Déjà Vu All Over Again
Current guidelines recommend the use of standard lipid measures, including the total/high-density lipoprotein cholesterol ratio, inexpensive and readily available, for routine cardiovascular disease risk assessment.1 Other studies and consensus panels, however, have suggested that the number of circulating atherogenic particles (and apo-B as a surrogate) provide better risk prediction than standard lipid measures.2 Tests such as the Vertical Auto Profile (VAP) (Atherotech, Birmingham, Alabama) which determines the cholesterol content of VLDL, LDL, and HDL subclasses, and patterns of LDL size; and nuclear magnetic resonance (NMR) spectroscopy, which determines the sizes and concentrations of lipoprotein particles, have been described as improving the predictive power of lipid measurements.3,4 At times there has been intense debate in the literature over the relative merits of these tests vs. the standard lipid profile.5 The clinical popularity of lipid subfractionation and particle number and size measurements varies widely, but it is not uncommon to have patients specifically ask for these tests, and multiple websites suggest that if your physician is not knowledgeable about such studies he or she is simply not to be thought of as keeping up with the times. (SELECT FULL TEXT TO CONTINUE)
- Received April 16, 2012.
- Accepted April 17, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited