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HelpMayo Test ID CERAM MI-Heart Ceramides, Plasma
Specimen Required
Patient Preparation: Patients should not be receiving Intralipid because it may cause false elevations in measured ceramides.
Collection Container/Tube: Lavender top (EDTA)
Submission Container/Tube: Plastic vial
Specimen Volume: 1 mL
Collection Instructions: Centrifuge, aliquot at least 1 mL of plasma into a plastic vial and freeze within 8 hours.
Useful For
Evaluating the risk of major adverse cardiovascular events within the next 1 to 5 years
Method Name
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
Reporting Name
MI-Heart Ceramides, PSpecimen Type
Plasma EDTASpecimen Minimum Volume
0.5 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Plasma EDTA | Frozen (preferred) | 30 days | |
| Refrigerated | 24 hours | ||
| Ambient | 8 hours |
Reject Due To
| Gross hemolysis | Reject |
| Gross lipemia | OK |
| Gross icterus | OK |
Clinical Information
MI-Heart Ceramides is a blood test that measures risk for adverse cardiovascular events and quantifies plasma ceramides. Plasma ceramides are predictors of adverse cardiovascular events resulting from unstable atherosclerotic plaque. Ceramides are complex lipids that play a central role in cell membrane integrity, cellular stress response, inflammatory signaling, and apoptosis. Synthesis of ceramides from saturated fats and sphingosine occurs in all tissues. Metabolic dysfunction and dyslipidemia results in accumulation of ceramides in tissues not suited for lipid storage. Elevated concentrations of circulating ceramides are associated with atherosclerotic plaque formation, ischemic heart disease, myocardial infarction, hypertension, stroke, type 2 diabetes mellitus, insulin resistance, and obesity.
Three specific ceramides have been identified as highly linked to cardiovascular disease and insulin resistance: N-palmitoyl-sphingosine (Cer16:0), N-stearoyl-sphingosine (Cer18:0), and N-nervonoyl-sphingosine(Cer24:1). A fourth ceramide, N-lignoceroyl-sphingosine (Cer24:0), is highly abundant in all individuals and is useful as a normalization factor for intra-individual variability of ceramide concentrations. Individuals with elevated plasma ceramides are at higher risk of major adverse cardiovascular events even after adjusting for age, gender, smoking status, and serum biomarkers such as low-density lipoprotein and high-density lipoprotein cholesterol, C-reactive protein and lipoprotein-associated phospholipase A2. Ceramide concentrations are reduced by current cardiovascular therapies including diet, exercise, statins, and proprotein convertase subtilisin/kexin type inhibitors.
Reference Values
MI-Heart Ceramide Risk Score:
0-2 Lower risk
3-6 Moderate risk
7-9 Increased risk
10-12 Higher risk
Ceramide (16:0): 0.19-0.36 mcmol/L
Ceramide (18:0): 0.05-0.14 mcmol/L
Ceramide (24:1): 0.65-1.65 mcmol/L
Ceramide (16:0)/(24:0): <0.11
Ceramide (18:0)/(24:0): <0.05
Ceramide (24:1)/(24:0): <0.45
Reference values have not been established for patients who are less than 18 years of age.
Note: Ceramide (24:0) alone has not been independently associated with disease and will not be reported.
Interpretation
Elevated plasma ceramides are associated with increased risk of myocardial infarction, acute coronary syndromes, and mortality within 1 to 5 years.
|
Ceramide Score |
Relative Risk |
Risk Category |
|
0-2 |
1.0 |
Lower |
|
3-6 |
1.5 |
Moderate |
|
7-9 |
2.2 |
Increased |
|
10-12 |
3.5 |
Higher |
Score is based on trial data including >4000 subjects.
Cautions
No significant cautionary statements.
Clinical Reference
1 Laaksonen R, Ekroos K, Sysi-Aho M, et al. Plasma ceramides predict cardiovascular death in patients with stable coronary artery disease and acute coronary syndromes beyond LDL-cholesterol. Eur Heart J. 2016;37(25):1967-1976
2. Havulinna AS, Sysi-Aho M, Hilvo M, et al. Circulating ceramides predict cardiovascular outcomes in the population-based FINRISK 2002 cohort. Arterioscler Thromb Vasc Biol. 2016;36(12):2424-2430
3. Wang DD, Toledo E, Hruby A, et al. Plasma ceramides, Mediterranean diet, and incident cardiovascular disease in the PREDIMED trial (Prevenci on con Dieta Mediterranea). Circulation. 2017;135(21):2028-2040. doi:10.1161/CIRCULATIONAHA.116.024261
4. Meeusen JW, Donato LJ, Bryant SC, et al: Plasma Ceramides. Arterioscler Thromb Vasc Biol. 2018;38(8):1933-1939. doi:10.1161/ATVBAHA.118.311199
5. Peterson LR, Xanthakis V, Duncan MS, et al. Ceramide remodeling and risk of cardiovascular events and mortality. J Am Heart Assoc. 2018;7(10). doi:10.1161/JAHA.117.007931
6. Hilvo M, Meikle PJ, Pedersen ER, et al. Development and validation of a ceramide- and phospholipid-based cardiovascular risk estimation score for coronary artery disease patients. Eur Heart J. 2020;41(3):371-380. doi:10.1093/eurheartj/ehz387
7. Alshehry ZH, Mundra PA, Barlow CK, et al. Plasma lipidomic profiles improve on traditional risk factors for the prediction of cardiovascular events in type 2 diabetes mellitus. Circulation. 2016;134(21):1637-1650
8. Anroedh S, Hilvo M, Akkerhuis KM, et al. Plasma concentrations of molecular lipid species predict long-term clinical outcome in coronary artery disease patients. J Lipid Res. 2018;59(9):1729-1737. doi:10.1194/jlr.P081281
9. Lemaitre RN, Jensen PN, Hoofnagle A, et al. Plasma ceramides and sphingomyelins in relation to heart failure risk. Circ Heart Fail. 2019;12(7):e005708. doi:10.1161/CIRCHEARTFAILURE.118.005708
Method Description
Ceramides are separated and quantified by liquid chromatography tandem mass spectrometry (LC-MS/MS).(Unpublished Mayo method)
Day(s) Performed
Monday, Wednesday, Friday
Report Available
2 to 7 daysSpecimen Retention Time
14 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
0119U
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| CERAM | MI-Heart Ceramides, P | 93883-7 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 42434 | MI-Heart Ceramide Risk Score | 93876-1 |
| 42428 | Ceramide (16:0) | 93882-9 |
| 42429 | Ceramide (18:0) | 93881-1 |
| 42430 | Ceramide (24:1) | 93880-3 |
| 42431 | Ceramide (16:0)/(24:0) ratio | 93879-5 |
| 42432 | Ceramide (18:0)/(24:0) ratio | 93878-7 |
| 42433 | Ceramide (24:1)/(24:0) ratio | 93877-9 |