The Benefits of Comprehensive Lipid Testing

I recently came across an article from Forbes that I feel compelled to address as it questions the value of comprehensive lipid testing. First and foremost, clinicians want to appropriately screen and identify people who are at a higher risk for cardiometabolic disorders. Throughout my twenty years of clinical practice, I have and continue to guide my patients towards achieving optimum heart health, whether it is through testing, lifestyle modifications and/or various other treatments. Comprehensive lipid tests, such as the VAP + Lipid Panel®, have always been a staple in my recommendations to patients seeking to gain full knowledge of their cardiovascular health in an attempt to predict and/or prevent an event, such as heart attack or stroke, from occurring. Such testing should be easy and affordable while also giving information that independently identifies people who are at a higher risk for cardiovascular disease (CVD)/death. Most importantly, such testing, if abnormal, should help motivate the clinician and patient regarding lifestyle changes and appropriate medical care. In short, it must be actionable.

While the fasting basic lipid panel (BLP) is one method for evaluating a person’s risk for CVD, clinical evidence has shown limitations of the BLP and the benefit of using a more comprehensive analysis, such as the VAP. Data published in the Journal of the American College of Cardiology (JACC) in August 2013 reported the VAP showed up to 60 percent of patients were misclassified as having “normal” cholesterol levels by the BLP. The authors concluded the “BLP tends to underestimate true low-density lipoprotein cholesterol (LDLc) – otherwise known as the ‘bad cholesterol’ in the body – when accuracy is most crucial and additional evaluation is warranted in high-risk patients.” Because BLP uses a calculated measurement of very-low density lipoprotein cholesterol (VLDLc) and another calculation of LDLc, levels are consistently underestimated. Unlike the VAP, the BLP is primarily concerned with identification of LDLc in the bloodstream. What many people don’t realize is that LDLc only accounts for 30 percent of the risk of premature CVD, while the remaining 70 percent represents residual risk factors not identified by the BLP. The BLP is primarily concerned with estimating the general level of LDLc in the bloodstream while the VAP will directly measure all LDLc and non high-density lipoprotein cholesterol (NHDLc) and its four atherogenic components.

Comparatively, the VAP provides a direct measurement – so there is no need to fast with VAP as VLDLc and LDLc are directly measured and not affected by the non-fasting triglyceride level used for calculation in BLP estimates – and provides residual risk to give the full picture of a patient’s risk in three key areas: cholesterol defects, triglyceride defects and hereditary lipid defects. By addressing these three areas, clinicians are able to create more personalized and effective treatment programs based on a patient’s individual risk to ultimately improve health outcomes. In addition to the JACC study, there have been more than 14 studies over the last three years examining the importance of directly measuring LDLc with VAP and other residual risk factors associated with CVD. Most recently, two meta-analyses using the VAP were presented earlier this year at the 2014 Annual Meeting of the American College of Cardiology. The analyses examined findings from two major highly cited cardiovascular studies – the Framingham Offspring study and Jackson Heart study – to show the significant impact high-density lipoprotein cholesterol (HDLc) and remnant lipoprotein cholesterol (RLPc) levels have on a patient’s risk. These findings – along with many others – are a critical step forward in helping clinicians develop a better understanding of the relationship between lipoproteins and cardiovascular risk – something that is not possible with the BLP.

The VAP is also the only commercially available panel that reports all lipoprotein parameters considered necessary by national guidelines including the American Diabetes Association, American College of Cardiology, American Association of Clinical Endocrinologists, as well as the National Cholesterol Education Program Adult Treatment Panel III (ATP III).

The prodigious benefits of accurate and affordable comprehensive lipid testing, to me, is noteworthy. Despite access to some of the best medicines and educational information available, it’s quite alarming to see that CVD is on the rise in the United States. As clinicians, we need to encourage our patients to be proactive when it comes to managing their heart health before it’s too late. The first step in doing so is by getting a full understanding of their risk through the use of comprehensive lipid testing. By utilizing the various diagnostic tools at our disposal, we have the ability to aid in lowering the rate at which CVD is growing and work toward developing a more health conscious and heart-healthy world.

