Tuesday, February 18, 2014

Did you know that you can prevent and control heart disease?  With proper nutrition and exercise, you can manage the health of your heart. 

Let's start with food: The question about eggs and cholesterol is popular, but largely answered after years of misinformation. In short, eggs seem to be an excellent food choice for protein, the brain nutrient, choline, and the super eye antioxidants lutein and zeaxanthin.

But the larger question relates to dietary cholesterol vs. blood cholesterol. Specifically, does our intake of dietary cholesterol-eggs having about 200 mg per unit- have a huge impact on our body's cholesterol level?

First, please note that cholesterol isn't an evil substance. We all need it! It contributes to brain function and healthy hormone levels. It's so important that the body is estimated to produce 3-4x more cholesterol than you consume in your diet! Researcher and medical doctor Uffe Ravnskov shows that low cholesterol is associated with an increased risk of susceptibility to infections, as well as dying from diseases of the stomach, intestines and lungs. Dr Ravnskov who has written extensively about cholesterol over the years in several peer-reviewed journals has demonstrated from the literature that there is no clear correlation to dietary cholesterol and blood cholesterol.
Furthermore, he contends that there's no evidence that consuming cholesterol-containing foods actually contributes to heart attacks.  He cites several cultures that consume nearly all of their calories from high cholesterol-containing animal foods.  In nearly every case, their blood cholesterol is about half that of the American's average cholesterol levels.

So if eggs/cholesterol aren't the culprit, what is? It's sugar, not fat, that causes heart attacks. . So the past 50 years of doctors' advice and government eating guidelines have been wrong. We've been told to swap eggs for Cheerios. But that recommendation is dead wrong. In fact, it's very likely that this bad advice has killed millions of Americans. (something to ponder)

A recent study shows that those with the highest sugar intake had a four-fold increase in their risk of heart attacks compared to those with the lowest intakes. That's 400%! Just one 20-ounce soda increases your risk of a heart attack by about 30%.

This study of more than 40,000 people, published in JAMA Internal Medicine, accounted for all other potential risk factors including total calories, overall diet quality, smoking, cholesterol, high blood pressure, obesity and alcohol.

This follows on how decades of research have been mostly ignored by the medical establishment and policy makers. In fact, the Institute of Medicine recommends getting no more than 25% of your total calories from added sugar. Surprisingly, this study showed that your risk of heart attacks doubles if sugar makes up 20% of your calories.

Yet more than 70% of Americans consume 10% of their daily calories from sugar. And about 10% of Americans consume one in every four (25%) of their calories from sugar.

Now here's a shocker: U.S. Dietary Guidelines provide no limit for added sugar, and the U.S. Food and Drug Administration (FDA) still lists sugar as a "generally regarded as safe" (GRAS) substance. That classification lets the food industry add unlimited amounts of sugar to our food. At least the American Heart Association recommends that our daily diet contain no more than 5% to 7.5% added sugar. Yet most of us are eating a lot more. I'll bet you don't know that a serving of tomato sauce has more sugar than a serving of Oreo cookies, or that fruit yogurt has more sugar than a Coke, or that most breakfast cereals - even those made with whole grain - are 75% sugar. That's not breakfast, it's dessert!  

For years, we've been brainwashed into thinking that fat causes heart attacks and raises cholesterol, and that sugar is harmless except as a source of empty calories. They are not empty calories. As it turns out, sugar calories are deadly calories. Sugar causes heart attacks, obesity, type 2 diabetes, cancer and dementia, and is the leading cause of liver failure in America.

The biggest offender is sugar-sweetened beverages including sodas, juices, sports drinks, teas and coffees. They are by far the single biggest source of sugar calories in our diet. In fact, more than 37% of our sugar calories come from soda. The average teenage boy consumes 34 teaspoons of sugar a day, or about 544 calories from sugar. What's worse? These kids are at risk for heart attacks at some later date in their lives. This is why this may be the first generation to NOT outlive their parents!

This new research is right in line with decades of data on how sugar causes insulin resistance, high triglycerides, lower HDL (good) cholesterol and dangerous small LDL (bad) cholesterol. It also triggers the inflammation we now know is at the root of heart disease.

And fats, including saturated fats, have been unfairly blamed. With the exception of trans fats, fats are actually protective. This includes omega-3 fats, nuts, avocado, lentils and olive oil, will help reduce heart attack risk by more than 30% .

