VAP Lipid Panel Powers Science in Eight AHA 2013 Scientific Presentations

scientific sessionsAHA 2013 is one the busiest but most exciting times of the year. For this year’s Scientific Sessions, I am  very pleased to report that the VAP (Vertical Auto Profile) Lipid Panel is utilized in eight independent investigator-initiated scientific presentations during the conference.

2013 has been a banner year for VAP-involved research projects: starting with the American College of Cardiology in March, continuing with the National Lipid Association Scientific Sessions in May and the eighth annual Cardiometabolic Health Congress (CMHC) in September. VAP is well traveled in 2013 and gaining more attention at every conference.

Most impressive is VAP’s validation of what I see in practice nearly every day — the lipid panel’s ability to support the important clinical utility of testing for comprehensive and accurate cardiovascular risk assessment.

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Remnant Ratio Gains Traction as Key Risk Marker in Women over 50

Heart disease and women

The apoA1 remnant ratio (apoA1/[VLDL3c+IDLc]) is an exciting, potential new risk marker and target of therapy that can be calculated using the VAP Lipid Panel.

Heidi T. May, Ph.D., and John R. Nelson, M.D., F.A.C.C., F.N.L.A., F.A.S.N.C., et al. recently co-authored a published study on this topic in the April 2013 edition of Lipids in Health and Disease. I asked Dr. Nelson to talk about the study on Cobble’s Corner and answer my questions about how this ratio can go beyond the basic lipid panel to more accurately assess risk in key patient populations.

 

The apoA1 Remnant Ratio and its Origins
The apoA1 remnant ratio is the good HDLc protein (apoA1) divided by the triglyceride-rich remnant lipoprotein (RLP) leftovers of non-HDLc (NHDLc). NHDLc represents the sum of intermediate density lipoprotein (IDLc) and very low density lipoprotein (VLDL3c), which is the smallest, most dense VLDLc subfraction. RLPs can have a significant negative impact on coronary heart disease risk, especially when combined with lower levels of apoA1, which is not affected by fasting or non-fasting states.

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A Look Back at an Exciting National Lipid Association Scientific Sessions Meeting

It was a great meeting earlier this month in “Lipid City” for the National Lipid Association Scientific Sessions. It is always a pleasure to discuss amongst peers and colleagues our passions for lipid management and improving outcomes.

Eliot A. Brinton, M.D., F.A.H.A., F.N.L.A., provided one of the highlights of the conference with an informative and compelling overview regarding a recent study of 1.36 million U.S. adults published in the Journal of the American College of Cardiology (online March 21, 2013). He’s a co-author of the study along with Steven R. Jones, M.D., F.A.C.C., A.B.C.L., and his colleagues at Johns Hopkins.

Brinton discussed the “massive study” in which each patient had a VAP Lipid Panel with direct-measured LDL cholesterol and a basic lipid panel with Friedewald estimated LDL cholesterol. He posed the question: “How good is the Friedewald LDL cholesterol?” Not surprisingly, it resulted in a significant misclassification in those patients most at risk, leading to undertreatment.

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Friedewald Falters as Major Study Identifies LDL Inaccuracy

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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ACC.13 Science Supports Direct LDL Subclass Measurement

Atherotech Diagnostics Lab | Arleen Francis Mike Cobble Sarah SchlitzIt 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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