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Researchers examining non-HDL cholesterol (NHDLc) as an alternative to LDL cholesterol (LDLc) recently reported significant errors in risk classification when evaluating patients with the basic lipid panel. The study titled "Non-HDL Cholesterol, Guideline Targets, and Population Percentiles for Secondary Prevention in a Clinical Sample of 1.3 Million Adults" is the product of an academic-industry collaboration between Atherotech Diagnostics Lab and investigators at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease.
Results of the study recently published online ahead of print in the Journal of the American College of Cardiology (JACC) showed that differences between LDLc and NHDLc levels are greatest when accurate measurement is most critical: in high-risk patients with low LDLc targets and high triglycerides.
The study examined lipid profiles in more than 1.3 million U.S. adults from the Very Large Database of Lipids (VLDL) dataset - a massive collection of blood lipid samples measured with vertical density gradient ultracentrifugation by the VAP® Lipid Panel from Atherotech. It is the second JACC-published study resulting from the VLDL research collaboration between Atherotech and Johns Hopkins. Results showed that a significant percentage of patients were reclassified by NHDLc and moved into to a higher treatment category compared with LDLc. For patients with estimated LDLc levels below 70 mg/dL and triglycerides between 150 and 199, 22 percent had NHDLc levels at or above 100 mg/dL, and 50 percent had NHDLc levels above the 93 mg/dL level.
"As the researchers suggest, non-HDL cholesterol targets probably need to be lowered to bring them more in line with LDLc targets," Atherotech Chief Medical Officer Michael Cobble, M.D., said. "However, from a clinical perspective, the variation and underestimation of risk that occurs with estimated LDLc in high-risk patients is unacceptable. A direct measure of LDLc along with non-HDLc components, as provided by the VAP Lipid Panel, is more accurate, fasting or non-fasting."
LDLc as estimated by the 1970s-era Friedewald equation has been the primary focus for heart disease risk assessment and prevention in the U.S. for decades. However, several limitations - including inaccuracy with elevated triglycerides as low as 150 - make LDLc a less accurate marker of cardiovascular risk than secondary measures such as NHDLc, which has targets set at about 30 mg/dL above LDLc targets with no specific studies establishing validity. This inaccuracy was recently highlighted in the Estimated v. Direct LDLc study in the Journal of the American College of Cardiology using the same VLDL dataset, where underestimation of risk occurred in nearly 60 percent of patients with basic lipid panel LDLc below 70 mg/dL and triglycerides over 200 compared to directly measured LDLc from the VAP Lipid Panel.
The VAP Lipid Panel can be ordered for high-risk patients and patients with elevated triglycerides at a cost comparable to the basic lipid panel. The comprehensive panel accurately identifies cardiovascular disease risk through directly measured LDLc and other parameters, improving cardiovascular risk stratification, leading to personalized treatment and improved patient outcomes.
About & the VAP®+ Lipid Panel
Atherotech Diagnostics Lab is a leading clinical reference laboratory specializing in cardiometabolic testing and disease management solutions. Atherotech’s proprietary and comprehensive VAP®+ Lipid Panel enables clinicians to accurately stratify a patient’s cardiovascular risk and deliver personalized treatment strategies to improve health outcomes. The Vertical Auto Profile (VAP+) technology reveals residual cardiometabolic risk as recommended in the NCEP ATP III, ADA/ACC Joint Consensus and AACE guidelines. The VAP+ utilizes direct measurement to identify cholesterol, triglyceride and genetic lipid disorders. The company’s dedication to affordable, comprehensive disease management solutions includes Our Healthy HeartTM, a patient consultation program and expert lipid management education service to health care providers. For more information call 1-866-VAP-TEST.
Non-HDL Cholesterol, Guideline Targets, and Population Percentiles for Secondary Prevention in a Clinical Sample of 1.3 Million Adults The Very Large Database of Lipids (VLDL-2 Study) ONLINE FIRST, Mohamed B. Elshazly, MD; Seth S. Martin, MD; Michael J. Blaha, MD, MPH; Parag H. Joshi, MD; Peter P. Toth, MD, PhD, FACC; John W. McEvoy, MB BCh; Mohammed A. Al-Hijji, MD; Krishnaji R. Kulkarni, PhD; Peter O. Kwiterovich, MD; Roger S. Blumenthal, MD, FACC; Steven R. Jones, MD, FACC, J Am Coll Cardiol. 2013. doi:10.1016/j.jacc.2013.07.045
Friedewald-Estimated Versus Directly Measured Low-Density Lipoprotein Cholesterol and Treatment Implications FREE CME, Seth S. Martin, MD; Michael J. Blaha, MD; Mohamed B. Elshazly, MD; Eliot A. Brinton, MD; Peter P. Toth, MD, PhD; John W. McEvoy, MB BCh; Parag H. Joshi, MD; Krishnaji R. Kulkarni, PhD; Patrick D. Mize, PhD; Peter O. Kwiterovich, MD; Andrew P. DeFilippis, MD; Roger S. Blumenthal, MD; Steven R. Jones, MD, J Am Coll Cardiol. 2013;62(8):732-739. doi:10.1016/j.jacc.2013.01.079
Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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