As I progress through my certification in functional medicine and keep “digging in” as they call it in the functional medicine world I keep learning about the latest tests and it becomes more and more apparent to me that clinical medicine is 10-15 years behind the latest medical science and the latest clinical applications of some of the science. Because we physicians are so busy and so overwhelmed with primary care, we do not have the time or ability to hear about the latest things unless we take extra-time to do so.
Evidence that the current lipid panel is outdated:
For example, do you know that 50% or greater of those who have their first heart attack have a normal lipid panel? If we are using this test to estimate a patient’s risk for cardiovascular disease, then this means as a physician you are flying half blind.
“Atherosclerotic cardiovascular disease results in >19 million deaths annually. Despite major advances in treatment of coronary heart disease patients, a large number of victims of the disease who are apparently healthy die suddenly without prior symptoms. Available screening and diagnostic methods are insufficient to identify the victims before the event occurs.”
Circulation: Journal of the American Heart Association, “From Vulnerable Plaque to Vulnerable Patient”, 2003 (50 authors listed)
LDL Cholesterol in current lipid panel is an estimated number:
- Currently, the LDL cholesterol is not directly measured using the routine lipid panel. Rather, it is estimated using the Friedewald equation:
- Thus, estimated LDL cholesterol levels are falsely low in patients with elevated triglycerides, and it does not correlate well in patients with diabetes, coronary disease, or other atherosclerotic diseases.
The Vertical Auto Profile (VAP) Test:
- This test by Atherotech spins the blood in an ultracentrifuge and divides the different subclasses of lipoproteins by weight.
It then directly measures the amount of each type of lipoprotein in the sample.
What the VAP Test Measures:
- Total VLDL: elevated levels=increased risk heart disease and diabetes.
- Sum Total Cholesterol= sum of HDL, LDL and VLDL
- Total Non-HDL= sum of LDL and VLDL, increased levels=increased risk heart disease.
- Total apoB100: helps create, carry and deliver “bad cholesterol” to cells.
- Lp(a) cholesterol= an inherited risk factor for atherosclerosis.
- IDL= intermediate density lipoprotein: increased in those with family history of diabetes.
- LDL-RC=LDL bound to C-reactive protein=inflammatory LDL
- Sum Total LDL-C= sum of Lp(a), IDL and LDL
- LDL Size Pattern= A, B, or A/B:
A= Large, fluffy and less dense
B= small, high-density molecules (4 x > risk heart disease)
A/B=combination of low and high dense molecules.
- HDL-2= subclass that is highly PROTECTIVE.
- HDL-3= subclass that is NOT protective.
- VLDL-3= triglyceride rich very low density lipoprotein: increased potential for diabetes.
From this list you can see that the VAP Test provides a great deal more specific information about a patient’s lipid status and therefore much better assessment of their risk for developing heart disease or stroke. Check out my blog next week and I will give some clinical examples of how this test can help physicians and their patients better treat their cardiovascular risk.