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Cardiometabolic Disease Assessment (CMDA) Panel
Test Code14273
Includes
Lipid Panel, Standard
Apolipoprotein B
Hemoglobin A1c
Insulin Resistance Panel with Score
TSH
Albumin, Random Urine with Creatinine
Comprehensive Metabolic Panel
Fibrosis-4 (FIB-4) Index
Platelet Count, EDTA
Kidney Profile Comments
Calculations typically used for Kidney Profile are intended to be reflected with the CMDA Panel. These calculations will utilize Creatinine with eGFR from the Comprehensive Metabolic Panel, in addition to the Albumin/Creatinine Ratio.
Apolipoprotein B
Hemoglobin A1c
Insulin Resistance Panel with Score
TSH
Albumin, Random Urine with Creatinine
Comprehensive Metabolic Panel
Fibrosis-4 (FIB-4) Index
Platelet Count, EDTA
Kidney Profile Comments
Calculations typically used for Kidney Profile are intended to be reflected with the CMDA Panel. These calculations will utilize Creatinine with eGFR from the Comprehensive Metabolic Panel, in addition to the Albumin/Creatinine Ratio.
Preferred Specimen
Red Top FULL
AND
Lavender Top FULL
AND
Urine collected in Sterile Cup
AND
Lavender Top FULL
AND
Urine collected in Sterile Cup
Patient Preparation
Patient should be fasting 9-12 hours
Additional Considerations for Patient Preparation:
Albumin, Random Urine with Creatinine: Exercise within 24 hours, infection, fever, congestive heart failure, marked hyperglycemia, and marked hypertension may elevate urinary albumin excretion over baseline values.
Cholesterol and Triglyceride testing: The assay manufacturer Beckman Coulter advises "N-Acetyl Cysteine (NAC), when administered in therapeutic concentrations (for the treatment of acetaminophen overdose), has been determined to interfere with assays for cholesterol, uric acid" where "NAC interference may lead to falsely low results." According to Beckman Coulter, the NAC interference should be insignificant by 12 hours after completion of the initial loading dose of an IV infusion treatment regime consisting of an initial loading dose of 150 mg/kg administered over 1 hour, a second dose of 50 mg/kg administered over 4 hours and a third dose of 100 mg/kg administered over 16 hours.
Comprehensive Metabolic Panel: Administration of STRENSIQ may interfere in certain assays and may falsely elevate values. For patients receiving STRENSIQ, consideration should be given to using alternate methods.
TSH: Specimen collection after fluorescein dye angiography should be delayed for at least 3 days. For patients on hemodialysis, specimen collection should be delayed for 2 weeks after angiography. According to the assay manufacturer Siemens: samples containing fluorescein can produce falsely depressed values.
Minimum Volume
2.5 mL serum • 1 mL EDTA whole blood • 2 mL random urine
Instructions
Serum: Allow serum samples to clot completely before centrifugation.
Random urine: Mix-well if aliquoting.
Whole blood: Maintain specimen at room temperature. Do not refrigerate. If multiple draw, collect lavender-top tube last. Traumatic venipuncture tap can introduce thromboplastin and trap white blood cells and platelets. Refrigeration can precipitate fibrin and trap white blood cells and platelets.
Random urine: Mix-well if aliquoting.
Whole blood: Maintain specimen at room temperature. Do not refrigerate. If multiple draw, collect lavender-top tube last. Traumatic venipuncture tap can introduce thromboplastin and trap white blood cells and platelets. Refrigeration can precipitate fibrin and trap white blood cells and platelets.
Transport Temperature
Serum: Refrigerated (cold packs)
Whole blood and urine: Room temperature
Whole blood and urine: Room temperature
Specimen Stability
Serum
Room temperature: 24 hours
Refrigerated: 72 hours
Frozen: Unacceptable
Whole blood
Room temperature: 48 hours
Refrigerated: Unacceptable
Frozen: Unacceptable
Random urine
Room temperature: 7 days
Refrigerated: 7 days
Frozen: 28 days
Room temperature: 24 hours
Refrigerated: 72 hours
Frozen: Unacceptable
Whole blood
Room temperature: 48 hours
Refrigerated: Unacceptable
Frozen: Unacceptable
Random urine
Room temperature: 7 days
Refrigerated: 7 days
Frozen: 28 days
Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)
Serum: Hemolysis • Grossly lipemic • Moderate to gross icterus • Anticoagulants other than heparin • Unspun serum separator tube (SST)
Whole blood: Gross hemolysis • Clotted
Random urine: Acid preserved urine
Whole blood: Gross hemolysis • Clotted
Random urine: Acid preserved urine
Methodology
Spectrophotometry (SP) • Immunoturbidimetric • Enzymatic • Immunocapture Liquid Chromatography/Tandem Mass Spectrometry • Electronic Cell Sizing/Counting/Cytometry/Microscopy • Immunoassay (IA)
Reference Range
See Laboratory Report
Clinical Significance
This panel combines tests used in the diagnosis and management of cardiometabolic disease elements, including metabolic syndrome, prediabetes, diabetes, thyroid conditions, kidney, fatty liver, and cardiovascular disease risk. This panel can help identify the presence and progression of cardiometabolic disease by assessing metabolic state and downstream effects on the liver, kidneys, and heart.
It is estimated that as many as 45% of Americans have a chronic disease; more than half of older adults have multiple chronic conditions [1]. The related chronic cardiometabolic conditions are characterized by initial stages that may remain clinically silent for years.
