Why Order The VAP® Cholesterol Test The VAP® Cholesterol Test is an affordable test that routinely reports direct LDL-C, non-HDL, and ApoB—the three major risk factors identified by the American Diabetes Association/American College of Cardiology joint consensus statement and the NCEP ATP III guidelines as targets to effectively reduce CVD risk. The VAP Test also routinely reports residual lipid risks posed by such components as: elevated lipoprotein (a); low HDL2; small, dense LDL particles; and triglyceride rich remnants. Accurate The accuracy of VAP measurements are verified by beta quantification, a standard procedure for lipoprotein analysis based on centrifugation. Affordable The VAP Test is reimbursed by most insurance carriers, Medicare and Medicaid. You can find out more information by contacting Atherotech. Easy Because the VAP Test directly measures all cholesterol components, including LDL-C, fasting is not required. Effective By reporting 22 values of cholesterol, the VAP Test identifies risks you can’t see with a standard lipid panel. Accessible Obtaining a VAP Test is easy. Contact your local clinical lab, or contact Atherotech directly. Who should get a VAP? • Any patient with established atherosclerosis/ vascular disease • Any patient with NCEP ATP III risk factors: o Cigarette smoking • Any patient with diabetes mellitus o Hypertension • Any patient with a Framingham risk score over 5% o Low HDL-C (<40 mg/dL) • Any patient with an elevated inflammatory biomarker o Family history of premature CHD o Age (men ≥ 45 years; women ≥ 55 years) How to get a VAP Test 1.You can order The VAP Test directly from Atherotech by calling 877-901-8510. 2.The VAP Test is reimbursed by most insurance carriers and Medicare/Medicaid. 201 London Parkway | Birmingham, AL 35211 | 877-901-8510 | www.Atherotech.com Patient Name: PATIENT, TEST Sex: F Date Drawn 03/12/09 Account: Test CLIENT Age: 34 Date Tested: 03/12/09 Physician: Physician, Test DOB: 10/01/1974 Accession: 6333743 Fasting Status: Fasting Client No: CLIENTACN12345 Patient ID: 3173769 Risk Direct-Measured Cholesterol Panel Actual Total LDL 162 <130 mg/dL LDL4+3+2+1 + Lp(a) + IDL LDL4+3+2+1 Total LDL minus Lp(a) and IDL Desirable Low Description High 128 <100 mg/dL Lp(a) 15 <10 mg/dL More atherogenic than LDL IDL 19 <20 mg/dL More atherogenic than LDL Total HDL 56 ≥40 mg/dL HDL2 + HDL3 HDL2 13 >15 mg/dL Large Buoyant, more protective HDL3 43 >25 mg/dL Small Dense, less protective Total VLDL 24 <30 mg/dL VLDL1+2 + VLDL3 VLDL1+2 9.8 <20 mg/dL Buoyant VLDL, less risk VLDL3 15 <10 mg/dL Dense VLDL, more risk Total Cholesterol 243 <200 mg/dL Secondary and Emerging Risk Factors Actual Desirable LDL + HDL + VLDL Risk Low Description High Triglycerides 141 <150 mg/dL Linked to increased risk for CHD Non-HDL Cholesterol 187 <160 mg/dL LDL + VLDL Remnant Lipoproteins 34 <30 mg/dL IDL + VLDL3 15 <10 mg/dL More atherogenic than LDL A/B Pattern A Lp(a) LDL Density (Pattern) B: more risk; A/B intermediate risk; A: less risk LDL Subclasses (mg/dL) LDL4=23.7, LDL3=56.6, LDL2=22.3, LDL1=25.4 Apolipoproteins Actual Desirable LDL4+3 small, dense. LDL2+1 large, buoyant Risk Low Description High Apo B 125 <109 mg/dL Sum atherogenic lipoprotein particles Apo A1 161 >145 mg/dL Sum anti-atherogenic lipoprotein particles Apo B/A1 ratio 0.78 <0.75 Metabolic Syndrome/Insulin Resistant Assessment Atherogenic Dyslipidemia Physician Input Required Triglycerides ≥150 mg/dL Blood Pressure ≥130 / ≥85 mm Hg HDL2 <10mg/dL males <15mg/dL females Fasting Glucose ≥100 mg/dL Pattern B Low ratio indicates lower risk Considerations The normal LDL target of <130mg/dL* for moderate risk patients can be lowered to <100mg/dL* due to the presence of any of the following ATP III emerging risks factors: LDL Size - Dense (Pattern B) Remnant Lipoproteins elevated Abdominal Obesity ≥102 cm (≥40 in) male ≥88 cm (≥35 in) female Lp(a) * If patient is defined as very high risk LDL target of <70 mg/dL can be considered. Clinicians: If you have questions about test interpretation and implications for care, call (877) 519-4807 to speak with a Medical Science Consultant. Patients: If you have had a VAP Test and are interested in nutrition and exercise instructions, call Our Healthy Heart Program at (866) 827-8378. Note: Atherotech does not mandate or advise treatment for individual patients. Patient