It’s May and Stroke Awareness Month. Stroke is the fourth leading cause of death in the U.S. and a leading cause of adult disability.

With stroke awareness in the news and on our patients’ minds, adding a valuable risk assessment to our patient’s lab work may create a greater sense of urgency to be compliant with treatment recommendations when they understand there is active disease present, and not just risk of disease.

The PLAC Test, developed by diaDexus, Inc. and offered with the VAP Lipid Panel from Atherotech, determines levels of Lp-PLA₂ (lipoprotein-associated phospholipase A2) in the blood. Individuals with elevated levels of Lp-PLA₂ have been shown to have an increased risk of ischemic stroke and coronary heart disease — especially when combined with high blood pressure.

More than 30 studies have evaluated the risk of CAD and CVD when Lp-PLA₂ is elevated. The optimal value appears to be under 200, although some studies have suggested even lower values.

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Study clarifies role of direct LDL cholesterol measurement in clinical practice

Results from a national study of 1.3 million Americans concluded that the Friedewald equation “underestimates LDLc when accuracy is most crucial.” Friedewald Estimated versus Directly Measured Low-Density Lipoprotein Cholesterol and Treatment Implications was published online ahead of print in March’s Journal of the American College of Cardiology.

Baltimore-based Johns Hopkins senior investigator and Atherotech Medical Advisory Board member Steven R. Jones, M.D., said the study marks the first time directly measured LDL cholesterol (LDLc) levels using density gradient ultracentrifugation (VAP Lipid Panel) and calculated LDLc levels using the Friedewald equation have been compared, and the results may come as quite a shock.

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The recent release of HPS2-THRIVE study results has caused quite a stir among the medical media, mainstream media and health care pundits. This includes predictable and misleading headlines about the failure of niacin to reduce multiple CVD endpoints.

The HPS2-THRIVE (Treatment of HDL to Reduce the Incidence of Vascular Events) trial concluded that adding Tredaptive — Merck’s extended-release (ER) niacin/laropiprant combination therapy — to current standard treatment patients did not produce worthwhile reductions in the risk of heart attacks, strokes and operations to open blocked arteries.

HPS2-THRIVE and the preceding AIM-HIGH study both endeavored to provide useful outcomes data on the clinical efficacy of combination niacin therapy in reducing major adverse cardiovascular events (MACE). LDLc was already aggressively controlled in both studies, and — not surprisingly — both studies showed (very small) increases in HDLc. The baseline LDLc/HDLc ratios were 1.5 and 2.0 respectively — very close to healthy physiologic levels.

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It was a busy and exciting American College of Cardiology 2013 conference. It’s great to see clinical experience validated with science presented in conjunction with the ACC.13 prevention track sessions.

It is encouraging that the evidence continues to build for emerging lipid risk factors in major population segments of the U.S. population. This includes technical inadequacies of Friedewald LDL calculation, which has been the mainstay of the basic lipid panel for more than 40 years. One thing is clear: there is a need for direct LDL measurement that also provides accurate non-HDL component measures and lipid subclasses for cardiovascular risk identification and prevention.

Highlights of ACC.13 presentations included:

• Two excellent ACC.13 posters presentations by Peter P. Toth, M.D., identified TG-rich remnant lipoproteins and HDL subclasses as significant, independent risk factors in heart disease, and highlighted the need for more research in this important area of preventive cardiology.
• In a cohort of the Intermountain Heart Study, Heidi T. May, Ph.D., of the Intermountain Medical Center Heart Institute provided further insight into LDL subclasses (LDL₃ and LDL₄) and apolipoprotein B as significant predictors of heart attack, death, and repeat revascularization (MACE).
• Researcher Mohamed B. Elshazly, M.D., and his team discovered significant disagreement (discordance) between key lipid calculations in the basic lipid panel and the direct measures in the VAP Lipid Panel, concluding that more research into better lipid risk assessment and the exploration of multiple lipid parameters in treatment decisions must be undertaken.
• Wrapping up the science involving the VAP Lipid Panel was a very well-researched oral presentation Sunday morning in front of a large audience on the impact of TG-rich remnant lipoproteins presented by Dr. Arif Khokhar of Northwest London Hospitals in the United Kingdom.

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American College of Cardiology Scientific Session 2013 (ACC.13) is upon us. I will be attending this year’s conference in San Francisco, and eagerly anticipate the excitement, learning opportunities and the many clinical trial results to be presented.

I’m pleased to report that the VAP Lipid Panel is utilized in five independent investigator-initiated scientific presentations during the conference — the highest number of VAP-involved scientific presentation to date for any major conference. This comprehensive lipid profile continues to demonstrate its ability to go beyond the limitations of the basic lipid panel in both scientific research and clinical practice.

The Vertical Auto Profile (VAP) was utilized in research being presented through four poster presentations and one oral presentation. Highly respected researchers Peter P. Toth, M.D., Heidi T. May, Ph.D., Mohamed B. Elshazly, M.D., and Arif A. Khokhar, B.M., B.Ch., M.A. (CANTAB), will present findings during the conference. Download a complete list of Atherotech-related scientific presentations at www.CobblesCorner.com/ACC13.

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