Did you know that one of the nation’s largest lipid testing databases exists in Birmingham, Alabama? It’s been used in hundreds of clinical studies and through an academic-industry partnership, researchers hope to improve patient outcomes in the fight against cardiovascular disease.

The news was announced today by Atherotech, detailing its strategic research collaboration with the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease. The partnership pairs Atherotech’s Very Large Database of Lipids (VLDL) with Johns Hopkins’ world-class cardiac research capabilities and aims to generate new knowledge through research, and translate that knowledge into clinical practice in the fight against cardiovascular disease.

Steven Jones, M.D. of Johns Hopkins says the collaboration is a perfect fit (click to watch the video on YouTube or view it below).

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Case #360: Basic lipid panel underestimates LDL, misclassifies risk

Fifty-eight year old “Zachary” was referred to our office in early 2012 to establish care and undergo a physical. He reported having occasional heartburn for years and recently had a basic lipid panel (BLP) through his work.

The patient’s initial checkup showed:

• Height = 72 inches
• Weight = 225 pounds
• Waist = < 40
• BMI = 30
• BP = 125/75
• HR = 73

The patient’s BLP and labs showed:

• LDLc = 89
• TC = 146
• TG = 120
• HDLc = 33
• Glucose = 92

Zachary has a strong family history of heart disease, reporting that multiple men on his father’s side have had heart attacks (including his father). Zachary is a non-smoker and non-drinker who exercises regularly.

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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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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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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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