 Here's the simple fact: Sugar calories are worse than other calories. All calories are not created equal. A recent study of more than 175 countries found that increasing overall calories didn't increase the risk of type 2 diabetes, but increasing sugar calories did - dramatically.

The average American consumes about 152 pounds of sugar and 146 pounds of flour a year. It's imperative that we revamp our outdated and dangerous national dietary guidelines. And we need clear strategies and medical programs to help people understand and address the health risks and addictive nature of sugar and refined carbohydrates.

That's how we can prevent heart attacks, obesity and chronic disease.

 Thanks to Dr. Elena Morreale (one of our DABCI attendees) who wrote this post.

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Kessinger Health and Wellness Diagnostic Centre
Virginia, Amanda, Lucy, Annette, Carrie, Sharon, Manon, Jess, Haley, Amy &
Jay Kessinger, DC, ND, DABCI, DAN Doctor 
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Christina Kessinger, DC

Monday, February 17, 2014


Keep score of your level of health
Know your personal diagnoses
Enjoy a maximum quality of life

      Complete Blood Profile
…..and ALL tests listed below

         ___Computerized EKG/ ECG  (for heart)
         ___Computerized Spirometry (lung function)
         ___Complete Urinalysis (kidney)
         ___Bone Density Testing (for Osteoporosis)
         ___Body Fat Analysis
         ___Doppler Carotid Study (for circulation)
         ___Aortic Artery Age Assessment (B Pro)
(all with detailed physician explanation)


Monday, February 10, 2014

VAP Cholesterol Testing

Advanced Technology Uncovers Hidden Cardiovascular Risks 
By Michael D. Ozner, MD
Although standard blood cholesterol tests (measuring total cholesterol, LDL, HDL, and triglycerides) have helped doctors to accurately assess heart disease risk in many patients, recent advances in medical science have demonstrated that conventional cholesterol testing provides only limited insight into the multiple factors that underlie cardiovascular disease. In fact, these tests identify only 40% of those at risk for coronary heart disease.
The good news is, scientists have developed a more advanced blood test that can far more accurately gauge your risk of heart disease. The Vertical Auto Profile (VAP) test augments the standard cholesterol profile with additional measurements that can identify the risk of cardiovascular disease.
Best of all, the VAP test not only offers a comprehensive assessment of cardiovascular risk, but also supplies vital information that can help you and your doctor formulate a customized disease-prevention program and measure its progress over time. This powerful diagnostic tool can help you take the steps necessary to avoid preventable health catastrophes—like heart attack and stroke—today.
The baby-boom generation understands that as they age, their risk for heart attacks, strokes, and other cardiovascular events continues to increase.1 Not content to succumb to disease and disability, this population is embracing a proactive, preventive approach to health care that includes advanced techniques of risk assessment such as the Vertical Auto Profile (VAP) cholesterol test.
Awareness of the VAP test is important for anyone who wants to stop cardiovascular disease in its tracks, even before signs and symptoms manifest. The VAP test is performed just like a traditional cholesterol panel: a technician or nurse draws blood and submits it to a laboratory. At reasonable cost, the VAP test provides more information than routine cholesterol tests and expands on this data. The comprehensive information derived from the VAP test enables physicians to more accurately predict their patients’ risk of heart disease, and to customize more aggressive, patient-specific treatment plans.
Even if your doctor’s office does not yet regularly utilize the VAP test, it is very likely that your physician will recognize the value of this advanced cholesterol screening tool, and will use the more detailed information it provides to devise the best treatment program to reduce your cardiovascular risk.

How the VAP Test Works

Routine cholesterol tests provide only the four following measurements:
  1. Total cholesterol
  2. Triglycerides
  3. Low-density lipoprotein (LDL, the “detrimental’ lipid), determined by a mathematical calculation, not by direct measurement
  4. High-density lipoprotein (HDL, the “beneficial” lipid).
The standard lipid panel above is what physicians have relied on for years to assess their patients’ risk of cardiovascular disease. It has been a successful tool, helping physicians to lower patient cholesterol levels using a variety of medical therapies, including statin drugs, and motivating people to make lifesaving changes in their diet and lifestyle.
However, there are serious limitations to relying solely on the standard cholesterol panel. Most important, it can identify only about 40% of patients at risk for coronary heart disease.2 The truth is, many risk factors are involved in the development of heart disease, and for some people, high cholesterol may or may not be one of them. The well-known Framingham Study illustrated that the higher the cholesterol, the higher the statistical risk of a heart attack.3 Nonetheless, a frightening number of heart attacks still occur every day in people whose cholesterol values are seemingly normal. In fact, the American Heart Association reports that 50% of men and 64% of women who died suddenly of coronary heart disease had no previous symptoms!1
Heart disease can lurk silently within, hidden and unsuspected. However, the additional information provided by the VAP test can help identify at-risk patients more accurately than routine cholesterol tests.2
The expanded information from the VAP test includes:
  • More accurate, direct measurement of LDL.
  • Measurement of LDL pattern density. This is important because small, dense LDL (“Pattern B”) triples the likelihood of developing coronary plaque and suffering a heart attack.4
  • Measurement of lipoprotein subclasses, which include HDL2 and HDL3, intermediate-density lipoprotein (IDL), very-low-density lipoproteins (VLDL1, VLDL2, VLDL3), and lipoprotein(a) [Lp(a)], a particularly dangerous lipoprotein that can lead to heart attacks and strokes.
Patients who test “normal” in a routine cholesterol panel often are found to be at risk for heart disease after taking the VAP test. This is crucially important, not only to diagnose a number of lipid disorders and optimize the choice of medications, but also for tracking improvement when patients are working to reduce their numbers, whether with drugs or lifestyle changes. Clearly, more information means more effective treatment, and thus better health outcomes.
In addition, VAP is the only cholesterol profile that tests for all the present and emerging risk factors identified in the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) cholesterol guidelines.5

Prevention Is Key to Cardiovascular Health

I have performed a VAP test for the first time on many patients who have already had heart attacks or strokes, or who have undergone heart procedures such as bypass surgery or placement of a coronary stent. The results have often led me to think that if a VAP test had been performed earlier, maybe the heart attack or stroke could have been prevented, or the surgery would not have been necessary.
Too often in the United States, medical care is reactionary. A heart attack or stroke occurs, the sufferer rushes to the emergency room, and then doctors desperately try to rise to the rescue. All the physicians and patients I know appreciate that this is not the best approach. Part of the beauty of the VAP test is that it can help reduce the likelihood of this scenario occurring. Identifying risks for cardiovascular disease—and then working to correct them in order to prevent heart and vascular disease—is a better choice than costly surgical interventions.
Baby boomers, who have taken more hands-on responsibility for their health than any previous generation, can be even more strongly motivated to adopt wellness strategies when they better understand the specific risks facing them. It is one thing to tell patients that their cholesterol is high and they need to reduce it by changing their diet and lifestyle or by taking medication. It is something else to tell them that they can decrease their risk of heart attacks and emergency room visits by implementing strategies to adjust their cholesterol particles. The more definitively a health threat can be identified, the greater the patients’ compliance with treatment will be.
Since the National Cholesterol Education Program recommends people begin regular cholesterol testing at age 20, young adults can take a VAP test to learn about their cardiovascular disease risk early in life. This will allow them to take aggressive steps now—including diet and exercise—to maintain a healthy heart for life. Taking a VAP test now makes infinitely more sense than waiting until a cardiovascular catastrophe occurs, and then wondering if the event might have been prevented if a more complete cholesterol profile had been obtained earlier.
  • Cardiovascular disease is America’s number-one cause of premature death. As adults age, their risk for heart attacks, strokes, and other cardiovascular events escalates.
  • Cardiovascular risk assessment using conventional lipid panels (measuring LDL, HDL, total cholesterol, and triglycerides) detects only about 40% of those at risk for a cardiovascular event. An advanced form of lipoprotein testing, the Vertical Auto Profile (VAP) cholesterol test, detects far more patients at risk of heart disease. The VAP test measures all the components of a standard lipid profile, as well as all cholesterol subclasses known to contribute to cardiovascular risk.
  • The data provided by a VAP test allows physicians to detect cardiovascular risk long before symptoms manifest, and to use this data to develop personalized prevention and treatment protocols for patients of all ages. Early intervention can help prevent costly hospitalizations and invasive surgery later in life.
  • All individuals who wish to fully and accurately understand their cardiovascular risk should consider a VAP test. In particular, adults at high risk—due to family history, previously diagnosed cardiovascular disease, or conditions such as high blood pressure, diabetes, obesity, or known lipid abnormalities—should undergo VAP testing.
  • The advanced data provided by the VAP test allow doctors and patients to proactively implement strategies to prevent cardiovascular events and mortality.

