The New Gold Standard for Lipoprotein Analysis. Advanced Testing for Cardiovascular Risk
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- Oswin Miller
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1 The New Gold Standard for Lipoprotein Analysis Advanced Testing for Cardiovascular Risk
2 Evolution of Lipoprotein Testing The Lipid Panel Total Cholesterol = VLDL + LDL + HDL
3 Evolution of Lipoprotein Testing The Lipid Panel Total Cholesterol = VLDL + LDL + HDL Friedewald Equation: VLDL = TG/5 Calculated LDL = TC (HDL + TG/5)
4 Evolution of Lipoprotein Testing The Lipid Panel Total Cholesterol = VLDL + LDL + HDL Friedewald Equation: VLDL = TG/5 Calculated LDL = TC (HDL + TG/5) Direct LDL is Better
5 Evolution of Lipoprotein Testing The Lipid Panel Total Cholesterol = VLDL + LDL + HDL Friedewald Equation: VLDL = TG/5 Calculated LDL = TC (HDL + TG/5) Direct LDL is Better Consensus Statement of the American Diabetes Assoc. & American College of Cardiology Apo B 100 (est. of non-hdl Particles) is Better Yet
6 Evolution of Lipoprotein Testing The Lipid Panel Total Cholesterol = VLDL + LDL + HDL Friedewald Equation: VLDL = TG/5 Calculated LDL = TC (HDL + TG/5) Direct LDL is Better Consensus Statement of the American Diabetes Assoc. & American College of Cardiology Apo B 100 (est. of non-hdl Particles) is Better Yet Lipoprotein Particles Predict Risk Better than Cholesterol
7 Evolution of Lipoprotein Testing The Lipid Panel Total Cholesterol = VLDL + LDL + HDL Friedewald Equation: VLDL = TG/5 Calculated LDL = TC (HDL + TG/5) Direct LDL is Better Consensus Statement of the American Diabetes Assoc. & American College of Cardiology Apo B 100 (est. of non-hdl Particles) is Better Yet Lipoprotein Particles Predict Risk Better than Cholesterol Lipoprotein Particle Numbers by Subgroup is Best
8 NCEP Guidelines for Cardiovascular Disease NCEP - ATP III 50% of at Risk Individuals are Not Identified
9 NCEP Guidelines for Cardiovascular Disease NCEP - ATP III 50% of at Risk Individuals are Not Identified 50% of Heart Attack Victims have Normal Cholesterol
10 NCEP Guidelines for Cardiovascular Disease NCEP - ATP III 50% of at Risk Individuals are Not Identified 50% of Heart Attack Victims have Normal Cholesterol NCEP Identified a Number of New Lipoprotein Risk Factors To Help Assess Those at Risk
11 NCEP New Lipoprotein Risk Factors RLP (Remnant Lipoprotein) - High in 20% of population - One of the Most Atherogenic Lipoproteins -Skips Oxidation Step in Forming Plaque
12 NCEP New Lipoprotein Risk Factors RLP (Remnant Lipoprotein) - High in 20% of population - One of the Most Atherogenic Lipoproteins -Skips Oxidation Step in Forming Plaque High in 25% of population - 3-fold Greater Risk of CVD than Buoyant LDL - Penetrates Arterial Endothelial Lining Easily - Less Recognized by LDL Receptors therefore Increases Small Dense LDL
