Table 4.

Main ceramide advantages and disadvantages for Translational and Clinical Applications.

Advantages	Disadvantages
isotope labelled standards availability of panel of ceramides and scores, which renders easier interpretation by clinicians	expensive test spectrometry instrumentation expensive expert and trained personnel needed difficulties in result interpretation not widespread in clinical laboratories
cardiovascular risk stratification in asymptomatic subjects and cardiometabolic patients	lack of reference ranges, lack of standardization, lack of control quality schemes lack of identification of key ceramides and panels/scores and the knowledge of their biological effects in different cardiometabolic conditions evaluation of additive ceramide value over and beyond conventional biomarkers and CV scores intra- and inter-biological variability to be assessed
targets of drugs and life-style therapy (e.g., anti-inflammatory agents)	identification of serum ceramide determinants needed (e.g., gender, age, circadian rhythm, and lifestyle) the extraction phase of the sample is operator-dependent possible ionic suppression caused by the nature of the matrix
residual risk biomarkers in coronary artery disease patients