ACC Data Shows Benefit of Using Comprehensive Lipid Testing to Determine Risk of Coronary Heart Disease

ACC LogoGreetings, all –

I’m Dr. Peter Toth of CGH Medical Center in Sterling, IL and I’ve been invited to serve as a guest blogger this month on behalf of Dr. Cobble. It was an exciting few days at ACC in Washington, DC, with some very promising data presented in support of the prevention, diagnosis and treatment of cardiovascular disease (CVD).

I was honored for the opportunity to present data from two meta-analyses we conducted with researchers from Johns Hopkins, Boston University, and the University of Mississippi, both of which were presented during a poster presentation. We examined the impacts of high-density lipoprotein (HDL) cholesterol and remnant lipoprotein (RLP) cholesterol on a patient’s risk for hard coronary heart disease (CHD) related events. We used findings from two major studies: the Framingham Offspring study and Jackson Heart study. Both studies included men and women without prevalent CHD and used Atherotech Diagnostic’s VAP® Lipid Panel to measure levels of HDL and its subfractions as well as RLP.

The VAP® Lipid Panel allowed us to take a deeper look at a patient’s cardiac risk assessment. Findings from the study showed that while there is a link between HDL-C and CHD, HDL subfractions, specifically HDL3-C, was predictive of reduced risk for events while HDL2-C was not.  This is interesting because it has long been assumed in the absence of supportive data that it is the large buoyant HDLs that are atheroprotective. It turns out this is incorrect. RLP cholesterol (the sum of cholesterol in the smallest VLDLs and intermediate lipoprotein cholesterol) was associated with an increased risk. This finding supports the use of non-HDL-C as a target of therapy for reducing risk for CHD. While further research is needed to fully confirm the impact these lipoproteins have on a patient’s risk, these findings are a critical step forward in helping clinicians develop a better understanding of the relationship between lipoproteins and cardiovascular risk. In addition, these findings show the benefit of using comprehensive lipid testing, such as the VAP® Lipid Panel, to assess risk, which may aid clinicians in creating more personalized, effective treatment plans to improve health outcomes.

There is still much work to be done in the cardiovascular disease space to help reduce risk, but there have been a number of advancements made over the past few months. I look forward to seeing how a number of new studies and findings progress over the next year.

It was a pleasure serving as this month’s Cobbles Corner guest blogger. For more information on the study presented at ACC, check out the press release at: http://www.prnewswire.com/news-releases/new-data-show-benefit-of-comprehensive-lipid-testing-in-determining-risk-for-hard-coronary-heart-disease-events-253194541.html or for more information on the VAP® Lipid Panel, visit www.Atherotech.com.

Signing off,

Peter P. Toth, MD, PhD


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Heart Health: Tips & Advice for Reducing Your Cardiovascular Disease Risk Throughout the Year

As we all know, February celebrated American Heart Month, a time to recognize personal heart health and show it a little extra love. While American Heart Month is an important time to encourage our patients to make improvements toward heart health, it’s critical that we stress lifestyle modifications (i.e., diet, exercise, etc.) throughout the entire year. Although cardiovascular disease (CVD) is the leading cause of death for both men and women in the United States, the risk factors of CVD are preventable and can be controlled. Understanding that everyone’s approach to heart health is different, I’ve outlined a few of my favorite tips below that I often share with my patients at higher risk for CVD. 02-03-14

Diet (Variety and Portion Control) Eating a well-balanced diet, including foods low in saturated fat, trans fats and high in fiber, can help patients lower their risk of CVD. Advise patients to consume at least five servings of fruits and vegetables daily. I also recommend the Mediterranean Diet for heart health, which includes healthy colorful foods, fibers and appropriate sized portions. It incorporates primarily plant-based foods, such as fruits and vegetables, whole grains and nuts, limits red meats, increases the intake of fish and poultry, replaces butter with healthy fats like olive oil, and replaces salt with herbs and spices for flavor.  Interestingly, a recent study published in the January 6 issue of the Annals of Internal Medicine found that a Mediterranean diet supplemented with extra-virgin olive oil cut the risk for developing type 2 diabetes by about a third among adults at high risk for CVD compared with a low-fat diet.

Exercise (Move your Muscles) Regular physical activity, which is recommended as 150 minutes of moderate-intensity activity per week plus muscle strengthening activities, can help patients maintain a healthy weight and lower cholesterol and blood pressure. There are different ways to incorporate exercise into their lives, especially if finding time seems difficult. Advise them to choose activities they enjoy, such as taking brisk walks, gardening, working in the yard,  swimming or bicycling, and alternate between each.

