Pro vider: Ordering Provider 123 Main Street Anytown, ST 12345 Account No: DOB: 00/00/1950 Framingham Risk Score: Patient Info: FAMILY HIST CVD Lipid, Lipoprotein and Apolipoprotein Tests Total Cholesterol 211 Range <200 200-240 >240 mg/dl Direct LDL-C 134 Range <100 100-160 >160 mg/dl HDL-C 40 Range >50 40-50 <40 mg/dl Triglycerides 229 Range <150 150-200 >200 mg/dl Non-HDL-C 171 Range <130 130-190 >190 mg/dl ApoB 127 Range <80 80-120 >120 mg/dl LDL-P⁵ 1321 Range <1000 1000-1599 1600 nmol/l sdldl-c¹ 35 Range <20 20-40 >40 mg/dl % sdldl-c 26 Range <20 20-30 >30 % VLDL-C 37 Range <30 30-40 >40 mg/dl Lp(a) <15 Range <30 30-50 >50 mg/dl ApoA-I 134.1 Range >160 120-160 <120 mg/dl Inflammation Tests Fibrinogen 323 Range <370 370-470 >470 mg/dl hs-crp 0.6 Range <1.0 1.0-3.0 >3.0 mg/l LpPLA₂ 192 Range <200 200-235 >235 ng/ml MPO 192 Range <350 350-633 >633 pmol/l Diabetes Tests HbA1c 6.0 Range <5.7 5.7-6.4 >6.4 % HOMA-IR 4.9 Range <2 2-3 >3 Glucose² 99 Range <70 or >125 70-99 100-125 mg/dl GSP 244 Range <200 200-250 >250 µmol/l Adiponectin 12.0 Range >10 7-10 <7 µg/dl GSP=Glycated Serum Protein Low Optimal High Insulin³ 20 Range <5 5-15 >15 µu/ml Gender: M Fasting: Yes Boston Heart HDL Map TM Test 1 ApoA-I (mg/dl) levels in HDL particles α-1 9.3 Range >20 14-20 <14 mg/dl α-2 50.0 Range >55 45-55 <45 mg/dl α-3 27.8 Range <25 25-30 >30 mg/dl α-4 20.1 Range <15 15-18 >18 mg/dl Preß-1 14.5 Range <10 10-15 >15 mg/dl Requistion No: Received Date & Time: 00/00/2015 00:00 PM Collection Date & Time: 00/00/2015 00:00 AM HDL Particles Optimal Male HDL Map Patient's HDL Map This HDL map is ABNORMAL and is associated with increased CVD risk. ApoA-I levels are reduced in the very large α-1 particle and increased in the very small preß-1 particle. Consideration: Optimize LDL-C and triglycerides with statin therapy; keep HbA1c to < 7%; exercise regularly; restrict sugar; if indicated, lose weight and stop smoking, and consider niacin therapy. Boston Heart Cholesterol Balance TM Test 1 Normalized Value (µmol x 100/mmol of Total Cholesterol) Optimal Borderline High Production Markers Lathosterol 76 Desmosterol 76 Absorption Markers Beta-Sitosterol 225 Campesterol 357 Cholesterol Balance Score Over Absorber Over Producer Production/Absorption 0.3 } OPTIMAL } HIGH OPTIMAL cholesterol production and HIGH absorption may be associated with elevated LDL-C levels and increased heart disease risk. Desmosterol accounts for a minor portion (20%) of overall cholesterol production. Consideration: Lifestyle modification and ezetimibe therapy if LDL-C lowering is indicated. Boston Heart Prediabetes Assessment TM Low Borderline High Risk Glucose is OPTIMAL. Prediabetes Assessment was not calculated. Laboratory Director Page 1 of 5
Lipid Ratios TC/HDL-C 5.3 Range <4 4-6 >6 VLDL-C/TG 0.16 Range <0.2 0.2-0.3 >0.3 ApoB/ApoA-I 0.9 Range <0.6 0.6-0.9 >0.9 HDL-C/TG 0.17 Range >0.5 0.25-0.5 <0.25 Liver, Kidney, Muscle, Thyroid and Other Tests Creatine Kinase (CK) 141 Range <300 300-1500 >1500 U/L NT-proBNP <20 Range <125 125-450 >450 pg/ml Uric Acid 6.0 Range <7 7-10 >10 mg/dl Homocysteine 15.6 Range <10 10-15 >15 µmol/l Low Optimal High Albumin 4.3 Range <3.5 3.5-5.2 >5.2 g/dl Vitamin D, 25-OH 30 Range <30 30-100 >100 ng/ml Genetic Tests by Genotyping 1,4 Statin Induced Myopathy (SLCO1B1) Reported Date: 00/00/2015 T/T (T/T) genotype normal statin metabolizer Standard doses of statins, if indicated, are recommended Clopidogrel Response (CYP2C19) Reported Date: 00/00/2015 *1/*1 (*1/*1) genotype normal clopidogrel metabolizer ApoE Reported Date: 00/00/2015 E3/E3 (E3/E3) genotype most common genotype If LDL-C or non-hdl-c lowering is needed, in addition to lifestyle change, statin therapy is recommended Factor II Reported Date: 00/00/2015 (-/-) genotype normal risk of clot formation Factor V Leiden Reported Date: 00/00/2015 -/- -/- (-/-) genotype normal risk of clot formation Laboratory Director Page 2 of 5