treatment and recommendations are the responsibility of the clinician. Atherotech, Inc. 201 London Parkway Birmingham, AL 35211 ATHER Revised Sample Test Results Slick_2011.indd 1 Phone: (877) 901-8510 Fax: (205) 314-7403 Lab Director: Dr. Kris Kulkarni www.Atherotech.com © 2011 Atherotech V-PH1-3.2011 3/28/11 1:47:44 PM VAP Cholesterol Test explanations for patients Your VAP® Cholesterol Test is a comprehensive lipid panel that shows risk factors that the routine lipid test cannot identify. Knowing these risk factors can help your physician create a treatment plan designed to reduce your risk of heart disease. The following definitions will help you understand each VAP measurement and what you can do to help avoid diabetes, stroke and heart disease. Test Test Description Normal Values Additional Lifestyle Suggestions Total Low Density Lipoprotein (LDL) Cholesterol (Direct Cholesterol) Your total “bad” cholesterol. There are three components: LDL4+3+2+1, Lp(a) and IDL. Patient at low risk: < 160 mg/dL Patient at moderate risk: < 130 mg/dL Patient at high risk: < 100 mg/dL Patient at highest risk: < 70 mg/dL (optional) Choose: sterols and stanols, high-fiber foods LDL 4+3+2+1 The amount of “bad” cholesterol carried by LDL particles. < 100 mg/dL Choose: sterols and stanols, high-fiber foods Lipoprotein (a) (Lp(a)) An inherited risk factor. It is an LDL-like particle with Velcro® -like attachment, so it sticks to the walls of the arteries. < 10 mg/dL Intermediate Density Lipoprotein (IDL) A carrier of triglycerides that increases risk for heart disease. < 20 mg/dL Choose: high-fiber foods, omega-3 fatty acids Limit: refined carbs Total High Density Lipoprotein (HDL) Cholesterol HDL 2 HDL 3 Your “good” or “protective” cholesterol. HDL 2 is the protective form of HDL. Its role is to act like a garbage truck to take the “bad” cholesterol out of circulation. HDL 3 is the least protective form of HDL. HDL-C (Total): > 40 mg/dL HDL-C for Patients with Metabolic Syndrome: > 40 mg/dL (M) > 50 mg/dL (F) HDL 2: > 10 mg/dL (M) > 15 mg/dL (F) HDL3: > 30 mg/dL (M) > 25 mg/dL (F) Choose: healthy fats Limit: refined carbs Stop: smoking Total Very Low Density Lipoprotein (VLDL) Cholesterol VLDL1&2 VLDL 3 Another type of “bad” cholesterol produced by the liver and the main carrier of triglycerides. It is a marker of prediabetes. VLDL1&2 includes the larger types of VLDL. VLDL 3 is smaller and is a greater risk factor for heart disease. VLDL (Total): < 30 mg/dL VLDL1&2: < 20 mg/dL VLDL 3: < 10 mg/dL Choose: omega-3 fatty acids, high-fiber foods Limit: refined carbs, alcohol Stop: smoking Triglycerides Another type of fat in the blood that can come from sugars and fats in your diet. It increases your risk of diabetes and heart disease. < 150 mg/dL Choose: omega-3 fatty acids, high-fiber foods Limit: refined carbs, alcohol Stop: smoking Non-HDL Cholesterol The sum of Total LDL and Total VLDL. Dependent upon LDL (Direct) goal (NonHDL-C goal = LDL goal + 30 mg/dL) Choose: omega-3 fatty acids, high-fiber foods, sterols and stanols Limit: refined carbs, alcohol Stop: smoking Remnant Lipoproteins The sum of IDL and VLDL 3. < 30 mg/dL Choose: omega-3 fatty acids, high-fiber foods Limit: refined carbs, alcohol Stop: smoking LDL Density (Pattern) Pattern A: large and fluffy LDL is like popped popcorn. Pattern B: small LDL is like popcorn kernels and can mean higher risk of heart disease. Pattern A/B: is like a mix of popped popcorn and popcorn kernels. Pattern A Choose: omega-3 fatty acids Limit: refined carbs, alcohol Apolipoprotein B (apoB) The number of “bad” cholesterol LDL and VLDL particles. Fewer is better. High risk: < 90 mg/dL Highest risk: < 80 mg/dL Choose: omega-3 fatty acids, high-fiber foods, sterols and stanols Limit: refined carbs, alcohol Stop: smoking Apolipoprotein A1 (apoA1) The number of “good” HDL cholesterol particles in your blood. More are better. > 118 mg/dL (M) > 145 mg/dL (F) Choose: healthy fats Limit: refined carbs Stop: smoking ApoB/apoA1 ratio A ratio of the number of bad LDL cholesterol particles to the number of good HDL cholesterol particles. The lower the number, the lower the risk of heart disease. < 0.92 (M) < 0.75 (F) Choose: healthy fats, high-fiber foods, sterols and stanols Limit: refined carbs, alcohol Stop: smoking 201 London Parkway | Birmingham, AL 35211 | 877-901-8510 | www.Atherotech.com