13 NCEP New Lipoprotein Risk Factors RLP (Remnant Lipoprotein) - High in 20% of population - One of the Most Atherogenic Lipoproteins -Skips Oxidation Step in Forming Plaque High in 25% of population - 3-fold Greater Risk of CVD than Buoyant LDL - Penetrates Arterial Endothelial Lining Easily - Less Recognized by LDL Receptors therefore Increases Small Dense LDL Lp(a) - High in 20% of population - Small Particles that are Easily Oxidized - Competes with Plasminogen, Prevents Fibrinolysis
14 NCEP New Lipoprotein Risk Factors RLP (Remnant Lipoprotein) - High in 20% of population - One of the Most Atherogenic Lipoproteins -Skips Oxidation Step in Forming Plaque High in 25% of population - 3-fold Greater Risk of CVD than Buoyant LDL - Penetrates Arterial Endothelial Lining Easily - Less Recognized by LDL Receptors therefore Increases Small Dense LDL Lp(a) - High in 20% of population - Small Particles that are Easily Oxidized - Competes with Plasminogen, Prevents Fibrinolysis HDL 2b & 3 Low in 20% of population - HDL 3 Picks Up Excess Cholesterol and Becomes HDL 2b in Reverse Cholesterol Transport
15 Lp(a) Competes with Plasminogen and Prevents Fibrinolysis Fibrinogen Fibrin Blood Clot (MI, Stroke or DVT)
16 Lp(a) Competes with Plasminogen and Prevents Fibrinolysis Fibrinogen Plasminogen Fibrin Plasmin Blood Clot (MI, Stroke or DVT) Fibrinolysis
17 Lp(a) Competes with Plasminogen and Prevents Fibrinolysis Many of the over 40 genetic variations of Lp(a) mimic plasminogen Plasminogen Fibrinogen Lp(a) Fibrin Plasmin Blood Clot (MI, Stroke or DVT) Fibrinolysis
18 Lp(a) Competes with Plasminogen and Prevents Fibrinolysis Many of the over 40 genetic variations of Lp(a) mimic plasminogen Plasminogen Fibrinogen Lp(a) Fibrin Plasmin Blood Clot (MI, Stroke or DVT) Fibrinolysis Possible Antithrombotic Therapy Indicated
19 Lipoprotein Particles Apolipoprotein A-1 (HDL) or B-100 (LDL)
20 Lipoprotein Particles Apolipoprotein A-1 (HDL) or B-100 (LDL) Unesterified Cholesterol Phospholipid
21 Lipoprotein Particles Apolipoprotein A-1 (HDL) or B-100 (LDL) Cholesterol Ester Triglyceride Unesterified Cholesterol Phospholipid
22 Atherogenic Particles Size (nm) Density (g/cm 3) VLDL RLP TG-rich Lipoproteins
23 Atherogenic Particles Size (nm) Density (g/cm 3) VLDL RLP Buoyant LDL Dense LDL TG-rich Lipoproteins
24 Atherogenic Particles Size (nm) Density (g/cm 3) VLDL RLP Buoyant LDL Dense LDL TG-rich Lipoproteins Mean Endothelial Pore Size
25 CETP in Cholesterol Metabolism Apo B-100 VLDL Liver Brewer HB et al. Am J Cardiol 2003;92:10K-16K.
26 CETP in Cholesterol Metabolism Apo B-100 VLDL LPL IDL Liver Brewer HB et al. Am J Cardiol 2003;92:10K-16K.
27 CETP in Cholesterol Metabolism Apo B-100 VLDL LPL IDL HL LDL 1-2 Liver Brewer HB et al. Am J Cardiol 2003;92:10K-16K.
28 CETP in Cholesterol Metabolism Apo B-100 VLDL LPL IDL HL LDL 1-2 HL LDL 3-4 Liver Brewer HB et al. Am J Cardiol 2003;92:10K-16K.
29 CETP in Cholesterol Metabolism Apo B-100 VLDL LPL IDL HL LDL 1-2 HL LDL 3-4 Liver TG s CETP CE Brewer HB et al. Am J Cardiol 2003;92:10K-16K.
30 CETP in Cholesterol Metabolism Apo B-100 VLDL LPL IDL HL LDL 1-2 HL LDL 3-4 Liver TG s CETP CE Liver Apo A-1 Nascent HDL Brewer HB et al. Am J Cardiol 2003;92:10K-16K.