Boston Heart Fatty Acid Balance TM Test 1 Optimal Borderline High Saturated FA Index 32.6 Saturated FA Index is HIGH. Restrict dietary intake of saturated fat. Choose Range <30.0 30.0-32.0 >32.0 % poultry without skin, fish, low fat dairy products, and lean cuts of meat, and replace butter with vegetable oils or trans fat free soft margarine. Trans FA Index 1.25 Trans FA Index is HIGH. Restrict dietary intake of fried foods, foods Range <0.80 0.80 1.10 >1.10 % containing hydrogenated fats, shortening or stick margarine. Replace with trans fat free soft margarine or vegetable oils. Optimal Borderline Low Monounsaturated FA Index 27.6 Monounsaturated FA Index is OPTIMAL. Range >22.0 19.0 22.0 <19.0 % Unsaturated/Saturated Ratio Index 1.95 Unsaturated/Saturated Ratio Index is LOW. Increase intake of vegetable fats Range >2.25 2.00 2.25 <2.00 (nuts, seeds, oils) and restrict intake of animal fats (fatty meat, cheese, ice cream, butter). Omega-3 FA Index 1.86 Omega-3 FA Index is BORDERLINE. Eicosapentaenoic Acid (EPA) level is Range >4.50 1.85 4.50 <1.85 % BORDERLINE. Docosahexaenoic Acid (DHA) level is BORDERLINE. Consider EPA 22.3 increasing intake of oily fish such as salmon, sardines, herring, tuna, or Range >50.0 10.0 50.0 <10.0 µg/ml mackerel, or take fish oil capsules daily. Increased EPA levels have been associated with lower risk of heart disease. DHA 59.1 Range >100.0 45.0 100.0 <45.0 µg/ml ALA 20.0 Alpha Linolenic Acid (ALA) level is BORDERLINE. Consider increasing intake Range >30.0 12.0 30.0 <12.0 µg/ml of walnuts, chia seeds, flaxseeds, and canola or flaxseed oil. Low Mid High Omega-6 FA Index 35.8 Values are reported according to the lowest, middle and highest thirds of Range <41.0 41.0 46.0 >46.0 % our reference population. Some authorities have recommended a goal Linoleic Acid (LA) 1044.2 below the 10th percentile for the Omega-6/Omega-3 Ratio Index (a value of Range >1040.0 9.0) and the AA/EPA Ratio Index (a value of 5.0). <825.0 825.0 1040.0 µg/ml Arachidonic Acid (AA) 276.7 Range <220.0 220.0 290.0 >290.0 µg/ml AA/EPA Ratio Index 12.4 Range <13.0 13.0 25.0 >25.0 Omega-6/Omega-3 Ratio Index 15.39 Range <15.0 15.0 24.0 >24.0 Clinician Notes Specimen: Acceptable Notes 1 This test was developed and its performance characteristics determined by Boston Heart Diagnostics. It has not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance is not necessary. This test is used for clinical purposes. It should not be regarded as investigational or for research. Methods: HDL Map: 2d gel electrophoresis; Cholesterol Balance and Fatty Acid Balance: GC/MS. 2 A fasting glucose level of >125 mg/dl indicates the presence of diabetes mellitus, and a fasting glucose level of <70 mg/dl indicates hypoglycemia. 3 An insulin test result <5 µu/ml is normal in a non-diabetic, but low if the patient has diabetes (consistent with Type 1 diabetes). 4 Genetic analysis is performed by real time Polymerase Chain Reaction (PCR) using TaqMan probes. Amplified gene nucleotide sites: APOE - Apolipoprotein E, T471C rs429358, C609T rs7412; F5 - Coagulation Factor V, G1746A rs6025; F2 - Coagulation Factor 2, G20210A rs1799963; CYP2C19 (Clopidogrel response) - Cytochrome P450 2C19, G681A rs4244275, G636A rs4986893, C-806T rs12248560; SLCO1B1 (Statin Myopathy) - Solute Carrier Organic Anion Transporter Family, Member 1B1, T625C rs4149056. MTHFR Methylenetetrahydrofolate reductase, C677T rs1801133, A1298C rs1801131. Limitations: Other rare mutations not detected by these assays may be present in some individuals. 5 LDL-P test performed by LipoScience Inc., CLIA ID# 34D0952253. High Risk further stratified: 1300-1599 Borderline High / 1600-2000 High / >2000 Very High (nmol/l). = Critical Value, = Alert Value, TNP=Test Not Performed Laboratory Director Page 3 of 5
