Researchers using the Atherotech VAP® Lipid Panel demonstrated the comprehensive lipid profile's accuracy in risk stratification through subclass measurement in two abstracts presented today at the American Heart Association (AHA) Scientific Sessions 2012. The VAP Lipid Panel measured cholesterol subclasses in Framingham and TRIUMPH populations, highlighting the lipid panel's accuracy and potential for improved outcomes in personalized heart disease risk assessment compared to the standard lipid panel, which is inadequate and inaccurate in select patients.
“These findings from TRIUMPH indicate that the more granular assessment of HDL subclasses adds important information beyond that provided by total HDL cholesterol levels alone”
The poster abstract #18939 Impact of LDL Pattern on Risk for CHD in the Framingham Offspring Population presented by study lead author Peter P. Toth, M.D., demonstrated that LDL pattern B (small, dense LDL particles) as measured by the VAP Lipid Panel is an independent risk factor for coronary heart disease (CHD), including acute myocardial infarction (AMI) — or heart attack — and sudden cardiac death.
"We know that traditional risk factors do not fully explain the risk for CHD events," said Toth, Director of Preventative Cardiology at CGH Medical Center in Sterling, Illinois, and a member of Atherotech's Medical Advisory Board.
"The results presented today are important because they suggest that LDL subclass measurement, when added to simple LDL concentration, conveys independent CHD risk assessment information leading to more accurate risk stratification and improved outcomes," said Toth, who has authored or coauthored more than 200 publications and is also president of the National Lipid Association.
LDL can be separated into two phenotypes called pattern A and pattern B. The LDL pattern A subclasses LDL1,2 are composed of larger, more buoyant LDL particles. LDL pattern B subclasses LDL3,4 are composed of smaller, more dense LDL particles, which penetrate the vascular wall more easily.
A second abstract, #16722, HDL Cholesterol Subclasses and Mortality after Acute Myocardial Infarction: The TRIUMPH Prospective Multi-Center Registry, was the subject of an oral presentation by Seth S. Martin, M.D., Fellow, Division of Cardiology, Johns Hopkins Hospital. Using direct measurement of HDL cholesterol subfractions (HLD2 and HDL3) provided by the VAP Lipid Panel, the study showed a 50% relative increase in mortality risk among study participants at two years after hospitalization in the lowest tertile of HDL3 cholesterol versus the middle tertile after adjusting for relevant confounders in the fully adjusted model.
"These findings from TRIUMPH indicate that the more granular assessment of HDL subclasses adds important information beyond that provided by total HDL cholesterol levels alone," said Martin. "After myocardial infarction, risk information captured in HDL2 and HDL3 cholesterol does not appear to be the same. Our findings speak to the complexity of HDL and help inform this rapidly evolving and intriguing HDL story."
Study authors examined data from 2,465 patients from the TRIUMPH registry to determine the relative prognostic importance of HDL subclasses (larger, more buoyant HDL2 and smaller, more dense HDL3) after AMI. The Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status (TRIUMPH) study is a prospective, 24-center U.S. study of AMI outcomes.
VAP Lipid Panel Research highlights importance of LDL and HDL subclass identification in heart disease risk assessment and mortality.
"Both presentations add to our knowledge of residual risk and the impact that cholesterol subfractions can have on cardiovascular risk assessment and prognosis," said Chief Medical Officer Michael E. Cobble, M.D. "These results will lead to more research that further clarifies the role of lipid subfraction measurement, beyond the capabilities of the basic lipid panel, leading to improved risk identification and management."
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