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Which is better: VAP or NMR Lipidprofile test?
jeanniey posted:
Hi All,

I'm thinking about paying for a VAP or NMR lipidprofile test to see what the breakdowns are for my LDL cholesterol particles/sizes. Has anyone used any of these two tests and know which one might be better? My doctor's not familiar with these and my insurance doesn't pay so I get to decide what test to go for.

I have a history of high cholesterol and it's been getting worse these past 2 years. My doctor has threatened to put me on statins and I want to avoid that if I can. Don't remember the exact numbers but I believe my last cholesterol test results were: TC=274, LDL=169, HDL=89, TG=80. The numbers are consistent with what I had last year and even though I've lost an addition 10 pounds (I can't lose anymore or it'd be mostly muscle). I read that the size of the LDL particles are more important than the basic cholesterol test results so therefore, I'm considering one of these two tests. NMR costs $90 while the VAP costs $110 in my area so it's similar.

Would appreciate anyone who's had these done or knows about them to chime in.

billh99 responded:
You might ask your question at the heart health forum. There is a cardiologist that responds to some of the questions.

There is a 3rd test. Berkley Heart Labs.

That VAP and NMR can be done through Quest or LabCorp. I think that the sample needs to be send directly to Berkley for their test.

Some doctors this that particle count is the important thing to look at. Other particle size.

You can google the different names and look at the companies website and see exactly what they report.

But I had the VAP and they report Pattern of A (large particles), B (small particles) or A/B. And they also compute ApoB100 which is a surrogate for LDL particle count.

I normally get my lipid panel done by my PCP. But when I went to my cardiologist last winter I asked him if he thought that there was anything to be learned by one of the advanced test. On statin my LDL is under 70, HDL over 50, and trig under 75. He did not think so, but mentioned that they used Berkly.

But he also mentioned that because of family history (father died at 43) that it would not hurt to get an Lp(a) test.

But when I developed blockages and before the statin my numbers where good. LDL 121 and HDL50. So I wanted to be sure that while the numbers on statin looked good that in fact the LDL was not all small and that the HDL was the better type.

And the VAP test also includes Lp(a).

So I asked my PCP to do the VAP at my next scheduled test.

Like you he had not heard of the VAP. And it was not on his list that he used to order test. It took some research for him to get the code to order it through Quest.

My insurance paid for it. And Quest billed $188 for it. But accepted the $42 that the insurance paid.

Now you did not give your age, family history, weight, or other medical conditions that you have.

But let me give you another suggestion. Look for a hospital that has a healthy heart or heart disease prevention program.

Now the ones that I am familar with only do the standard lipid test. But some do also test for some other factors. Here is one local program.

Depending on all of the factors they might feel that you are low risk, medium risk, or high risk for developing heart disease.

If you are in the middle you might want to look at a Cardio Scan (Coronary Calcium scan, CT coronary scan). It is a specialized CT that looks for calcium (hardened plaque) in the arteries. That can help put you into the low risk catagory where you don't need to be concerned about the cholesterol or put you in high risk and where you want to maximum LDL reduction.

It normally cost $200-300 but some hospital offer it for $50-75.

Let me know how it works out for you.
jeanniey replied to billh99's response:
Thanks for all the great suggestions Bill. I will re-post on the heart health forum as you suggested.

I think I'm in the middle risk category since both my parents have high blood pressure and high cholesterol levels too. Their conditions are being treated by drugs. Also, my mom has diabetes so I may be prone to that when I get older. I just turned 42 a few days ago, weigh 112-115 pounds at 5'1". I run around 25-30 miles a week along with an occasional bike ride on the weekend and some yoga stretches in between. I do need to do more resistance training but I'm a bit lazier in that department.

My total cholesterol level has never been below 200 (first time I had it measured was in college and it was 202). My HDL has always been above 60 (it has gotten as high as 108). Also, both of my parents have naturally high HDL levels as well so maybe that's where I got mine from. I do have high blood pressure so I'm on Lisinopril. Also, I have asthma (not severe, but a little worse during the winter). Although I feel like I'm in shape from all the running and other activities, listing my chronic conditions makes me feel like I'm 90 years old.

My work pays for the insurance premiums but it has a $3500 deductible and $4500 out of pocket payment before any insurance payment will kick in, thus, I need to keep an eye on the lab costs. I will also definitely check out the hospitals that specialize in heart health testing though.

Thanks again.

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