Should Everyone Take the VAP Test?

This question is still being debated in the medical community. It is more expensive than routine cholesterol panels, but it provides more information. It is simply the best way for physicians to learn more about their patients and identify heart disease risk earlier. As time goes by, more physicians are recognizing the limitations of conventional lipid assessment and turning to advanced lipoprotein testing for better answers.
Certainly anyone who has reason to believe he or she may be at high risk for cardiovascular disease—because of family history, previously diagnosed coronary or vascular disease, or factors such as high blood pressure, diabetes, obesity, any measure of coronary plaque, or identified abnormalities in cholesterol or triglycerides6—should strongly consider VAP testing. Even if you are simply concerned about heart disease, you can proactively encourage your doctor to perform this advanced test. It is now widely available in diagnostic laboratories around the country.
Being proactive means being eager to learn about ways to improve your health, and working with your doctor to create a personalized prevention and treatment plan. However, when it comes to tests that involve risk—such as imaging procedures that deliver radiation—I caution you to be wary. Sometimes, being proactive can lead you down that slippery slope to unnecessary surgical intervention. Fortunately, the VAP test has the distinct advantage of providing added information without added risk.
The VAP test assesses levels of all the blood lipids measured in a standard lipid profile (total cholesterol, LDL, HDL, and triglycerides), plus subclasses of lipids that are known or emerging risk factors for cardiovascular disease, such as LDL particle size and lipoprotein(a). Below is a guide to the various components of the VAP test and their implications for the development of cardiovascular disease:
LDL: Low-density lipoprotein; elevated levels are considered a primary cause of heart disease. LDL is the primary cholesterol target in heart disease risk management.
HDL: High-density lipoprotein; considered protective to the cardiovascular system. Low levels are associated with increased risk for coronary heart disease.
VLDL: Very-low-density lipoprotein; the main carrier for triglycerides. Elevated levels can be an independent risk factor for heart disease.
Total Cholesterol: The total amount of cholesterol circulating throughout your body.
Triglycerides: Energy-rich molecules needed for normal functions throughout the body. Elevated levels are associated with diabetes and cardiovascular disease.
Non-HDL Cholesterol: The sum of LDL and VLDL; elevated levels are a better predictor of heart disease risk than LDL alone.
Lp(a): Lipoprotein(a); an inherited risk factor for heart disease. It is more dangerous than other types of cholesterol, and does not respond to traditional LDL-lowering drugs.
IDL: Intermediate-density lipoprotein; an inherited, independent risk factor for heart disease. It is often elevated in patients with a family history of diabetes.
Real LDL: The “real” cholesterol circulating in your body, it is a component of LDL. Real LDL is calculated by subtracting Lp(a) and IDL from LDL.
LDL Size Pattern: LDL particles vary in size, ranging from small, dense “Pattern B” particles to large, buoyant “Pattern A” particles. Smaller LDL particles are associated with an increased risk for heart disease. Small, dense LDL (“Pattern B”) is associated with insulin resistance or diabetes.
Metabolic Syndrome: A condition characterized by a combination of several metabolic risk factors—including elevated triglycerides, low HDL, and small, dense “Pattern B” LDL particles—that increase the overall risk for heart disease.
HDL2\ HDL3: HDL subfractions are used to predict cardiovascular risk. HDL2 is large and buoyant, and is the most protective form of HDL. Low HDL2 with normal LDL is associated with cardiovascular risk. HDL3 is not as protective as HDL 2.
VLDL3: VLDL3 is the densest VLDL sub-fraction, and confers a greater risk factor for heart disease than both VLDL1 and VLDL2.


