Study shows LDL cholesterol estimated by basic lipid panel misses nearly 60 percent of at-risk patients with triglycerides over 200 when compared with VAP Lipid Panel
The basic lipid panel, relied upon for more than 85 percent of adult cholesterol testing each year, could be leaving millions at risk due to errors in estimation of LDL cholesterol levels. That’s according to a major study published in the Journal of the American College of Cardiology, which compared the accuracy of calculated LDL cholesterol measurement in the traditional basic lipid panel (standard cholesterol test) to directly measured LDL cholesterol in the VAP® Lipid Panel from Atherotech Diagnostics Lab.
The research, which involves more than 1.3 million U.S. adults, represents the largest study of its kind to date and could significantly impact patient care and clinical practice guidelines in the years ahead.
Senior Investigator Steven R. Jones, M.D., of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, said LDL cholesterol is routinely estimated by the 1970s-era Friedewald equation in order to guide treatment and lower heart disease risk. However, rigorous comparison with direct LDL cholesterol measurement has received little attention, especially at levels below 70 mg/dl, which is often the target in high-risk patients, including those with conditions such as diabetes or coronary heart disease.
“It’s the first time we’ve compared LDL cholesterol measurements using the Friedewald calculation to the density gradient ultracentrifugation method, which directly measures LDL cholesterol, the primary target of therapy in cholesterol testing for heart disease risk assessment,” Jones said. “What’s important in this study is that Friedewald and direct LDL cholesterol are most different, with Friedewald LDL generally lower than direct LDL, when accuracy is most crucial — in patients with LDL cholesterol levels in the high-risk treatment target range and elevated triglycerides.”
From 2009 to 2011, researchers examined consecutive lipid profiles in 1,310,440 patients from the Very Large Database of Lipids (VLDL) dataset who underwent vertical density gradient ultracentrifugation of cholesterol by the Vertical Auto Profile (VAP Lipid Panel). Results showed the basic lipid panel underestimated risk in 23 percent to 59 percent of patients with Friedewald estimated LDL cholesterol levels below 70 md/dl and triglycerides above 150, which could result in under treatment of high-risk patients.
The study titled “Friedewald Estimated versus Directly Measured Low-Density Lipoprotein Cholesterol and Treatment Implications” is the product of academic-industry collaboration between investigators at Johns Hopkins University and Atherotech Diagnostics Lab.
The comprehensive 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 LDL and other parameters, improving cardiovascular risk stratification, leading to personalized treatment and improved heart-health outcomes.
Atherotech provides a full complement of more than 60 routine and specialty diagnostic tests, including its patented VAP Lipid Panel to help physicians establish the most effective course of treatment from a single source.
Source: Atherotech Diagnostics Lab