31 CETP in Cholesterol Metabolism Apo B-100 VLDL LPL IDL HL LDL 1-2 HL LDL 3-4 Liver TG s CETP CE Liver Apo A-1 HDL Enters Cells & Arterial Intima Nascent HDL Brewer HB et al. Am J Cardiol 2003;92:10K-16K.
32 CETP in Cholesterol Metabolism Apo B-100 VLDL LPL IDL HL LDL 1-2 HL LDL 3-4 Liver TG s CETP CE Liver Apo A-1 HDL3 LCAT HDL Enters Cells & Arterial Intima Nascent HDL Brewer HB et al. Am J Cardiol 2003;92:10K-16K.
33 CETP in Cholesterol Metabolism Apo B-100 VLDL LPL IDL HL LDL 1-2 HL LDL 3-4 Liver TG s CETP CE Liver Apo A-1 Reverse Cholesterol Transport HDL2b LCAT HDL3 LCAT HDL Enters Cells & Arterial Intima Nascent HDL Brewer HB et al. Am J Cardiol 2003;92:10K-16K.
34 Atherosclerotic Plaque Formation ARTERIAL LUMEN HDL REMOVES EXCESS LIPIDS LDL Lp(a) MONOCYTE CELL ARTERIAL INTIMA
35 Atherosclerotic Plaque Formation ARTERIAL LUMEN HDL REMOVES EXCESS LIPIDS LDL Lp(a) MONOCYTE CELL ARTERIAL INTIMA MACROPHAGE CELL
36 Atherosclerotic Plaque Formation ARTERIAL LUMEN HDL REMOVES EXCESS LIPIDS LDL Lp(a) MONOCYTE CELL DENSE LDL ARTERIAL INTIMA MACROPHAGE CELL
37 Atherosclerotic Plaque Formation ARTERIAL LUMEN HDL REMOVES EXCESS LIPIDS LDL Lp(a) MONOCYTE CELL DENSE LDL OXIDIZED LDL ARTERIAL INTIMA MACROPHAGE CELL
38 Atherosclerotic Plaque Formation ARTERIAL LUMEN HDL REMOVES EXCESS LIPIDS LDL Lp(a) MONOCYTE CELL FOAM CELL DENSE LDL OXIDIZED LDL ARTERIAL INTIMA MACROPHAGE CELL
39 Atherosclerotic Plaque Formation ARTERIAL LUMEN HDL REMOVES EXCESS LIPIDS FOAM CELLS BUILD PLAQUE LDL Lp(a) MONOCYTE CELL FOAM CELL DENSE LDL OXIDIZED LDL ARTERIAL INTIMA MACROPHAGE CELL
40 Atherosclerotic Plaque Formation ARTERIAL LUMEN HDL REMOVES EXCESS LIPIDS RLP FOAM CELLS BUILD PLAQUE LDL Lp(a) MONOCYTE CELL FOAM CELL DENSE LDL OXIDIZED LDL ARTERIAL INTIMA MACROPHAGE CELL
41 Atherosclerotic Plaque Formation ARTERIAL LUMEN HDL REMOVES EXCESS LIPIDS RLP FOAM CELLS BUILD PLAQUE LDL Lp(a) MONOCYTE CELL FOAM CELL DENSE LDL OXIDIZED LDL ARTERIAL INTIMA MACROPHAGE CELL
42 Atherosclerotic Plaque Formation INFLAMMATION RUPTURES PLAQUE ARTERIAL LUMEN HDL REMOVES EXCESS LIPIDS RLP FOAM CELLS BUILD PLAQUE LDL Lp(a) MONOCYTE CELL FOAM CELL DENSE LDL OXIDIZED LDL ARTERIAL INTIMA MACROPHAGE CELL
43 Why Have the LPP Test? Provides a More Complete Risk Answer than the Standard Cholesterol Test
44 Why Have the LPP Test? Provides a More Complete Risk Answer than the Standard Cholesterol Test LPP Has Three Risk Identifying Components
45 Why Have the LPP Test? Provides a More Complete Risk Answer than the Standard Cholesterol Test LPP Has Three Risk Identifying Components 1. NCEP s New Lipoprotein Risk Factors
46 Why Have the LPP Test? Provides a More Complete Risk Answer than the Standard Cholesterol Test LPP Has Three Risk Identifying Components 1. NCEP s New Lipoprotein Risk Factors 2. Lipoprotein Particle Numbers vs. Cholesterol Content
47 Why Have the LPP Test? Provides a More Complete Risk Answer than the Standard Cholesterol Test LPP Has Three Risk Identifying Components 1. NCEP s New Lipoprotein Risk Factors 2. Lipoprotein Particle Numbers vs. Cholesterol Content 3. Non-Lipid Risk Factors: Lp-PLA 2, CRP, Insulin and Homocysteine
48 Why Have the LPP Test? Provides a More Complete Risk Answer than the Standard Cholesterol Test LPP Has Three Risk Identifying Components 1. NCEP s New Lipoprotein Risk Factors 2. Lipoprotein Particle Numbers vs. Cholesterol Content 3. Non-Lipid Risk Factors: Lp-PLA 2, CRP, Insulin and Homocysteine These Components Identify Many at Risk Individuals that are Missed
49 Lipoprotein Particle Profile (LPP ) ) Process Separates by Density using Analytical Ultracentrifugation the CDC s s Gold Standard
50 Lipoprotein Particle Profile (LPP ) ) Process Separates by Density using Analytical Ultracentrifugation the CDC s s Gold Standard The New Gold Standard - Enhancements
51 Lipoprotein Particle Profile (LPP ) ) Process Separates by Density using Analytical Ultracentrifugation the CDC s s Gold Standard The New Gold Standard - Enhancements Continuous Gradient Clinically Relevant Lipoprotein Particles are Detected Not the Surrogate Marker Cholesterol
52 Lipoprotein Particle Measurement Fluorescent Dye a Phospholipid Analog Fluorescent - Hydrophilic End Hydrophobic End
53 Lipoprotein Particle Measurement Fluorescent Dye a Phospholipid Analog Fluorescent - Hydrophilic End Hydrophobic End When Hydrophobic End Imbeds into the Phospholipid Shell of the Lipoprotein the Hydrophilic End Fluoresces
54 Lipoprotein Particle Measurement Fluorescent Dye a Phospholipid Analog Fluorescent - Hydrophilic End Hydrophobic End When Hydrophobic End Imbeds into the Phospholipid Shell of the Lipoprotein the Hydrophilic End Fluoresces The Fluorescence is a Direct Measurement of Particle Number
55 Separation by Density Centrifuge Tube with Mixture of Serum, Gradient and Dye
56 Separation by Density Centrifuge Tube with Mixture of Serum, Gradient and Dye Density (g/ml) Separated Lipoproteins Intense Gravitational Force 600,000 G s VLDL LDL HDL Proteins
57 LPP Test - Lipoprotein Groups and Subgroups Accurate Densities
58 LPP Test - Lipoprotein Groups and Subgroups Particle Measurement
59 LPP Test - Lipoprotein Groups and Subgroups VLDL
60 LPP Test - Lipoprotein Groups and Subgroups LDL
61 LPP Test - Lipoprotein Groups and Subgroups LDL
62 LPP Test - Lipoprotein Groups and Subgroups LDL
63 LPP Test - Lipoprotein Groups and Subgroups LDL
64 LPP Test - Lipoprotein Groups and Subgroups Buoyant -Large
65 LPP Test - Lipoprotein Groups and Subgroups Dense -Small
66 LPP Test - Lipoprotein Groups and Subgroups HDL
67 LPP Test - Lipoprotein Groups and Subgroups HDL HDL3 HDL2b
68 LPP showing NCEP s s New Lipoprotein Risk Factors Healthy Profile Buoyant LDL High HDL 2b Low RLP Atherogenic Profile
69 LPP showing NCEP s s New Lipoprotein Risk Factors Healthy Profile Atherogenic Profile Buoyant LDL High HDL 2b Low RLP Atherogenic Profile High RLP Dense LDL Low HDL 2b
70 Lipoprotein Particle Numbers All of These Patients have the Same LDL Cholesterol A B C D 125 mg/dl 125 mg/dl 125 mg/dl 125 mg/dl
