Laboratories
CERT – Coronary Event Risk Test (brand name Hertta) is a new test to assess the patient’s risk for severe cardiovascular events, such as myocardial infarction, stroke, and cardiac death. Also CERT measures the risk of type 2 diabetes onset.
Test structure
S -Keram / S -CERT / Pt -Hertta:
Ceramides, Cardiovascular and Diabetes Risk Test
subtests:
- S -CVrisk: Risk Score and Statement
- S -DMrisk: Risk Score and Statement
Sample
1 ml (minimum 0,5 ml) of serum.
Gently invert collection tube 5-6 times to start clot activation. Allow specimen to clot in an upright position for a minimum of 30 minutes and centrifuge sample within 1 hour. Pipette serum into clean labeled sample tube. Refrigerate specimen (serum) sample until shipment, if shipped within 48h. Otherwise freeze the sample.
If serum gel tube is used, transfer serum into a clean tube immediately after centrifugation.
Storage and shipment
Serum can be stored at +4-8 °C up to 72 hours. Longer storage frozen.
If specimen reaches the destination within 48 hours from sample collection, the samples can be shipped in room temperature. Otherwise the samples are shipped frozen on dry ice.
Required Prerequisites
Cardiovascular Risk:
- Have you been diagnosed with coronary artery disease? Y/N
- Cholesterol medication: Y/N
Diabetes Risk:
- Have you been diagnosed with diabetes? Y/N
- Age
- Gender
- Height
- Weight
Method: LC-MS/MS
Cardiovascular Risk Score
The Cardiovascular Risk Score (CV Risk Score) is determined by the concentrations of ceramides measured in the serum sample and the ratios between them. Zero, one or two risk points can be obtained from the ceramide measurements, depending on the result category. The sum of the points indicates the person’s risk score.
The result is reported as a Risk Score and a statement based on the risk score.
Risk score and reference values:
| CV Risk Score | Risk Category |
| 0 – 2 | Low Risk |
| 3 – 6 | Intermediate Risk |
| 7 – 9 | Increased Risk |
| 10 – 12 | High Risk |
Interpretation
Patients having high CV Risk Score (Above 9) efforts should enhance primary or secondary prevention of coronary heart disease.
There are two key actions. First of all, commitment to treatment and lifestyle changes can be supported by more individualized concrete risk of myocardial infarction or cardiovascular death. Secondly, the High Risk Score may support decisions to optimize medication such as statin medication or possibly starting PCSK9 treatment.
Furthermore, monitoring of changes in the Risk Score may allow the maintenance of motivation and commitment to treatment over a longer period of time.
Diabetes Risk Score
Diabetes Risk Score reflects the percentage probability (0-100%) to develop type II diabetes over the next ten years. It is calculated from a particular ceramide ratio and taking into account the person’s body mass index, age, and sex.
DM Risk Score and Risk Categories :
| DM Risk Score | Risk Category |
| 0 – 4 | Low Risk |
| 5 – 14 | Intermediate Risk |
| 15 – 100 | High Risk |
Interpretation
Patients with a high diabetes risk score (>15) should be motivated to change their lifestyle. For example, a 5% weight loss or moderate increase of exercise may reduce the risk (Saaristo et al. 2010). Motivation to lifestyle changes can be supported by bringing out more individualized concrete risk to type II diabetes.
The Diabetes Risk Score can be used for monitoring effects of lifestyle changes.
Availability
In Finland Hertta-test is available through: