Cardiovascular Disease
Atherosclerosis is the condition in which the artery wall thickens as the result of the buildup of fatty material such as cholesterol. Management of atherosclerosis is an integral part of clinical practice.
Historically, clinicians manage a patient's risk for cardiovascular disease by measuring plasma lipids such as LDL-C, HDL-C and triglycerides. More recently, it's been shown that measurement of lipoprotein particles, the containers that carry cholesterol, may be beneficial for patient management.
Among cardiometabolic risk (CMR) patients, about two-thirds have high Low Density Lipoprotein particle number (LDL-P) despite optimal levels of LDL-C. For cardiometabolic risk patients, LDL-P should be considered as a primary goal of therapy due to its stronger association with cardiovascular risk.1
Manage your patients with clarity and confidence with LDL-P by NMR.
1. Rosenson, RS, et al. Atherosclerosis 2010, in press
Pathway to CVD
It is lipoproteins that interact with the arterial wall and set in motion the cascade of events that leads to atherosclerosis. Measurements of cholesterol are indirect estimates of the number of lipoproteins that transport the bulk of cholesterol in plasma and are the most atherogenic.1
Ideal candidates for measuring LDL particle levels are cardiometabolic risk patients whose LDL-C levels are optimal, near optimal or borderline high. These include patients with known cardiovascular disease, metabolic syndrome or Type 2 Diabetes, low HDL-C, overweight/obese or have a family history of heart disease.
LDL particles move into the arterial intima in a gradient-driven process. The rate of passive diffusion is increased when the concentration of circulating LDL particles is increased. Once inside the intima, LDL particles bind to proteoglycans and initiate a process whereby the LDL particles are modified and taken up by macrophages to form foam cells resulting in progression of the atherosclerotic lesion. Cholesterol molecules are just “passengers” but the particles drive atherosclerosis.1,2
Because of variability in the amount of cholesterol carried in LDL particles, frequent disagreement occurs between LDL-C and LDL particle number (LDL-P).2 Among high cardiometabolic risk patients with LDL-C <100 mg/dL, about two-thirds of patients have high LDL particle concentration (LDL-P).3
Given the prevalence and magnitude of discordance between LDL-C and LDL-P, when discordance is present, recent recommendations by the ADA and ACC recommend using LDL-P by NMR as a target of therapy to aid in the management of CVD. 1,4
With a simple blood test, LipoScience offers a CVD management tool with actionable results.
1. Brunzell et al. JACC. 2008;15:1512-1524. 2. Contois et al. Clin Chem. 2009;55(3):407-419. 3. Rosenson et al. Atherosclerosis (2010), doi:10.1016/j.atherosclerosis.2010.03.038. 4. Cromwell et al. Curr Cardiol Rep 2009;11:468-475.
Case Studies
Our case studies represent patients with conditions contributing to cardiometabolic risk and have been provided by clinicians who use the NMR LipoProfile® test routinely in their practices. Results from our laboratory show approximately 30% of our population exhibit a discordance between LDL-C and LDL-P. These case studies are for informational purposes only and not for diagnostic use. Click on a link below for a PDF of the full case study.
Meet Dan, Age 60: Hypertension and Dyslipoproteinemia
Risk Factors: On Therapy, T2DM and Dyslipidemia. Currently on Lipitor® 20, ACTOplus met® 15/850mg, Altace® 5mg, Toprol XL® 50mg
Meet Kathy, Age 56: Type II Diabetes and Hypertension
Risk Factors: Type II diabetes and hypertension. Currently on Simvastatin 80mg, Metformin, Zestoretic
Meet Henry, Age 46: Family History
Risk Factors: Family History. Father died of MI at age 49, Premature ASHD
Clinician Resource Program - Share and gather case study information on real patients. LipoScience offers a free case study resource program for clinicians. Whether you want to share an interesting case study, or ask an expert about management options for your patients, the Clinician Resource Program provides this opportunity by offering a free, one-on-one peer teleconference. To speak with an expert about the NMR LipoProfile test, please contact inquiries@liposcience.com.
How to Order the Test
There are several ways to order the NMR LipoProfile test:
- The NMR LipoProfile test is available through LabCorp (test code 884247) and other laboratory service providers.
- Contact your local laboratory services provider.
- If your laboratory service provider does not offer the NMR LipoProfile test, you may order it directly from LipoScience. Please contact our Client Services department toll-free at (877) 547-6837 to get started.
- Bill to LDL-P/NMR specific CPT Code 83704.
Clinician Resource Program - Share and gather case study information on real patients. LipoScience offers a free case study resource program for clinicians. Whether you want to share an interesting case study, or ask an expert about management options for your patients, the Clinician Resource Program provides this opportunity by offering a free, one-on-one peer teleconference. To speak with an expert about the NMR LipoProfile test, please contact inquiries@liposcience.com.
Understanding the Results
With a simple blood test, LipoScience offers a CVD management tool with actionable results.
The following strategy was adopted by a group of experts in the field of lipidology to facilitate integration of LDL-P into clinical practice and address therapeutic options available to meet recommended targets of therapy. 1
Step 1: Assess Clinical Risk
Assess your patient's risk and assign them to an appropriate risk category based on your clinical judgment.
Step 2: Define Goals of therapy for the degree of risk present
Information obtained from the NMR LipoProfile tests should be utilized to aid in clinical decision making to manage cardiometabolic risk. Based on your risk assessment, you may determine appropriate goals for your patient.
Step 3: Consider therapeutic lifestyle changes and medications if necessary
Once at LDL-C goal, integration of LDL-P in the patient management plan may be considered.
Improved diet and exercise is an important part of a patient's overall heart health and may lower LDL particle number. LipoScience developed a resource based on the well documented Mediterranean diet, with easy exercise tips, to help your patients adopt a heart healthy lifestyle. Click here to download the brochure.
Step 4: Assess response to therapy and modify intervention as needed
If therapeutic changes are made, repeat the NMR LipoProfile test to evaluate response to therapy.
1Cromwell, WC et al, Current Cardiology Reports 2009
Clinician Resource Program - Share and gather case study information on real patients. LipoScience offers a free case study resource program for clinicians. Whether you want to share an interesting case study, or ask an expert about management options for your patients, the Clinician Resource Program provides this opportunity by offering a free, one-on-one peer teleconference. To speak with an expert about the NMR LipoProfile test, please contact inquiries@liposcience.com.
Reimbursement
The NMR LipoProfile test has been recognized by many health insurers encompassing over 150 million lives.The test is covered or reimbursed by Medicare, Tricare, many national and regional plans including most Blue Cross Blue Shield products across the country.
If you have specific questions regarding coverage, please contact our billing specialists. 866-547-0245.
LipoScience continues to pursue expansion of reimbursement to include all providers.
Events
CVC Cardio Care Update
Scottsdale, AZ
Baptist Health Cardiovascular Disease Prevention
Miami Beach, FL
National Lipid Association (MWLA & PLA)
San Diego, CA
American College of Cardiology Meeting (ACC)
Chicago, IL
Carolina Clinical Connection
Charlotte, NC
2012 National Lipid Association Scientific Sessions
Scottsdale, AZ
American Diabetes Association (ADA)
Philadelphia, PA
South Carolina AFP Meeting
Pawley's Island, SC
American Association of Clinical Chemistry (AACC)
Los Angeles, CA
National Lipid Association (SELA & NELA)
Charlotte, NC
American Academy of Family Physicians (AAFP)
Philadelpia, PA
Online Results
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