71 Lipoprotein Particle Numbers All of These Patients have the Same LDL Cholesterol A B C D 125 mg/dl 125 mg/dl 125 mg/dl 125 mg/dl LDL Particles with Varying Cholesterol Content Large - Buoyant
72 Lipoprotein Particle Numbers All of These Patients have the Same LDL Cholesterol A 125 mg/dl B 125 mg/dl C 125 mg/dl D 125 mg/dl LDL Particles with Varying Cholesterol Content TG s & CETP Large - Buoyant Large - Buoyant Depleted
73 Lipoprotein Particle Numbers All of These Patients have the Same LDL Cholesterol A B C D 125 mg/dl 125 mg/dl 125 mg/dl 125 mg/dl LDL Particles with Varying Cholesterol Content TG s & CETP -TG s & CETP Large - Buoyant Large - Buoyant Depleted Small - Dense Enriched
74 Lipoprotein Particle Numbers All of These Patients have the Same LDL Cholesterol A B C D 125 mg/dl 125 mg/dl 125 mg/dl 125 mg/dl LDL Particles with Varying Cholesterol Content TG s & CETP -TG s & CETP TG s & CETP Large - Buoyant Large - Buoyant Depleted Small - Dense Enriched Small - Dense Depleted
75 Lipoprotein Particle Numbers All of These Patients have the Same LDL Cholesterol A B C D 125 mg/dl 125 mg/dl 125 mg/dl 125 mg/dl LDL Particles with Varying Cholesterol Content TG s & CETP -TG s & CETP TG s & CETP Large - Buoyant Large - Buoyant Depleted Small - Dense Enriched Small - Dense Depleted Low Particle Numbers or Apo B-100 Increased Increased High
76 Lipoprotein Particle Numbers All of These Patients have the Same LDL Cholesterol A B C D 125 mg/dl 125 mg/dl 125 mg/dl 125 mg/dl LDL Particles with Varying Cholesterol Content TG s & CETP -TG s & CETP TG s & CETP Large - Buoyant Large - Buoyant Depleted Small - Dense Enriched Small - Dense Depleted Low Risk Particle Numbers or Apo B-100 Increased Increased High
77 Cholesterol Depleted Profile High VLDL and TG s
78 Cholesterol Depleted Profile High VLDL and TG s TG s TG s CETP exchanges cholesterol for triglycerides
79 Cholesterol Depleted Profile High VLDL and TG s Chemistry 191 LDL 112 HDL 39 No LDL Treatment LPP - CEQ TC 226 LDL 135 HDL 43 Treat LDL TG s TG s CETP exchanges cholesterol for triglycerides
80 Relevance of Lipoprotein Particle Numbers A Disconnect Exist between Lipoprotein Particle Number and Cholesterol Number 30% of the Population is Cholesterol Depleted 20% of the Population is Cholesterol Enriched
81 Relevance of Lipoprotein Particle Numbers A Disconnect Exist between Lipoprotein Particle Number and Cholesterol Number 30% of the Population is Cholesterol Depleted 20% of the Population is Cholesterol Enriched The LPP Test is Like Having Apo B-100 Broken Down into Subgroups for a Better Therapeutic Approach
82 Test Report Page 1 Reference Value
83 Test Report Page 1 Reference Value Green is Normal Yellow is Borderline Red is High
84 Test Report Page 1 Reference Value Green is Normal Yellow is Borderline Red is High The Magnitude of the Result is Easy to Judge with Respect to the Reference Value Color Highlighted Numerical Results
85 Test Report Page 2 Primary Risk Assessment Direct Lipid Panel in Cholesterol Equivalents