For more information about the VAP, visit www.Atherotech.com


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AHA study shows African Americans and women are predominantly impacted by CVD risk factors

A study recently published in the American Heart Association’s (AHA) journal, Circulation, suggested there is an unequal impact of cardiovascular disease (CVD) on race and gender. Researchers from Women’s Hospital in Boston, Massachusetts studied data from 13,541 people in the Atherosclerosis Risk in Communities study. Participants attended examinations during four periods (1987-89, 1990-92, 1993-95 or 1996-98) when they were 52-66 years old and free of CVD. Researchers examined population attributable risk (PAR) changes for five major cardiovascular risk factors — high cholesterol, smoking, high blood pressure, obesity, and diabetes. The PAR measures how common a risk factor is and how much the factor raises the chance of future cardiovascular disease.

These results highlight that African Americans and women are the demographic populations most prominently impacted by CVD risk factors. The study results highlight the ongoing need for targeted as well as population-based approaches to risk factor modifications in order to reduce the overall risk for heart and vascular disease, researchers said.

The VAP+ Lipid Panel® provides patients with a comprehensive lipid analysis in order to identify their risk for CVD. Knowing your risk is the first step in preventing hard coronary events. Interestingly, the Jackson Heart Study – the largest investigation to date of causes of cardiovascular disease in an African American population – found increased levels of triglyceride rich remnant lipoprotein cholesterol (VLDL3, IDL) measured with the VAP+ Lipid Panel® were a significant, independent predictor of heart attack events among participants in multivariate analysis.  These findings show the value of comprehensive lipid testing in specific patient populations to provide valuable information not captured by the basic lipid panel.

To learn more about the VAP+®, visit Atherotech.com.  To learn more about this study, visit: http://newsroom.heart.org/news/blacks-women-face-greater-burden-from-cvd-risk-factors?preview=2c70


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Atherotech’s Kenneth French Appears on Eva Herr Radio Show

select1394On June 15, Atherotech’s very own Kenneth French was featured as one of the guest’s on a six-part early detection and prevention series hosted by The Eva Herr Radio Show. Eva Herr is considered one of the world’s top experts in integrative and preventive healthcare issues.   During the segment, Kenneth detailed the increasing prevalence of cardiovascular disease (CVD) in the United States and the benefit of comprehensive lipid testing, such as the VAP® + Lipid Panel, on determining a patient’s CVD risk. Kenneth discussed the importance of patient’s knowing their cholesterol numbers to determine the real risk of CVD without relying on a calculated low-density lipoprotein (LDL) cholesterol (the “bad” cholesterol in the body), which can be misleading in regards to lipid based CVD risks. Kenneth explained the history of cholesterol testing, starting with the basic lipid panel, and its limitations, and stressed that by knowing your risk, patients have the ability to prevent future and recurrent cardiac events.

Kenneth is a Medical Science Consultant at Atherotech and has extensive experience in atherosclerosis and dyslipidemia. For several years now, Kenneth has served as a medical liaison for several companies as well as national laboratories through education regarding topics on atherosclerosis, dyslipidemia, metabolic syndrome, and comprehensive testing.  He is utilized as a resource in lipid management, participating in numerous round-table discussions and consulting with physicians on how to interpret laboratory metrics.

To listen to Kenneth discuss the impact cardiovascular disease has on our nation and the evolution of lipid testing, click here, or to listen to Kenneth’s full segment, visit: http://bit.ly/1jBkWVe.


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Lipoprotein and Vascular Diseases Division and Atherotech Diagnostics to Hold Annual Dinner Meetings on July 28-29 during the American Association for Clinical Chemistry’s Annual Meeting & Clinical Lab Expo

Atherotech Diagnostics is excited to announce two events it will co-sponsor with the AACC Lipoproteins and Vascular Diseases Division (LVDD) during the American Association for Clinical Chemistry’s Annual Meeting & Clinical Lab Expo in ChicDr. Davidsonago, IL.

 

The first event is the annual LVDD Dinner Meeting scheduled for Monday, July 28 at the Hyatt Regency in Chicago from 5:30-9:30 p.m. The event will be led by Dr. Michael Davidson of the University of Chicago. LVDD members are invited to this annual awards celebration and scientific session on current topics in cardiovascular disease. Tickets cost $50 and are limited to the first 100 LVDD members. Registration includes a reception, awards presentation and dinner followed by scientific presentations. Tickets can be picked up at the McCormick Place Convention Center at Conference Registration.