Patient Progress Report 00/00/2015 Change Boston Heart HDL Map TM Test 1 α-1 9.3 α-2 50.0 α-3 27.8 α-4 20.1 Preß-1 14.5 Boston Heart Cholesterol Balance TM Test 1 Lathosterol 76 Desmosterol 76 Beta-Sitosterol 225 Campesterol 357 Boston Heart Prediabetes Assessment TM Prediabetes Assessment (%) TNP Lipid, Lipoprotein and Apolipoprotein Tests Total Cholesterol 211 Direct LDL-C 134 HDL-C 40 Triglycerides 229 Non-HDL-C 171 ApoB 127 LDL-P⁵ 1321 sdldl-c¹ 35 % sdldl-c 26 VLDL-C 37 Lp(a) <15 ApoA-I 134.1 Lipid Ratios Diabetes Tests TC/HDL-C 5.3 VLDL-C/TG 0.16 ApoB/ApoA-I 0.9 HDL-C/TG 0.17 HbA1c 6.0 HOMA-IR 4.9 Glucose² 99 GSP 244 Adiponectin 12.0 Insulin³ 20 00/00/2015 Change Inflammation Tests Fibrinogen 323 hs-crp 0.6 LpPLA₂ 192 MPO 192 Liver, Kidney, Muscle, Thyroid and Other Tests Creatine Kinase (CK) 141 NT-proBNP <20 Uric Acid 6.0 Homocysteine 15.6 Albumin 4.3 Vitamin D, 25-OH 30 Boston Heart Fatty Acid Balance TM Test 1 Saturated FA Index 32.6 Trans FA Index 1.25 Monounsaturated FA Index 27.6 Unsat/Sat Ratio Index 1.95 Omega-3 FA Index 1.86 EPA 22.3 DHA 59.1 ALA 20.0 Omega-6 FA Index 35.8 Linoleic Acid (LA) 1044.2 Arachidonic Acid (AA) 276.7 AA/EPA Ratio Index 12.4 Omega-6/Omega-3 Ratio 15.39 Index Laboratory Director Page 4 of 5
Report Interpretation Based on test results, Boston Heart Diagnostics recommends lifestyle modifications, medications and/or supplements to reduce cardiovascular disease (CVD) risk. These recommendations are provided below, along with the test result(s) that prompted them. In order to achieve optimal results, appropriate actions taken in response to these recommendations should be determined by the patient and their healthcare provider. Lifestyle Modifications (exercise daily, restrict animal fat, dairy fat and sugar; if indicated, lose weight and stop smoking): ApoB levels are HIGH. sd non- HbA1c is BORDERLINE. Insulin is HIGH. Prediabetes Assessment: risk of developing diabetes within 10 years: Glucose is OPTIMAL. Prediabetes Assessment was not calculated. Glycated serum protein is BORDERLINE. Control of Inflammation and Diabetes: HbA1c is BORDERLINE, which is in the prediabetic range. Insulin is HIGH. Statins (to get LDL-C to < 70 mg/dl in patients with CVD and/or diabetes, and to < 100 mg/dl in high risk patients): Ezetimibe (to get LDL-C to < 70 mg/dl in patients with CVD and/or diabetes and to < 100 mg/dl in high risk patients): ApoB levels are HIGH. sd non- Niacin (in CVD patients if not diabetic or prediabetic to optimize alpha-1 HDL if low or Lp(a) if high): Fibrates and/or Omega-3 Fatty Acids (to optimize triglyceride values if high and the HDL Map if alpha-1 HDL is low, especially in diabetics): Dietary Fats: Saturated FA Index is HIGH. Restrict dietary intake of saturated fat by Trans FA index is HIGH. Restrict dietary intake of fried foods, foods containing choosing poultry without skin, fish, low fat dairy products, lean cuts of meat, hydrogenated fats, shortening, stick margarine, and replace with vegetable and replace butter with vegetable oil or trans fat free soft margarine. oils or trans fat free soft margarine. Unsaturated/Saturated Ratio Index is LOW. Increase intake of vegetable fat Omega-3 FA Index is BORDERLINE. (nuts, seeds, oils) and restrict intake of animal fat (fatty meat, cheese, ice DHA level is BORDERLINE. cream). Increase intake of oily fish such as salmon, herring, tuna, or mackerel, or take EPA level is BORDERLINE. fish oil capsules daily. ALA level is BORDERLINE. Consider increasing intake of walnuts, chia seeds, flaxseeds, and vegetable oils rich in alpha linolenic acid (canola or flaxseed oil). 2014 Boston Heart Diagnostics Corporation. All rights reserved. The Boston Heart Diagnostics logo, Boston Heart HDL Map and Boston Heart Cholesterol Balance are trademarks of Boston Heart Diagnostics. TaqMan is a registered trademark of Roche Molecular Systems, Inc. Laboratory Director Page 5 of 5 07200215