While I haven’t had a chance to do so yet, I thought I’d mention that it does seem to be well-designed and like the VAP test is far better than the regular cholesterol panels. As Marc explains, rightly I think, it’s arguable that the NMR test is better than the VAP test in at least some ways, in particular via the direct measurement of the small-particle LDL cholesterol count.

I found a vendor that offers the NMR LipoProfile test for considerably less (about 1/3 less!) than the VAP cholesterol profile. Click through NMR LipoProfile test for $69.60 to see how to order it.

The NMR LipoProfile test and measured (not calculated) apoB tests, on the other hand, are supported by a large body of published outcomes data, and have been recognized by expert panels from the American Diabetes Association (ADA), American College of Cardiology (ACC), and the American Association for Clinical Chemistry (AACC – lab experts). The VAP test has not been recognized by these expert panels (although Atherotech has been quoted by the media and issued press releases falsely claiming that VAP has been recognized by ADA & ACC).

Atherotech also likes to claim that their calculation of apoB is “peer reviewed.” In reality, a poster of their study was accepted (via a low level “peer-review” process) for presentation at an American Association for Clinical Chemistry meeting and the ABSTRACT was published – along with abstracts from ALL OTHER POSTERS at the meeting. This type of low level review and publication of an ABSTRACT does not constitute a traditional (much more rigorous) “peer review” process.

VAP’s apoB calculation is based upon the high level of correlation between non-HDL-C and measured apoB. This correlation has been addressed by experts from the ADA, ACC, AACC, and the Thirty-Person Ten-Country Panel, all of whom conclude that the correlation is of limited clinical value because non-HDL-C and apoB and only “moderately concordant.” In other words, if I test 1000 people, non-HDL-C and measured apoB will agree strongly (be highly correlated) at a population level, but many not agree strongly (not be concordant) at an individual patient level.

“Calculated apoB” is merely Atherotech’s attempt to keep their cholesterol-based VAP test relevant in a world that is moving away from cholesterol and toward lipoprotein particle number testing (LDL-P by NMR and measurements of apoB).

I have extensive documentation on all topics discussed above, and would be happy to share this information upon request.

You’re right the apoB value in the VAP test is calculated. Direct measurement probably would be better. But Atherotech did do a fairly large study of 1797 patients comparing their calculation and direct measurement and found the errors were relatively small, unlike the kinds of massive errors that happen with LDL calculations. This study was also peer-reviewed, presented, and published.

(from Frequently Asked Questions)

Q: How accurate is the apo-B data in determining risk compared with the gold standard?

A: Atherotech has developed a novel procedure to calculate apoB utilizing non-HDL-cholesterol along with lipoprotein density distribution using the patented VAP ultracentrifugation method. Atherotech has thoroughly validated this new procedure by comparing its calculated apoB with the gold standard* using serum from 1,797 patients. This comparison has yielded an excellent correlation coefficient (r = 0.96) with bias of only 3.8%. The long term (40 days) reproducibility of VAP apoB is 3.0% CV (coefficient of variance). The VAP apoB calculation work was accepted through a peer review process for presentation at 2007 Annual Meeting of American Association of Clinical Chemistry (AACC), and was subsequently published by AACC as an abstract.

* apoB immunoassay provided by Abbott Diagnostics; calibrated against WHO/IFCC/CDC Apolipoprotein Reference Material

Here’s a link to a PDF file containing references to dozens of peer-reviewed clinical studies that have used the VAP test.

Clinical Studies Using the VAP Cholesterol Test

Answer: No. Zero. Zip. Nada.

If you want to go “beyond” the standard lipid panel, then either request the NMR LipoProfile test or a measurement of apolipoproteinB (apoB). Note – the VAP test “calculates” apoB, and this calculation has not been scientifically validated. Measurements (not “calculations”) of apoB are the way to go.