 

Toth

In addition to the annual dinner, the second event will be the International Lipoprotein Standardization Forum and takes place the following night on Tuesday July 29, 2014 from 6:00-9:00 p.m. at the Hyatt Regency in Chicago. Dr. Peter Toth of CGH Medical Center in Sterling, IL will lead the forum entitled, ‘ACC/AHA Guidelines on Blood Cholesterol Management: Controversies and Curious Omissions.’ LVDD members are invited to join the discussion on recent findings related to lipoproteins, with a focus on new technologies and standardization efforts. Tickets cost $40 and are limited to the first 60 LVDD members. Registration includes a reception followed by dinner and scientific presentations. After July 23, registration will take place onsite at the meeting.

 

Atherotech is committed to supporting scientific lipoprotein advances and standardization efforts for research and clinical care.

For more information on both events, visit: http://www.aacc.org/events/2014_annual_meeting/conference/special-events/pages/default.aspx


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Does one treatment plan fit all? The Benefit of Patient-Centered Management of Dyslipidemia

According to the Centers for Disease Control and Prevention (CDC), 71 million American adults have dyslipidemia, or high strongheartcholesterol, with only one in three of them taking the necessary steps to control it.  As this issue greatly impacts our nation, it’s critical that we as clinicians are doing everything we can to understand our patients risk for cardiovascular disease (CVD), specifically coronary heart disease. With heart disease being the leading cause of death in both men and women in the United States, it’s imperative that we are educating our patients on the various ways to prevent and/or manage dyslipidemia.  It’s critical that we are identifying primary and secondary patients who are at risk for heart attacks, strokes and death early on. By identifying those patients we can work together to prevent and/or manage dyslipidemia. There are staggering statistics that show heart attacks and strokes occur every 60 seconds in America. What’s more – during any 30 minute block of time 120 Americans will have a heart attack or stroke and one-third of them will die. That is why it is so crucial to catch the warning signs early in order to prevent one of these life-threatening events from occurring.

Statin Therapy Guidelines

As I’m sure many of you are aware, the American College of Cardiology (ACC) and the American Heart Association (AHA) latest guidelines recommended statin therapy  to manage cholesterol for four groups of people who have or are at a high risk for developing the disease. While these recommendations can be beneficial to some patients, the guidelines only address four types of cases and therapy needs that are based heavily on the use of a statin. Since patient cases vary, I’m a firm believer that we need to establish a “back-to-basics” approach and personalize therapy options to successfully help each unique patient case.

NLA Draft Recommendations

The National Lipid Association (NLA) recently issued draft recommendations for patient-centered management of dyslipidemia.  These recommendations were created by an expert panel looking to add information to the statin therapy guidelines by the ACC and AHA. The draft recommendations outlined the importance of acknowledging risk factors for dyslipidemia including age, gender and family history of cardiovascular disease (CVD). They also highlighted the importance of non-high-density lipoprotein (all of the bad cholesterol) and low-density lipoprotein (which usually approximates 70% of the bad cholesterol) as primary targets for therapy and the need for clinicians to personalize how each patient manages dyslipidemia.

I’m a fan of this proposed approach and hope the recommendations are adopted.  In my practice, I always customize my treatment plan based on the particular patient. What works for one patient, may not always work for the next. The expert panel suggested that clinicians take a personalized approach by counseling patients and catering to their specific needs in order to obtain overall heart health. I find this recommendation to be especially useful as it focuses on patient’s needs on a case-by-case basis as opposed to generalizing all dyslipidemia patients.

When I work with my patients, I start off our first meeting by asking them about their family history, lifestyle, eating habits and acknowledge any other health concerns they may have. Based on their situation, I recommend the VAP® + Lipid Panel, which provides me with an in-depth picture of their potential cardiovascular lipid risks. Once we receive the results from the VAP® + Lipid Panel, I work with the patient to determine what form of treatment will be the most beneficial in lowering their individual risk. We discuss various forms of treatment from medications to lifestyle modifications, such as losing weight, quitting smoking, eating a well-balanced diet and getting necessary exercise, and we determine what will work best to help he or she lessen their risk for CVD. It is important for patients to know their options when looking to control and/or eliminate risk factors that could lead to a life-threatening disease.

The relationship between clinician and patient is essential to the treatment process and overall outcome. I strongly encourage you to use comprehensive lipid testing for your patients to gain a better picture of their CV risk. This will help you customize their specific treatment plans. I hope to see these recommendations come to fruition in the near future as I think our dyslipidemia patients may benefit from more personalized care.


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