The VAP cholesterol test provides accurate, detailed results, identifying people at risk for cardiovascular disease—with a detection rate that is more than twice that of routine cholesterol panels. Compared to conventional lipid panels, the sophisticated VAP test enables physicians to more accurately assess their patients’ risks for cardiovascular disease, and thus to better manage their treatment. As we learn more about emerging risk factors for heart disease, advanced lipid testing will become even more crucial in helping to arrest the progression of what remains America’s leading cause of premature death.
Michael D. Ozner, MD, FACC, is a board-certified cardiologist specializing in cardiovascular disease prevention, and is author of The Miami Mediterranean Diet.
1. Heart Disease and Stroke Statistics—2006 Update. Dallas, TX: American Heart Association; 2006.
2. Superko HR. Did grandma give you heart disease? The new battle against coronary artery disease. Am J Cardiol. 1998 Nov 5:82 (9A);34Q-46Q.
3. Castelli WP, Anderson K, Wilson PW, Levy D. Lipids and risk of coronary heart disease. The Framingham Study. Ann Epidemiol. 1992 Jan;2(1-2):23-8.
4. Lamarche B, TchernofA, Moorjani S, et al. Small, dense low-density lipoprotein particles as a predictor of the risk of ischemic heart disease in men. Prospective results from the Quebec Cardiovascular Study. Circulation. 1997 Jan 7;95(1):69-75.
5. 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 III) Final Report. Washington, DC: National Institutes of Health; 2002. NIH Publication No. 02-5215.
6. No author. The rising tide of metabolic syndrome. Foldout Feature. Postgrad Med. Dec 2004;116(6):54I-54VII.

Monday, February 3, 2014

The Importance of VAP Testing - A COMPLETE Cholesterol Test


More than 600,000 people die of heart disease every year, making the need for more accurate risk stratification even more urgent(1)
  • Heart disease accounts for 25% of all US mortalities(1)
  • 1 in 3 US adults has 1 or more types of cardiovascular disease (CVD)(2)
  • CVD kills more women each year than the next 4 causes of death combined(3)
  • Vascular disease is either under-diagnosed or under-treated in women(4)

Basic lipid panels (BLPs) are inaccurate and inadequate at assessing
residual risk in all patients
  • 50% of patients hospitalized with coronary artery disease had “normal” cholesterol: admission low-density lipoprotein (LDL) cholesterol <100 as="" basic="" by="" dl="" li="" lipid="" measured="" mg="" panels="">
  • Over 75% of patients with myocardial infarction (MI) fell within current guideline-recommended targets for LDL as measured by basic lipid panels(5)
  • Patients with diabetes are at increased risk for MI, stroke, amputation, and death(6)
    • Diabetes causes metabolic abnormalities that induce vascular dysfunction, which predisposes this population to atherosclerosis

LDL is often underestimated and does not reveal true risk
·        Calculated LDL using the Friedewald equation—the foundation for basic lipid panel test results—was found to be highly variable and strongly influenced by triglyceride (TG) concentrations(8),*
·        The magnitude of underestimation in Friedewald LDL often leads to under-treatment based on ATP III categorization(8),*
o       For patients with normal TG levels <150 10="" 70="" a="" adult="" approximately="" be="" category="" dl="" higher="" into="" is="" mg="" of="" p="" patients="" population="" reclassified="" risk="" the="" which="" would="">
  • Direct LDL measurement should be used to assess true risk:
    • LDL <100 dl="" mg="" tg="">200 mg/dL; specimen is non-fasting; patient is at moderate or high risk for CVD9-11 LDL status alone does not identify all patients at risk for cardiometabolic disorders
·        LDL accounts for 30% of the risk of premature CVD, while the remaining 70% represents additional risk factors(13)
·        The VAP Lipid Panel includes a comprehensive assessment of cardiometabolic risk factors

* Results from a recent independent investigator–initiated study involving 1.3 million adults that examined National Cholesterol Education Panel, Adult Treatment Panel  (NCEP/ATP III) Guidelines and commonly accepted standards of care. 8

VAP=Vertical Auto Profile.

1. Gutstein DE, Krishna R, Johns D, et al. Anacetrapib, a novel CETP inhibitor: pursuing a new approach to cardiovascular risk reduction. Nature. 2012;91(1):109-122;
2. Roger VL, Go AS, Lloyd-Jones DM, et al; on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke
statistics—2011 update: a report from the American Heart Association. Circulation. 2011;123(4):e18-e209; 3. Association of Women’s Heart Programs. Final report. The National
Coalition for Women With Heart Disease Web site. http://www.womenheart.org/healthCarePro/upload/AWHP_Report_Final-3-11.pdf. Published March 2011. Accessed May 10, 2012;
4. Vouyouka AG, Kent KC. Arterial vascular disease in women. J Vasc Surgery. 2007;46(6):1295-1302;
5. Sachdeva A, Cannon CP, Deedwania PC, et al. Lipid levels in
patients hospitalized with coronary artery disease: an analysis of 136,905 hospitalizations in Get With The Guidelines. Am Heart J. 2009;157(1):111-117;
6. Beckman JA, Creager
MA, Libby P. Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. JAMA. 2002;287(19):2570-2581;
7. Superko HR. Did grandma give you heart
disease? The new battle against coronary artery disease. Am J Cardiol. 1998;82(9A):34Q-46Q;
8. Sniderman A, Toth P, Kwiterovich P, et al. Clinically meaningful underestimation
of LDL-C by Friedewald at levels below 70 mg/dL: a study of 1.3 million adults [very large database of lipid (VLDL)]. Presented at: American College of Cardiology 61st Annual
Scientifi c Session; March 24-27, 2012: Chicago, IL. Summarized in: Cobble M. Atherotech Medical Affairs Bulletin. Published March 2012;
9. Scharnagl H, Nauck M, Wieland H,
März W. The Friedewald formula underestimates LDL cholesterol at low concentrations. Clin Chem Lab Med. 2001;39(5):426-431;
10. Nauck M, Warnick GR, Rifai N. Methods for
measurement of LDL-cholesterol: a critical assessment of direct measurement by homogenous assays versus calculation. Clin Chem. 2002;48(2):236-254;
11. Third report of the expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III): fi nal report. National Heart, Lung, and Blood Institute Web site.
http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf. Published September 2002. Accessed May 10, 2012;
12. Stampfer MJ, Ridker PM, Dzau VJ. Risk factor criteria.
Circulation. 2004;109(25 suppl 1):IV3-IV5;
13. Kreisberg RA, Oberman A. Clinical review 141: lipids and atherosclerosis: lessons learned from randomized controlled trials
of lipid lowering and other relevant studies. J Clin Endocrinol Metab. 2002;87(2):423-427;
14. Tremblay M, Gaudet D, Brisson D. Metabolic syndrome and oral markers of
cardiometabolic risk. J Can Dent Assoc. 2011;77:b125;
15. Jellinger PS, Dickey RA, Ganda OP, et al; AACE Lipid Guidelines Committee. AACE medical guidelines for clinical practice for the diagnosis and treatment of dyslipidemia and prevention of atherogenesis. Endocr Pract. 2000;6(2):162-213;
16. Grundy SM, Cleeman JI, Merz CN, et al; National Heart,
Lung, and Blood Institute; American College of Cardiology Foundation; American Heart Association. Implications of recent clinical trials for the National Cholesterol Education
Program Adult Treatment Panel III guidelines. Circulation. 2004;110(2):227-239;
17. The VAP® Test from Atherotech: Physician Guide. Atherotech Diagnostics Lab Web site.
http://www.atherotech.com/images/vapliterature/pdfs/physicianguide_20110831.pdf. Accessed June 5, 2012;
18. Peters AL. Clinical relevance of non-HDL cholesterol in patients
with diabetes. Clin Diabetes. 2008;26(1):3-7;
19. Brunzell JD, Davidson M, Furberg CD, et al; American Diabetes Association; American College of Cardiology Foundation. Lipoprotein management in patients with cardiometabolic risk: consensus statement from the American Diabetes Association and the American College of Cardiology Foundation.
Diabetes Care. 2008;31(4):811-822;
20. Analytical performance of the cholesterol profi le measurement by Vertical Auto Profi le [VAP]: analysis of NCEP III guidelines lipid analytes. Atherotech Web site. http://www.atherotech.com/images/vapliterature/pdfs/vapaccuracywhitepaper_20110831.pdf. Published 2011. Accessed May 10, 2012;
21. Why order the VAP® cholesterol test. Atherotech Web site. http://www.atherotech.com/images/vapliterature/pdfs/why_order_the_vap_test.pdf. Accessed May 10, 2012; 22. Study: VAP comprehensive cholesterol test improves outcomes, reduces costs for managed care by 35% [press release]. Birmingham, AL: Atherotech Web site. Published January 4, 2012.
Accessed May 10, 2012; 23. McAna JF, Goldfarb NI, Couto J, Henry MA, Piefer F, Rapier GM III. Improved cardiac management with a disease management program incorporating

comprehensive lipid profi ling. Popul Health Manag. 2012;15(1):46-51.