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The VAP Cholesterol Test
Dave Glenn, MT (ASCP)
The Vertical Auto Profile (VAP) Cholesterol test is the only lipid panel that directly measures the National Cholesterol Education Project (NCEP) Adult Treatment Panel III (ATPIII) primary target, LDL cholesterol, as well as both secondary treatment targets and all three ATPIII “emerging lipid risk factors,” in a single test.
The VAP test offers many advantages over conventional lipid profiles. Direct LDL Measurement provides a more accurate evaluation than the usual lipid profile that relies on the Friedewald calculation (LDL = Cholesterol – HDL – Triglycerides/5). If the patient is not fasting or has high triglycerides (>150 mg/dL), the LDL will be underestimated.
Metabolic Syndrome is associated with greatly increased risk for type 2 diabetes and CHD. It is estimated to be present in ¼ of all adults and 42% of all American 60 year olds. These patients are likely to have elevated triglycerides and may be missed using conventional lipid panels. The VAP test identifies Metabolic Syndrome patients with elevated triglycerides, low HDL and dense LDL particles.
ATPIII Emerging Risk Factors: It is important to differentiate the LDL components as (1) they confer different risk, (2) they respond to different medications, and (3) they have different inheritance. The ATPIII considers Lp(a), small/dense LDL and the Remnant-LDL cholesterol as emerging lipid risk factors which are superior detectors of risk in women. According to the Framingham Heart Study, a Lp(a) level of 10mg/dL is the 75th percentile and more than doubles coronary event risk. Triglycerides are not intrinsically atherogenic. However, small particles penetrate the endothelial barrier and deposit cholesterol into the artery wall. In women the VLDL-3 levels are a better predictor or coronary event risk than LDL alone.
Statin-responsive patients can be differentiated from statin-resistant patients. If most of the LDL is Lp(a) and IDL, the patient will be relatively statin-resistant and may need niacin with the statin.
The VAP method uses ultracentrifugation to vertically line up the lipoproteins based on their size and density characteristics. The bottom of the tube is then pierced and each vertical layer is measured by enzymatic determination of all lipoprotein fractions with approximately 400 sequential spectrophotometric measurements per sample.
Measurements include the five major lipids: HDL, Lp(a), R-LDL, IDL and VLDL and their subcomponents. R-LDL or “real-LDL” is defined as the total LDL minus its Lp(a) and IDL components. The VAP test reports the HDL measured components including HDL2 (protective) and HDL3 (less protective). LDL measured components including Lp(a) (atherogenic), IDL (atherogenic) and LDL-R (atherogenic). The LDL-R components reported are Pattern A (less atherogenic), or Pattern A/B (intermediate/transition), or Pattern B (more atherogenic).
The VAP cholesterol test should be ordered when the triglycerides are >150, the HDL is <40, the LDL is >130 or the total cholesterol is >200. The VAP test should also be ordered if routine cholesterol tests are “normal,” but the patient has: a family history of heart disease (males < age 55, females < age 65), diabetes, hypertension, hypothyroidism, obstructive liver disease, chronic renal failure or are taking prescribed cholesterol lowering drugs or drugs to decrease LDL, or raise HDL including progestins, anabolic steroids and corticosteroids.
As part of your personalized P.O.W.E.R. ® "start up" program, a VAP cholesterol test will be performed. VAP cholesterol tests will also be part of the routine P.O.W.E.R. ® "followup" programs in patients who elect to be followed under our supervision and care.
P.O.W.E.R. ® programs are personalized to each individual under the supervision of qualified physicians licensed in the State of Nebraska. A multidisciplinary team designs, implements and regularly reviews the P.O.W.E.R. ® program of each individual to increase the likelihood of successful weight loss and weight management as well as decreasing the risks of developing cardiovascular disease or diabetes mellitus.
HEALTHY NEBRASKA ® offers healthcare services dedicated to the good health of you, your friends and loved ones in Nebraska. Through our offices and affiliates in Nebraska, we offer health assessment, disease prevention, diagnosis and treatment for a variety of common medical conditions.
500 West Leota Street #200
North Platte, Nebraska 69101
Byron L. Barksdale, M.D.
Phone: 308-532-4700
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