Smoking and Alcohol A person’s risk of CVD greatly increases if he or she smokes, and secondhand smoke is just as hazardous. If your patient smokes, talk to him or her about the benefits of quitting and assist in strategizing a plan to quit. As for alcohol, although the Mediterranean Diet suggests drinking red wine, moderate consumption of alcohol is advised.

Monitor Your Blood Pressure High blood pressure often has no warning signs or symptoms but increases the risk for heart disease and stroke, so it’s important to check your patients’ blood pressure during appointments. Advise them to utilize blood pressure monitors available at pharmacies as well.

Cholesterol Tests –Uncover True CVD Risk Comprehensive, accurate lipid analysis is vital to understand true CVD risk to personalize treatment and improve patient outcomes. There is a strong positive relationship between low-density lipoprotein cholesterol (LDLc), otherwise known as the bad cholesterol in the body, and the frequency of CVD events. Lowering LDLc levels with treatment, specifically statins, has been shown to improve cardiovascular outcomes; however, an estimated 59 percent of patients in the U.S. do not reach their target LDLc goal. Twenty five percent of adults qualify for statin therapy. Fifty percent will stop statins over time. As such, patients may continue to have poorly controlled LDLc levels and persistent cardiovascular risks.

The basic lipid panel (BLP) routinely used for years often underestimates real LDLc (bad cholesterol) and misclassifies the risk category in up to 60% of patients. Due to the inaccuracy of the basic lipid test, I strongly advise clinicians and people in general to use more accurate lipid tests. Testing methods that are more comprehensive have value in cardiovascular risk predictions as well.

The VAP®+ (Vertical Auto Profile) Lipid Panel is one such test identifying more people at risk for heart attack and death, unlike the traditionally used basic lipid panel (BLP) which has been proven to be up to 60% inaccurate in those patients most at risk. I strongly advise physicians to employ comprehensive and accurate testing methods, such as the VAP®+ Lipid Panel, which evaluates the complete picture – not only cholesterol, but triglycerides and hereditary risk factors as well. Unlike the BLP, the VAP®+ Lipid Panel directly measures a variety of factors associated with CVD, providing a more accurate picture of a patient’s risk. This allows for clinicians to create a personalized and effective treatment program to improve heart health – or – prevent events – or achieve healthy heart outcomes.

To conclude, CVD is preventable. Understanding true risk with comprehensive lipid testing is an important step. Taking precautionary actions and practicing healthier lifestyle habits can lower a patient’s risk. Share the tips listed above with your patients, talk to them about their heart health and discuss the importance of getting a clear picture of lipid-related cardiovascular disease with comprehensive lipid testing to find hidden risks for heart attack and death.


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Keep it Simple for the Holidays and New Year

holiday saladReflecting on the many complex and controversial developments in heart health and lipidology over the past year – and looking ahead to the challenge and promise of a new year – one common theme comes to mind: Keep it Simple.

Why? Because it’s easy for the clinician and patient to become overwhelmed with the vast amount of data, studies, guidelines, news reports and opinions that can accrue in the space of a single year.

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New ACC/AHA Cholesterol Guidelines Build on Past Recommendations

New guidelines issued on heart disease prevention and treatment were a hot topic at the 2013 AHA scientific sessions in Dallas.

statins

Statins” by AJC1 is licensed under CC BY 2.0

Under the new ACC/AHA Practice Guidelines published just prior to AHA, statins are recommended in four large groups: 1) individuals with clinical atherosclerotic vascular disease (ASCVD); 2) diabetics aged 40-75 years with LDL cholesterol (LDLc) 70-189 mg/dL; 3) individuals with primary LDLc >= 190 mg/dL; and 4) people aged 40 – 79 years with estimated 10-year ASCVD risk ≥ 7.5%. This group of individuals for whom statins are now recommended represents more than 30 million Americans, according to practice guidelines task force numbers.

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VAP Lipid Panel Highlighted at AHA 2013 in Dallas

AHA13

Atherotech Diagnostics Lab — Booth #2308

The American Heart Association (AHA) Annual Scientific Sessions 2013 are held in Dallas November 16 – 20 at the Dallas Convention Center in Dallas, Texas. The following is a list of presentations that involved the patented, comprehensive, VAP (Vertical Auto Profile) Lipid Panel and related research.

