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The VAP Cholesterol Test: Beyond Traditional Cholesterol Testing

Can the VAP Cholesterol Test Detect Your Risk For Heart Disease?

By Betsy Lee-Frye

Updated October 03, 2008

(LifeWire) - The VAP cholesterol test is a type of cholesterol that is a little more detailed that a typical cholesterol test. In fact, it may be able to identify more people at risk for heart disease later in life.

The standard cholesterol test, known as the lipid profile -- with its needle prick and subsequent discussion of "good cholesterol" (HDL) and "bad cholesterol" (LDL) -- has been around for nearly 30 years. But its era may be coming to an end.

Certainly, cholesterol still matters. Unhealthy cholesterol levels are a key risk factor for heart disease, stroke and diabetes. But a new technology, the vertical auto profile test (VAP), promises to provide far more detailed information than the more traditional cholesterol test.

Researchers in Birmingham, Alabama, have been developing the new VAP test for more than a decade.  During this time, the Birmingham-based cardio-diagnostic company Atherotech Inc. was developed to introduce the VAP test commercially. On March 6, 2007, the FDA gave Atherotech the green light to begin marketing this test.

The traditional cholesterol test works by spinning blood in a high-speed centrifuge to separate the lipids (fats). This standard test, called a lipid profile, distinguishes three lipid categories:  high-density lipoproteins, or HDL; low-density lipoproteins, or LDL; and triglycerides, the main form of fat in the body.

But for nearly half of all individuals who have suffered a heart attack, the standard lipid profile reveals no abnormalities. According to Atherotech, the VAP test will be able to identify twice as many individuals at risk for heart disease, when compared to traditional techniques.

The traditional cholesterol test measures:

In the traditional cholesterol test, these levels are calculated using a specific formula. In contrast, the new VAP test is able to measure these levels directly.

Like the lipid profile, the VAP test works by spinning a blood sample to separate lipids by weight. But the VAP test provides more detail than the traditional test.

For example, the VAP test categorizes LDL cholesterol by relative size, and also breaks HDL cholesterol down into subclasses. Current research indicates that certain patterns of LDL particle sizes may indicate a greater risk for the development of heart disease.  Additionally, one subclass of HDL, HDL2, is considered to be particularly heart-protective.

The VAP test also measures some blood lipids that the current lipid profile ignores, such as very low density lipoprotein (VLDL); intermediate-density lipoprotein (IDL); and lipoprotein(a) [Lp(a)]. Atherotech researchers say measuring these additional lipid classes and subclasses can reveal more information concerning the risk of developing heart disease, which the traditional test might miss.

Specifically, the VAP test measures:

Total VLDL: Elevated VLDL levels correspond to an increased risk of heart disease and diabetes.

Sum Total Cholesterol: The sum of HDL, LDL and VLDL levels.

Total non-HDL: The sum of only LDL and VLDL levels; a higher value indicates a greater risk for developing heart disease. 

Total apoB100: Apolipoprotein B100 helps create, carry and deliver "bad cholesterol" to cells; measuring apoB100 levels aids in determining the type and/or cause of high cholesterol. 

Lp(a) cholesterol: Research suggests that Lp(a), which is similar to LDL, is an inherited risk factor for atherosclerosis.

IDL: A lipoprotein of intermediate density; according to Atherotech, this number is elevated among individuals with a family history of diabetes.

LDL-RC: LDL that is bound to C-reactive protein; this type of LDL is found at the site of atherosclerotic plaques in the body, which are one of the key features of artery disease and -- when they rupture -- the primary initiator of heart attacks.

Sum Total LDL-C: The sum of Lp(a), IDL and LDL.

LDL Size Pattern: Reported as one of three categories -- A, A/B or B. In pattern A, the LDL molecules are larger and less dense, making them easier for the body to remove. In pattern A/B, there is a combination of light and dense molecules. In pattern B, smaller, high-density molecules predominate. According to Atherotech, patients with small, dense LDL particles (pattern B) have a four-fold greater risk of developing heart disease than patients with LDL size pattern A.

HDL-2:  A subclass of "good cholesterol" that is particularly protective against heart disease. A low number here could mean an increased risk of coronary artery disease, even in those with otherwise normal cholesterol levels.

HDL-3: Another subclass of HDL, which does not protect against coronary artery disease to the same degree as HDL-2. 

VLDL-3: A triglyceride-rich very low-density lipoprotein; some studies suggest a potential correlation between higher VLDL-3 numbers and the development of diabetes.

In addition, the VAP test provides individuals with a better idea of their vulnerability to the metabolic syndrome, a combination of factors that significantly elevate the risk an individual will develop diabetes or cardiovascular disease.

Sources:

Bioletto, Silvana, Alain Golay, Robert Munger, Barbara Kalix and Richard W. James. "Acute Hyperinsulinemia and Very-Low-Density and Low-Density
Lipoprotein Subfractions in Obese Subjects." American Journal of Clinical Nutrition 71(2000): 443-449. <http://www.ajcn.org/cgi/reprint/71/2/443>

Mayo Clinic Staff. "Cholesterol Test: Sorting out the Lipids." MayoClinic.com. 1 Feb. 2007. The Mayo Clinic. 11 Mar 2008 <http://www.mayoclinic.com/health/cholesterol-test/CL00033>.

Crider, Kristin. "Unique Lipoprotein Phenotype and Genotype." CDC.gov. 2 Nov. 2007. Centers for Disease Control. 11 Mar 2008
<http://www.cdc.gov/genomics/hugenet/ejournal/lipoprotein.htm>.

"Fact Sheet: The VAP Cholesterol Test." The Most Comprehensive Cholesterol Test - VAP. 2008. Atherotech, Inc.. 20 Mar 2008 <http://www.atherotech.com/aboutus/presskit.asp?presskititem=vapcholesteroltestfacts>.

Kulkarni, KR, DW Garber, SM Marcovina and JP Segrest. "Quantification of Cholesterol in all Lipoprotein Classes by the VAP-II Method." Journal of Lipid Research. 35(1994) 159-168. 20 MAR 08 <http://www.jlr.org/cgi/content/abstract/35/1/159?ijkey=d20e388ec3061eb7fd0df98e17f01fe91121e17b&keytype2=tf_ipsecsha>.

"Metabolic Syndrome." Metabolic Syndrome. 2008. American Heart Association. 20 Mar 2008 <http://www.americanheart.org/presenter.jhtml?identifier=4756>.

Singh, SK, MV Suresh, B Voleti and A Agrawal. "The Connection Between C-reactive Protein and Atherosclerosis." Annals of Medicine. 40.2. 16 NOV 2007 110-120. 20 MAR 08 <http://www.ncbi.nlm.nih.gov/pubmed/18293141?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pu>.

Ziajka, Paul. "Using VAP Expanded Lipid Testing from Atherotech to Develop Optimal Patient Treatment Plans." 2008. Atherotech. 20 Mar 2008 <www.atherotech.com/HealthcareProfessionals/pdfs/ziajkamonograph_thirded.pdf>.
LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. Betsy Lee is an independent journalist living in Kansas City, Mo.

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