content":[{"text":"Conclusion","type":"text"}]},{"type":"paragraph","content":[{"type":"hardBreak"}]},{"type":"paragraph","content":[{"text":"According to our analysis, only two markers meet the criteria of being both closely associated with cardiovascular risk and having a total error of < 15%: ApoB and TC. There are several other markers that have stronger associations with CVD risk and may present valuable information however, the test results are less reliable, due in most cases, to a lack of standardization or a low level of accuracy.","type":"text"}]},{"type":"paragraph","content":[{"text":"Accuracy refers to how close a measurement is to the true or accepted value. Precision refers to how close measurements of the same item are to each other. Many test methods in our analysis exhibited a high level of precision but a low-level of accuracy. ","type":"text","marks":[{"type":"textColor","attrs":{"color":"#000000"}}]}]},{"type":"paragraph","content":[{"text":" ","type":"text"},{"text":" ","type":"text","marks":[{"type":"textColor","attrs":{"color":"#000000"}}]},{"text":" ","type":"text","marks":[{"type":"textColor","attrs":{"color":"#444444"}}]},{"text":" ","type":"text","marks":[{"type":"textColor","attrs":{"color":"#212121"}}]},{"text":"High intraindividual variability in many of the markers is also associated with CVD risk which speaks for regular measurement of these biomarkers. However, with regard to the assessment of variability, neither the number of measurements nor the time between measurements has been standardized ","type":"text","marks":[{"type":"textColor","attrs":{"color":"#000000"}}]},{"text":"(","type":"text","marks":[{"type":"textColor","attrs":{"color":"#212121"}}]},{"text":"Simpson, 2019","type":"text","marks":[{"type":"textColor","attrs":{"color":"#212121"}},{"type":"link","attrs":{"href":"https://sci-hub.se/10.1097/HCO.0000000000000627"}}]},{"text":"). ","type":"text","marks":[{"type":"textColor","attrs":{"color":"#212121"}}]},{"text":" ","type":"text","marks":[{"type":"textColor","attrs":{"color":"#444444"}}]},{"text":" ","type":"text","marks":[{"type":"textColor","attrs":{"color":"#000000"}}]},{"text":" ","type":"text"}]},{"type":"paragraph","content":[{"text":"As seen by the large error levels in testing and in contrast to the cost-driven approach taken by many guidelines of recommending measurement of lipid biomarkers once every 5 years, more frequent measurement of biomarkers is required to approach a true value. Based on the level of error in lipid testing, it would be ideal to take serial, duplicate measurements of 4 specimens within two months, each at least 1 week apart. ","type":"text"},{"text":"For average risk, this should be repeated annually. For higher-risk individuals, the monitoring could be repeated every 3-6 months. ","type":"text","marks":[{"type":"textColor","attrs":{"color":"#000000"}}]}]},{"type":"paragraph","content":[{"text":"Screening should be performed at least once during childhood in order to identify any inherited conditions and repeated once in early adulthood. If results are normal, annual screening should begin at age 40 and continue at least until age 79. 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There are still issues with the error level and between method comparability, however, the method is well-standardized and nonproprietary. 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However,","type":"text","marks":[{"type":"textColor","attrs":{"color":"#000000"}}]},{"text":" the test is relatively well-standardized with an acceptable error. Potentially useful for identifying the risk associated with intraindividual variations over time. Necessary for the calculation of non-HDL-C & usually comes with the other values on a standard lipid panel. 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The test is not widely available and results between methods are highly variable. Precise but not accurate (differs significantly by method). Provides additional information on subfractions.","type":"text"}]}]}]},{"type":"tableRow","content":[{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[157.0]},"content":[{"type":"paragraph","content":[{"text":"Lp(a)","type":"text"}]}]},{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[147.0]},"content":[{"type":"paragraph","content":[{"type":"status","attrs":{"color":"yellow","style":"bold","text":"Optional","localId":"26dabff3-bfc4-4345-aabc-aeead6bf5c8f"}}]}]},{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[85.0]},"content":[{"type":"paragraph","content":[{"text":"1.3 ","type":"text"}]}]},{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[158.0]},"content":[{"type":"paragraph","content":[{"text":"Immunoassay","type":"text"}]}]},{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[236.0]},"content":[{"type":"paragraph","content":[{"text":"Precision: ± 9% ","type":"text"},{"type":"hardBreak"},{"text":"Accuracy: unknown ","type":"text"},{"type":"hardBreak"},{"text":"Total error: unknown","type":"text"}]}]},{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[209.0]},"content":[{"type":"paragraph","content":[{"text":"At least once ","type":"text"}]}]},{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[185.0]},"content":[{"type":"paragraph","content":[{"text":"< 30 mg/dL","type":"text"},{"type":"hardBreak"},{"text":"< 75 nmol/L","type":"text"}]}]},{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[581.0]},"content":[{"type":"paragraph","content":[{"text":" ","type":"text","marks":[{"type":"textColor","attrs":{"color":"#000000"}}]},{"text":" ","type":"text","marks":[{"type":"textColor","attrs":{"color":"#444444"}}]},{"text":"Lp(a) measurement should be considered at least once in each adult person’s lifetime to identify those with very high inherited Lp(a) levels >180 mg/dL.","type":"text","marks":[{"type":"textColor","attrs":{"color":"#000000"}}]},{"text":" ","type":"text","marks":[{"type":"textColor","attrs":{"color":"#444444"}}]},{"text":" ","type":"text","marks":[{"type":"textColor","attrs":{"color":"#000000"}}]}]}]}]},{"type":"tableRow","content":[{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[157.0]},"content":[{"type":"paragraph","content":[{"text":"ApoA-I","type":"text"}]}]},{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[147.0]},"content":[{"type":"paragraph","content":[{"type":"status","attrs":{"color":"yellow","style":"bold","text":"Optional","localId":"4cc99cdd-ce4d-4434-a5d6-a5a9f508562c"}}]}]},{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[85.0]},"content":[{"type":"paragraph","content":[{"text":"1.16","type":"text"}]}]},{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[158.0]},"content":[{"type":"paragraph","content":[{"text":"Immunoassay","type":"text"}]}]},{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[236.0]},"content":[{"type":"paragraph","content":[{"text":"Precision: ± 4%","type":"text"},{"type":"hardBreak"},{"text":"Accuracy: ± 5.4%","type":"text"},{"type":"hardBreak"},{"text":"Total error: ± 10% (estimate)","type":"text"}]}]},{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[209.0]},"content":[{"type":"paragraph","content":[{"text":"Duplicate analyses of 4 specimens (fasting unnecessary), repeated annually ","type":"text"}]}]},{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[185.0]},"content":[{"type":"paragraph","content":[{"text":"men: < 120 mg/dL","type":"text"}]},{"type":"paragraph","content":[{"text":"women: < 140 mg/dL","type":"text"}]}]},{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[581.0]},"content":[{"type":"paragraph","content":[{"text":"ApoA-I does not appear to add additional information to CVD risk assessment, over and above HDL-C on its own. However, measurement is recommended because the ApoB/ApoA-1 ratio is one of the most predictive measurements currently available. ","type":"text","marks":[{"type":"textColor","attrs":{"color":"#000000"}}]}]}]}]},{"type":"tableRow","content":[{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[157.0]},"content":[{"type":"paragraph","content":[{"text":"Ox-LDL","type":"text"}]}]},{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[147.0]},"content":[{"type":"paragraph","content":[{"type":"status","attrs":{"color":"yellow","style":"bold","text":"Optional","localId":"f3f9b0c6-762b-486e-8ce0-d11bc655fa49"}}]}]},{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[85.0]},"content":[{"type":"paragraph","content":[{"text":"1.44 ","type":"text"}]}]},{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[158.0]},"content":[{"type":"paragraph","content":[{"text":"ELISA","type":"text"}]}]},{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[236.0]},"content":[{"type":"paragraph","content":[{"text":"Total error: ± 15-23% ","type":"text"}]}]},{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[209.0]},"content":[{"type":"paragraph","content":[{"text":"Duplicate analyses of 4 specimens (fasting unnecessary), repeated annually ","type":"text"}]}]},{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[185.0]},"content":[{"type":"paragraph","content":[{"text":"< 15 mg/L","type":"text"}]}]},{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[581.0]},"content":[{"type":"paragraph","content":[{"text":"Ox-LDL has shown value in the prediction of CVD events. ","type":"text"}]}]}]}]},{"type":"paragraph","content":[{"type":"hardBreak"}]},{"type":"paragraph","content":[{"type":"hardBreak"}]},{"type":"paragraph","content":[{"type":"hardBreak"}]},{"type":"paragraph","content":[{"type":"hardBreak"}]},{"type":"paragraph","content":[{"type":"hardBreak"}]},{"type":"paragraph","content":[{"type":"hardBreak"}]},{"type":"panel","attrs":{"panelType":"warning"},"content":[{"type":"paragraph","content":[{"text":"To be part of the team creating reviews like this, see our ","type":"text"},{"text":"open positions","type":"text","marks":[{"type":"link","attrs":{"href":"https://www.forever-healthy.org/careers"}}]}]}]},{"type":"paragraph","content":[{"type":"hardBreak"}]},{"type":"paragraph","content":[{"type":"hardBreak"}]}],"version":1}

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