VAP: A Better Cholesterol Test for the 21st Century

By Michael A. Smith, MD

Recent cholesterol research has revealed that cholesterol levels only account for a portion of your cardiovascular risk profile. It’s becoming more and more apparent that cholesterol subtypes and the lipoproteins responsible for transporting cholesterol through the blood play a far greater role in atherosclerosis than previously thought.

For instance, the size and density of lipoproteins are important factors for assessing cardiovascular risk. Large, buoyant LDL (bad cholesterol) is much less dangerous than smaller, dense LDL particles. Likewise, large HDL (good cholesterol) offers greater protection than smaller HDL.

The problem is that the standard cholesterol test that your doctor orders doesn’t include cholesterol subtypes and doesn’t characterize the size and shape of the lipoproteins. For this reason, if you really want to assess your risk for heart disease, you should consider an advanced cholesterol test called the VAP test.

What’s the VAP Test?

The VAP test is an advanced cholesterol test that more accurately assesses your risk for atherosclerosis. VAP stands for Vertical Auto Profile because it gives you a nice vertical display of all the cholesterol and lipoprotein subtypes.

The power of the test can be best demonstrated with a sample case study: Jim is 42 years old and has no significant history of heart disease. His blood pressure, weight, and fasting blood sugar are all optimal.

Jim’s dad suffered a heart attack at age 59. During a routine check-up, Jim’s doctor ordered a basic cholesterol test. Here are the results that came back:

  1. Total cholesterol = 210
  2. LDL-cholesterol = 110
  3. HDL-cholesterol = 45
  4. Triglycerides = 120
Based on the results of the test, coupled with Jim’s medical history, his doctor tells him he’s at a low risk for heart disease but needs to diet and exercise to lower his LDL-cholesterol and raise his HDL-cholesterol.

Two months later, Jim suffers a mild heart attack. Luckily, he’s okay — but what did his doctor miss?

Why VAP Test Results are a Better Measure of Atherosclerosis Risk

After leaving the hospital, Jim went to a second doctor who ordered a VAP test. Listed below are three of Jim’s additional measurements that are dangerously abnormal. See, the standard cholesterol test didn’t measure these and inaccurately assessed Jim’s risk as low when his risk is actually moderate-to-high.

  1. Total Cholesterol = 235
  2. Direct LDL-cholesterol = 135
  3. Direct HDL-cholesterol = 40
  4. Direct triglycerides = 130
  5. Lipoprotein (a) = 40
  6. ApoB100 = 140
Jim’s results are all higher with the VAP test because it directly measures cholesterol and its subtypes. The standard test is only an estimate and can often be misleading.

The last two measurements listed are only included with a VAP test. These measure highly atherogenic proteins, which means they’re directly involved in arterial plaque formation and progression. Jim’s results are extremely high and dangerous. This could be why he suffered a mild heart attack.

What Does the VAP Test Measure?

The table below lists each component of the VAP test and the clinical significance of each measurement. The information was provided by Atherotech®, the company that Life Extension® uses for all of our VAP testing services:

Direct LDL-Cholesterol
(Low-Density Lipoprotein)
A direct measurement of the “bad” cholesterol throughout your body. (The standard cholesterol test only provides an estimate.) The higher the number the greater the risk of heart disease.
Direct HDL-Cholesterol
(High-Density Lipoprotein)
A direct measurement of the “good” cholesterol. The higher the number the lower the risk of heart disease.
Direct VLDL-Cholesterol
(Very Low-Density Lipoprotein)
A direct measurement of the “bad” cholesterol. The higher the number the greater the risk for heart disease and diabetes.
Total VLDL-3 An independent risk factor of heart disease.
Sum Total Cholesterol HDL + LDL + VLDL. Used to help further assess risk of heart disease.
Direct Triglycerides
(fats in bloodstream)
A direct measurement of fats in your blood. The higher the number the greater the risk of heart disease and may be related to simple sugar intake.
Total Non-HDL Cholesterol LDL + VLDL. The higher the number the greater the risk of heart disease.
Total ApoB100
(Apolipoprotein B100)
This special protein helps to create and deliver “bad” cholesterol to the body. Knowing this number adds validity to the VAP test risk assessment.
[Lipoprotein (a)]
A highly atherogenic (plaque-causing) protein that is inherited. It does not respond to traditional cholesterol lowering strategies.
IDL Cholesterol
(Intermediate-Density Lipoprotein)
Inherited and elevated in people with a family history if diabetes.
LDL-R (Real) Cholesterol The real amount of circulating “bad” cholesterol.
Sum Total LDL-Cholesterol Lp(a) + IDL + Real LDL.
LDL-Cholesterol Size & Pattern Measures the size and the pattern of “bad” cholesterol. Small & dense are risk factors of heart disease while large & buoyant are protective.
Total HDL-2 The most protective form of “good” cholesterol. A low number is a risk factor of heart disease.
Total HDL-3 Not as protective as HDL-2.

What’s Your Real Level of Cardiovascular Risk?

Do you know what you Lp(a) is? What about your ApoB100? Our friend Jim didn’t know either and he thought his “cholesterol” was okay.

If you don’t want this to happen to you, consider getting a VAP test today. It really is a much better measure of your overall risk. You can either order one through your doctor or from the Life Extension blood testing service.


Anonymous said...

Awesome article! If I'd had this information a few years ago, I would not be the wounded duck that I am (after a double bypass that should NEVER have been necessary). I did the NMR based tests that do about the same thing as the VAP, and found that I had high VLDL (the small, high density LDL that kills). After a short period of careful diet (avoiding ANY sugar or simple carbo and upping omega three foods (grass fed/finished beef/lamb, IRISH butter (no grain fed to cows) and of course Sockeye Salmon), my VLDL went to zero and my arteries should not be receiving a continued plaque load.

Life Extension said...

Thank you so much for your very kind words. Dr. Mike wanted to let you know that since you had bypass surgery, you might want to add a PLAC-2 test every year to your work up. You can read about the test here:

LabE spy said...

Cholesterol is an essential compound for every cell structure, and for proper functioning of brain and nerve.I ask them to speak with their doctor about taking a break from the statin medication. More than 80% of the time, their diabetes type II goes away and their other health problems return to normal.

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