86 Test Report Page 2 Primary Risk Assessment Graph Quick Assessment Direct Lipid Panel in Cholesterol Equivalents
87 Test Report Page 2 Primary Risk Assessment Graph Quick Assessment Direct Lipid Panel in Cholesterol Equivalents Risk Modification LPP+ includes Lp-PLA 2, C-Reactive Protein, Insulin and Homocysteine
88 Test Report Page 2 Primary Risk Assessment Graph Quick Assessment Direct Lipid Panel in Cholesterol Equivalents Risk Modification LPP+ includes Lp-PLA 2, C-Reactive Protein, Insulin and Homocysteine Therapeutic Approach Direct Measurement of Lipoprotein Particle Numbers, Lp(a) and LDL Size
89 Interrelation Between Atherosclerosis and Metabolic Syndrome - Insulin Resistance Six Possible Traits Hypertension Obesity High Glucose
90 Interrelation Between Atherosclerosis and Metabolic Syndrome - Insulin Resistance Six Possible Traits Hypertension Obesity High Glucose High Triglycerides Small, Dense LDL Low HDL
91 Interrelation Between Atherosclerosis and Metabolic Syndrome - Insulin Resistance Six Possible Traits Hypertension Metabolic Syndrome Insulin Resistance Obesity High Glucose High Triglycerides Small, Dense LDL Low HDL Atherosclerosis Risk Increases
92 The Role of CETP and TG s in Metabolic Syndrome Liver Apo B-100 High TG s VLDL Bays H. Expert Rev Cardiovasc Ther 2004;2:
93 The Role of CETP and TG s in Metabolic Syndrome Liver Apo B-100 High TG s VLDL TG s CETP CE LDL 1-2 Depleted Bays H. Expert Rev Cardiovasc Ther 2004;2:
94 The Role of CETP and TG s in Metabolic Syndrome TG s Liver Apo B-100 High TG s VLDL TG s CETP CE LDL 1-2 Depleted HL Small Dense LDL 3-4 Bays H. Expert Rev Cardiovasc Ther 2004;2:
95 The Role of CETP and TG s in Metabolic Syndrome TG s RLP LPL TG s Liver Apo B-100 High TG s VLDL TG s CETP CE LDL 1-2 Depleted HL Small Dense LDL 3-4 Bays H. Expert Rev Cardiovasc Ther 2004;2:
96 The Role of CETP and TG s in Metabolic Syndrome TG s RLP LPL TG s Liver Apo B-100 High TG s VLDL TG s CETP CE LDL 1-2 Depleted HL Small Dense LDL 3-4 CE CETP TG s HDL Depleted Bays H. Expert Rev Cardiovasc Ther 2004;2:
97 The Role of CETP and TG s in Metabolic Syndrome TG s RLP LPL TG s Liver Apo B-100 High TG s VLDL TG s CETP CE LDL 1-2 Depleted HL Small Dense LDL 3-4 CE CETP HDL Depleted TG s TG s HL Small Dense HDL3 Bays H. Expert Rev Cardiovasc Ther 2004;2:
98 The Role of CETP and TG s in Metabolic Syndrome TG s RLP LPL TG s Liver Apo B-100 High TG s VLDL TG s CETP CE LDL 1-2 Depleted HL Small Dense LDL 3-4 CE CETP HDL Depleted TG s TG s HL Small Dense HDL3 Low HDL from Renal Clearance of Apo A1 Bays H. Expert Rev Cardiovasc Ther 2004;2:
99 The Role of CETP and TG s in Metabolic Syndrome TG s RLP LPL TG s Liver Apo B-100 High TG s VLDL TG s CETP CE LDL 1-2 Depleted HL Small Dense LDL 3-4 CE CETP HDL Depleted TG s TG s HL Small Dense HDL3 Low HDL from Renal Clearance of Apo A1 Bays H. Expert Rev Cardiovasc Ther 2004;2:
100 Atherogenic Profile with High TG s, Low HDL and Dense LDL. Patient has Metabolic Syndrome High Triglycerides (VLDL) Dense LDL Low HDL
