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