This year’s presentations include:

Poster presentations 13843 and 14026 examine HDL subfractions, remnant lipoprotein subfractions and their relationship with cardiovascular events from a meta-analysis of the Framingham Offspring Study and Jackson Heart Study. Both will be presented from 3:00 p.m. to 4:30 p.m. on Monday, November 18, 2013, in Hall F, Core 2. Poster presentations 17313 and 17492  examine an investigational, cholesterol-lowering drug targeting the PCSK9 protein-coding gene. Both will be presented on Tuesday, November 19, from 3:00 p.m. to 4:30 p.m. in Hall F, Core 2.

Three additional poster presentations — 1602018557, and 18730 — detail studies by Johns Hopkins researchers from the Ciccarone Center for the Prevention of Heart Disease using Atherotech’s Very Large Database of Lipids (VLDL) and the VAP Lipid Panel. The current VLDL dataset includes more than 1.4 million data points representing unique individuals. Researchers involved in the VLDL presentations at AHA 2013 examined cholesterol subclasses, lipid phenotypes and the triglyceride/HDL cholesterol ratio.

The final abstract presentation — 11909 from the Best of AHA Specialty Conferences — is an oral presentation about the connection between remnant lipoprotein cholesterol and mortality after acute myocardial infarction in the TRIUMPH Prospective Multi-Center Registry.

ABSTRACTS PRESENTED on SUNDAY, NOVEMBER 17

Session: Lipoprotein Metabolism: Clinical and Population Studies
Presentation: 18557 – Lipid Phenotypes at the Extremes of HDL Cholesterol: Very Large Database of Lipids Study-9
Time: 9:30 AM -11:00 AM
Date: Sunday, Nov 17, 2013
Location: Hall F, Core 2, Poster Board: 2027
Lead Author: Mohammad Al-hijji M.D., Johns Hopkins Ciccaroni Center for the Prevention of Heart Disease
Co-Author: Parag H. Joshi, M.D., Johns Hopkins Ciccaroni Center for the Prevention of Heart Disease. Dr. Joshi is supported by the Irene Pollin Cardiovascular Prevention Fellowship.

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Session: Lipoprotein Metabolism: Clinical and Population Studies
Presentation: 16020 – Narrowing Sex Differences in Lipoprotein Cholesterol Subclasses Following Menopause: Insights From the Very Large Database of Lipids (VLDL-10B)
Time: 9:30 AM -11:00 AM
Date: Sunday, Nov 17, 2013
Location: Hall F, Core 2, Poster Board: 2021
Lead Author: Kristopher J. Swiger, M.D., Johns Hopkins Ciccaroni Center for the Prevention of Heart Disease
Co-Author: Seth S. Martin, M.D., Johns Hopkins Ciccaroni Center for the Prevention of Heart Disease. Dr. Martin is supported by the Irene Pollin Cardiovascular Prevention Fellowship as well as the Marie-Josée and Henry R. Kravis endowed fellowship.

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ABSTRACTS PRESENTED on MONDAY, NOVEMBER 18

Session: Dyslipidemia and Treatment
Presentation: 13843 – High-density Lipoprotein Cholesterol Subfractions and Risk for Cardiovascular Events in the Framingham Offspring and Jackson Heart Studies: A Meta-analysis
Time: 3:00 PM – 4:30 PM
Date: Monday, Nov 18, 2013
Location: Hall F, Core 2, Poster Board: 2099
Lead Author:  Peter P. Toth, M.D., Director of Preventative Cardiology at CGH Medical Center in Sterling, Illinois; member of Atherotech’s Medical Advisory Board

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Session: Dyslipidemia and Treatment
Presentation:  14026 – Remnant Lipoprotein Cholesterol Fractions and Risk for Cardiovascular Events in the Jackson Heart and Framingham Offspring Studies: A Meta-Analysis
Time:  3:00 PM – 4:30 PM
Date: Monday, Nov 18, 2013
Location: Hall F, Core 2, Poster Board: 2100
Lead Author:  Peter P. Toth, M.D., Director of Preventative Cardiology at CGH Medical Center in Sterling, Illinois; member of Atherotech’s Medical Advisory Board

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ABSTRACTS PRESENTED on TUESDAY, NOVEMBER 19

Session:  Biomarkers, Lipoprotein Metabolism and CVD
Presentation:   18730 – Correlates and Cut-points of the Triglyceride/HDL Cholesterol Ratio: The Very Large Database of Lipids 4 (VLDL-4)
Time:  3:00 PM – 4:30 PM
Date:   Tuesday, Nov 19, 2013
Location:  Hall F, Core 2, Poster Board: 2020
Co-Author:  Steven R. Jones, M.D., Johns Hopkins Hospital, Johns Hopkins Ciccarone Center for the Prevention of Heart Disease
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