DESCRIPTION
Intermediate density lipoproteins (IDLs) have a density that falls between low-density lipoproteins (LDLs) and very low-density lipoproteins (VLDLs). The density is based on separation during ultracentrifugation. IDLs, also referred to as remnant lipoproteins vary in size and contain varying proportions of triglycerides and cholesterol.
Direct measurement of IDLs has become available through use of an immunoseparation assay. Measurement of IDLs is being investigated in two settings: As a tool for risk assessment for coronary heart disease, and as a technique to diagnose type III hyperlipoproteinemia (also called dysbetaliproteinemia).
POLICY
Measurement of serum intermediate density lipoproteins is considered investigational.
See also: Lipid Risk Factors in Risk Assessment and Management of Cardiovascular Disease
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
Published scientific evidence in the form of well-designed studies in peer-reviewed journals regarding the application of the measurement of serum intermediate density lipoproteins is lacking. There is insufficient evidence to permit conclusions regarding the use of this measurement or benefits compared to established alternative measurements.
SOURCES
BlueCross BlueShield Association. Medical Policy Reference Manual. (4:2008). Measurement of serum intermediate density lipoproteins (remnant-like particles) (2.04.31). Retrieved March 27, 2009 from BlueWeb.
Choi, Y.J., Jo, Y.E., Kim, Y.K., Ahn, S.M., Jung, S.H., Kim, H.J., et al. (2006) High plasma concentration of remnant lipoprotein cholesterol in obese children and adolescents. Diabetes Care, 29 (10), 2305-2310.
Goldberg, I.J., (2009). Hypertriglyceridemia: impact and treatment. Endocrinology and Metabolism Clinics of North America, 38 (1), 137-149.
Havel, R. J. (2000). Remnant lipoproteins as therapeutic targets. Current Opinion in Lipidology, 11, 615-620.
Kugiyama, K., Doi, H., Takazoe, K., Kawano, H., Soejima, H., Mizuno, Y., et al. (1999). Remnant lipoprotein levels in fasting serum predict coronary events in patients with coronary artery disease. Circulation, 99, 258-260.
Leary, E. T., Wang, T., Baker, D. J., Cilla, D. D., Zhong, J., Warnick, R. G., et al. (1998). Evaluation of immunoseparation method for quantitative measurement of remnant-like particle-cholesterol in serum and plasma. Clinical Chemistry, 44 (12), 2490-2498.
National Institutes of Health. (2001, May). Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel (ATP) III). Retrieved August 14, 2003 from http://www.nhlbi.nih.gov/guidelines/cholesterol/profmats.htm.
ORIGINAL EFFECTIVE DATE: 2/1/2004
MOST RECENT REVIEW DATE: 5/14/2009
ID_BT
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