Ceramides, Plasma [A Test in Focus]

ceramides-brochure-buttonPlasma ceramides are predictors of adverse cardiovascular events resulting from unstable atherosclerotic plaque. Three specific ceramides have been identified as highly linked to cardiovascular disease and insulin resistance: Cer16:0, Cer18:0, and Cer24:1.

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 LDL and HDL cholesterol, CRP, and Lp-PLA2.


CERAM — Ceramides, Plasma

  • Plasma ceramides predict risk of myocardial infarction, coronary revascularization, acute coronary syndrome hospitalization, and mortality within 5 years.
  • Risk conferred by plasma ceramides is independent of LDL cholesterol, C-reactive protein, LDL particles, and Lp-PLA2.
  • Plasma ceramides are lowered by simvastatin, rosuvastatin, and ezetimibe.

When Should I Order This Test:

Ordering this test is helpful for establishing an individual’s risk or determining whether a residual risk remains. Specific ordering scenarios include:

  • Patients with established coronary artery disease.
  • Patients with history of or clinical suspicion for acute coronary syndrome or a myocardial infarction.
  • Patients with intermediate or undetermined atherosclerotic cardiovascular risk, as 19.4% cardiovascular events occur in the absence of traditional risk factors.1
  • Plasma ceramides predict adverse cardiovascular events
    • Within 1 year among patients with established coronary artery disease.2
    • Within 3 to 5 years for patients with suspected CAD and/or chronic heart failure.2-4
  • Risk conferred by plasma ceramides is independent of LDL cholesterol, HDL cholesterol, C-reactive protein, LDL particles, HDL particles, and Lp-PLA2 (concentration and activity).
  • Plasma ceramides are a modifiable risk marker.4,5
    • Standard statin therapies (simvastatin and rosuvastatin) significantly reduce plasma ceramides within 5 weeks.
    • Plasma ceramides are significantly lower among patients with reduced PCSK9 activity.
  • Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
  • Plasma EDTA

Day(s) and Time(s) Test Performed:

  • Tuesday, 9 a.m.

Analytic Time:

  • 2 days


1. Khot UN, Khot MB, Bajzer CT, et al: Prevalence of conventional risk factors in patients with coronary heart disease. JAMA 2003 Aug;290(7)898-904
2. 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 April;28: pii: ehw148. [Epub ahead of print]
3. Yu J, Pan W, Shi R, et. al: Ceramide is upregulated and associated with mortality in patients with chronic heart failure. Can J Cardiol. 2015 Mar;31(3):357-63
4. Tarasov K, Ekroos K, Suoniemi M, et al: Molecular Lipids Identify Cardiovascular RIsk and Are Efficiently Lowered by Simvastatin and PCSK9 Deficiency. J Clin Endocrinol Metab. 2014 Nov;99(11):E45-52
5.  Ng TW, Ooi EM, Watts GF, et al: Dose-dependent effects of rosuvastatin on the plasma sphingolipidome and phospholipidome in the metabolic syndrome. J Clin Endocrinol Metab. 2014 Nov;99(11):E2335-40
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