101 Atherogenic Profile with High TG s, Low HDL and Dense LDL. Patient has Metabolic Syndrome High Triglycerides (VLDL) Dense LDL Three Lipid Traits is a Probable Diagnosis of Metabolic Syndrome Low HDL
102 Atherogenic Profile with High TG s, Low HDL and Dense LDL. Patient has Metabolic Syndrome High Triglycerides (VLDL) Dense LDL Low HDL Three Lipid Traits is a Probable Diagnosis of Metabolic Syndrome Most Likely the Patient has One or More non-lipid Traits: 1. Hypertension 2. Obesity 3. High glucose
103 Atherogenic Profile with High TG s, Low HDL and Dense LDL. Patient has Metabolic Syndrome High Triglycerides (VLDL) Dense LDL Low HDL Three Lipid Traits is a Probable Diagnosis of Metabolic Syndrome Most Likely the Patient has One or More non-lipid Traits: 1. Hypertension 2. Obesity 3. High glucose Risk Level Increases Check for Insulin Resistance
104 The role of Lp-PLA 2 in plaque formation LUMEN INTIMA
105 The role of Lp-PLA 2 in plaque formation LUMEN Plaque Formation INTIMA Oxidized LDL Macrophage Foam Cell
106 The role of Lp-PLA 2 in plaque formation LUMEN INTIMA Oxidized LDL Lp-PLA 2
107 The role of Lp-PLA 2 in plaque formation LUMEN Lyso-PC OxFA INTIMA Lp-PLA 2 Oxidized LDL
108 The role of Lp-PLA 2 in plaque formation LUMEN Monocytes Lyso-PC OxFA Adhesion molecules Cytokines INTIMA Lp-PLA 2 Oxidized LDL
109 The role of Lp-PLA 2 in plaque formation LUMEN Monocytes Lyso-PC OxFA Adhesion molecules Cytokines INTIMA Oxidized LDL Lp-PLA 2 Macrophage
110 The role of Lp-PLA 2 in plaque formation LUMEN Monocytes Lyso-PC OxFA Adhesion molecules Cytokines INTIMA Oxidized LDL Lp-PLA 2 Macrophage
111 LPP Treatment Strategy
112 LPP Treatment Strategy 1 Primary Risk Assessment from Direct Lipid Panel with Cholesterol Equivalents
113 LPP Treatment Strategy 1 Primary Risk Assessment from Direct Lipid Panel with Cholesterol Equivalents 2 Modify Risk Level Using Metabolic Syndrome Traits Lp-PLA 2, CRP and Insulin
114 LPP Treatment Strategy 1 Primary Risk Assessment from Direct Lipid Panel with Cholesterol Equivalents 2 Modify Risk Level Using Metabolic Syndrome Traits Lp-PLA 2, CRP and Insulin 3 Direct Therapeutic Approach Based on LDL and HDL Subgroup Distributions and Lp(a)
115 Important Benefits of the LPP Test Identification of the NCEP New Risk Factors
116 Important Benefits of the LPP Test Identification of the NCEP New Risk Factors Measurement of Lipoprotein Particles Numbers with Lipid Panel in Cholesterol Equivalents
117 Important Benefits of the LPP Test Identification of the NCEP New Risk Factors Measurement of Lipoprotein Particles Numbers with Lipid Panel in Cholesterol Equivalents Identification of Lipid Metabolic Syndrome Traits
118 Important Benefits of the LPP Test Identification of the NCEP New Risk Factors Measurement of Lipoprotein Particles Numbers with Lipid Panel in Cholesterol Equivalents Identification of Lipid Metabolic Syndrome Traits LPP+ Adds Inflammation Risk Factors Lp-PLA 2 and CRP plus Insulin and Homocysteine
