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.

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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. 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. 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. 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. Published 2011. Accessed May 10, 2012;
21. Why order the VAP® cholesterol test. Atherotech Web site. 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.

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