Advanced Tests

Optimal risk assessment starts with leading-edge diagnostic testing.

The routine cholesterol test developed in 1972 is no longer accurate or comprehensive enough to optimally stratify people at increased risk for cardiovascular disease and to direct the initiation and titration of optimal lipid-modifying therapy to reduce that risk. Traditional lipid risk factors for atherosclerosis account for only 40 percent of premature cardiovascular disease(1). Seventy-five percent of patients with myocardial infarctions have “normal” levels of LDL and HDL cholesterol(2). Eighty percent of the patients who had an event in the landmark Framingham Study had lipid levels identical to the population that was event-free(3). It is clear that in order to optimally stratify patient risk (and to intervene to reduce that risk) information beyond the traditional lipid panel is required.

Geneva Diagnostics Hunter LabCorp Quest Diagnostics Spectracell Labs

Advanced cholesterol testing such as the VAP Cholesterol Test, Berkeley HeartLab Panel, NMR Profile, Mayo Clinic and others provide all or many of the updated NCEP emerging risk factor information missing from the routine cholesterol test. Based on the prevalence of expanded lipid abnormalities in CAD patients, the additional information provided can improve the ability to predict the risk of patients developing cardiovascular disease from about 40 percent to over 90 percent(6) and better direct therapy. The following advanced diagnostic tests are ranked in order of their availability, affordability and compliance with the expanded lipid risk factors identified in the current NCEP guidelines

Advanced Lipid Profile:

Includes direct measured traditional lipid factors and NCEP ATP III emerging risk factors that increase predictive powers and takes the guesswork out of selecting therapeutic agents.
  • HDL2:
  • Large, buoyant HDL
  • HDL3:
  • Small, dense HDL
  • Pattern A:
  • Large, buoyant LDL
  • Pattern B:
  • Small, dense HDL
Knowledge of primary, secondary and emerging lipid risk factors and the effects of lipid-lowering therapies can take the guesswork out of selecting an individuals optimal therapeutic agent(s) to reduce absolute risk for coronary heart disease.
LDL Cholesterol STATIN NIACIN FIBRATE RESIN
LDL-C +++ ++ + ++
Lp(a) no effect +++ no effect no effect
IDL ++ ++ + unknown
LDL Pattern:
Small > Largest		 + +++ ++ unknown
HDL Cholesterol STATIN NIACIN FIBRATE RESIN
HDL-C + +++ ++ no effect
HDL2 + +++ ++ unknown
VLDL Cholesterol STATIN NIACIN FIBRATE RESIN
VLDL/TG Reduction + ++ +++ negative effect