119 Male Patient on 4 gm EPA & DHA Omega-3 s, adding 10 mg Rosuvastatin for two months and then 600 mg N-acetyl N Cysteine for two weeks 10 mg Rosuvastatin LDL decreased from 152 to 78 (48%) 10 mg Statin
120 Male Patient on 4 gm EPA & DHA Omega-3 s, adding 10 mg Rosuvastatin for two months and then 600 mg N-acetyl N Cysteine for two weeks 10 mg Rosuvastatin LDL decreased from 152 to 78 (48%) 600 mg NAC 10 mg Statin 600 mg NAC VLDL decreased from 140 to 82 TG s decreased from 182 to 97 (46%) Homocysteine decreased from 10.2 to 6.9
121 Examples of the Atherogenic Apo C-1 C 1 Enriched HDL and Low Birth Weight Babies (~6 lb vs ~7 lb)* Apo C-1 HDL at d = 1.06 High and Very Buoyant HDL Low TG s, VLDL and RLP
122 Examples of the Atherogenic Apo C-1 C 1 Enriched HDL and Low Birth Weight Babies (~6 lb vs ~7 lb)* Apo C-1 HDL at d = 1.06 High and Very Buoyant HDL Apo C-1 HDL Characteristics Observed in 1-2% of Specimens Low TG s, VLDL and RLP
123 Examples of the Atherogenic Apo C-1 C 1 Enriched HDL and Low Birth Weight Babies (~6 lb vs ~7 lb)* Apo C-1 HDL at d = 1.06 Low TG s, VLDL and RLP High and Very Buoyant HDL Apo C-1 HDL Characteristics Observed in 1-2% of Specimens Proinflammatory HDL Associated with Endothelial Dysfunction
124 Examples of the Atherogenic Apo C-1 C 1 Enriched HDL and Low Birth Weight Babies (~6 lb vs ~7 lb)* Apo C-1 HDL at d = 1.06 Low TG s, VLDL and RLP High and Very Buoyant HDL Apo C-1 HDL Characteristics Observed in 1-2% of Specimens Proinflammatory HDL Associated with Endothelial Dysfunction 62 year old female MD with a healthy profile like shown found that her calcium score was in the 90 th percentile
125 Lipoprotein Particle Numbers Therapeutic Guidelines Lipoprotein Therapeutic Statins Niacin Fibrates Estrogens Resins Absorption Omega-3 s Alcohol Life Style Inhibitors EPA & DHA (moderate) Changes (diet & exercise) VLDL (Triglycerides) X X RLP (IDL) X X ** LDL I & II - buoyant ** LDL III - dense ** LDL IV or Lp(a) HDL 2b - buoyant HDL 2a & 3 Therapeutic Beneficial Little or No Effect X Negative Result *These guidelines provide some of the treatment options available to modify lipoprotein particle numbers determined by the LPP TM test. **Spectracell Laboratories observed response to treatment. The National Cholesterol Education Program (NCEP) guidelines provide dosage information on the treatment options.
126 Lipoprotein Particle Numbers Therapeutic Guidelines Lipoprotein Therapeutic Statins Niacin Fibrates Estrogens Resins Absorption Omega-3 s Alcohol Life Style Inhibitors EPA & DHA (moderate) Changes (diet & exercise) VLDL (Triglycerides) X X RLP (IDL) X X ** LDL I & II - buoyant ** LDL III - dense ** LDL IV or Lp(a) HDL 2b - buoyant HDL 2a & 3 Therapeutic Beneficial Little or No Effect X Negative Result *These guidelines provide some of the treatment options available to modify lipoprotein particle numbers determined by the LPP TM test. **Spectracell Laboratories observed response to treatment. The National Cholesterol Education Program (NCEP) guidelines provide dosage information on the treatment options.
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