Medical societies, like the American Heart Association, recognize the interrelated impacts of metabolic risk factors (ie, obesity and diabetes), chronic kidney disease, and cardiovascular disease, and the gap in early screening, prevention, and management of these chronic conditions [2,3]. Rising rates of metabolic dysfunction, obesity, and type 2 diabetes mellitus (T2DM) also contribute to increased prevalence of nonalcoholic fatty liver disease (NAFLD), also known as metabolic dysfunction-associated steatotic liver disease (MASLD) [4]. Thyroid health may either be impacted by or exacerbate cardiometabolic conditions, such as CHD, NAFLD, and CKD [5-8].
The Cardiometabolic Disease Assessment Panel includes guideline-recommended testing that spans interrelated areas of cardiometabolic disease to determine the extent of metabolic dysfunction (glycemic control and advanced lipid assessment), identify whether thyroid health contributes to or is altered by metabolic dysfunction, and adverse impacts to heart, liver, and kidney function [9-13]. Identification of cardiometabolic disease presence can help implement personalized treatment strategies that can prevent or delay disease progression and related complications.
The results of this test should be interpreted in the context of pertinent clinical and family history and physical examination findings.
References
1. Raghupathi W, et al. Int J Environ Res Public Health. 2018;15(3):431. doi:10.3390/ijerph15030431
2. Ndumele CE, et al. Circulation. 2023;148(20):1636-1664. doi.org/10.1161/CIR.0000000000001186
3. Khan SS, et al. Circulation. 2024;149(6):430-449. doi: 10.1161/CIRCULATIONAHA.123.067626
4. Bril F, et al. J Clin Endocrinol Metab. 2021;106(11):e4360-e4371. doi:10.1210/clinem/dgab417
5. Cappola AR, et al. Circulation. 2019;139(25):2892- 2909. doi.org/10.1161/circulationaha.118.036859
6. Kalra S, et al. Diabetes Ther. 2019;10(6):2035-2044. doi:10.1007/s13300-019-00700-4
7. Mantovani A, et al. Thyroid. 2018;28(10):1270-1284. doi:10.1089/ thy.2018.0257
8. Iglesias P, et al. Rev Endocr Metab Disord. 2017;18(1):131-144. doi:10.1007/s11154-016-9395-7
9. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S14-S31. doi: 10.2337/dc23-S002
10 Arnett DK, et al. J Am Coll Cardiol. 2019. doi: 10.1161/CIR.0000000000000677
11. Cusi K, et al. Clinical Practice Guidelines. 2022;28(5):P528-562. doi:10.1016/j.eprac.2022.03.010
12. Rinella NE, et al. Hepatology. 2023;77(5):1797-1835. doi:10.1097/HEP.0000000000000323
13. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. Kidney Int. 2024;105(4S):S117-S314. doi:10.1016/j.kint.2023.10.018
It is estimated that as many as 45% of Americans have a chronic disease; more than half of older adults have multiple chronic conditions [1]. The related chronic cardiometabolic conditions are characterized by initial stages that may remain clinically silent for years.
Medical societies, like the American Heart Association, recognize the interrelated impacts of metabolic risk factors (ie, obesity and diabetes), chronic kidney disease, and cardiovascular disease, and the gap in early screening, prevention, and management of these chronic conditions [2,3]. Rising rates of metabolic dysfunction, obesity, and type 2 diabetes mellitus (T2DM) also contribute to increased prevalence of nonalcoholic fatty liver disease (NAFLD), also known as metabolic dysfunction-associated steatotic liver disease (MASLD) [4]. Thyroid health may either be impacted by or exacerbate cardiometabolic conditions, such as CHD, NAFLD, and CKD [5-8].
The Cardiometabolic Disease Assessment Panel includes guideline-recommended testing that spans interrelated areas of cardiometabolic disease to determine the extent of metabolic dysfunction (glycemic control and advanced lipid assessment), identify whether thyroid health contributes to or is altered by metabolic dysfunction, and adverse impacts to heart, liver, and kidney function [9-13]. Identification of cardiometabolic disease presence can help implement personalized treatment strategies that can prevent or delay disease progression and related complications.
The results of this test should be interpreted in the context of pertinent clinical and family history and physical examination findings.
References
1. Raghupathi W, et al. Int J Environ Res Public Health. 2018;15(3):431. doi:10.3390/ijerph15030431
2. Ndumele CE, et al. Circulation. 2023;148(20):1636-1664. doi.org/10.1161/CIR.0000000000001186
3. Khan SS, et al. Circulation. 2024;149(6):430-449. doi: 10.1161/CIRCULATIONAHA.123.067626
4. Bril F, et al. J Clin Endocrinol Metab. 2021;106(11):e4360-e4371. doi:10.1210/clinem/dgab417
5. Cappola AR, et al. Circulation. 2019;139(25):2892- 2909. doi.org/10.1161/circulationaha.118.036859
6. Kalra S, et al. Diabetes Ther. 2019;10(6):2035-2044. doi:10.1007/s13300-019-00700-4
7. Mantovani A, et al. Thyroid. 2018;28(10):1270-1284. doi:10.1089/ thy.2018.0257
8. Iglesias P, et al. Rev Endocr Metab Disord. 2017;18(1):131-144. doi:10.1007/s11154-016-9395-7
9. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S14-S31. doi: 10.2337/dc23-S002
10 Arnett DK, et al. J Am Coll Cardiol. 2019. doi: 10.1161/CIR.0000000000000677
11. Cusi K, et al. Clinical Practice Guidelines. 2022;28(5):P528-562. doi:10.1016/j.eprac.2022.03.010
12. Rinella NE, et al. Hepatology. 2023;77(5):1797-1835. doi:10.1097/HEP.0000000000000323
13. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. Kidney Int. 2024;105(4S):S117-S314. doi:10.1016/j.kint.2023.10.018
