Q: Is the VAP test, which was featured on the TV show The Doctors, really a better way to measure cholesterol?
A: It may have some advantages for some people, but we don’t recommend it as a general screening blood test.
A standard cholesterol lab panel includes total cholesterol, HDL (“good”) cholesterol, LDL (“bad”) cholesterol and triglycerides. But some tests, including the VAP (for Vertical Auto Profile), go beyond the basics. They measure additional blood components—lipoprotein(a), apolipoprotein A (apoA) and apolipoprotein B (apoB), among other “emerging risk factors” for heart disease. Studies show, for example, that apoB (a component of LDL and other atherogenic particles) is a stronger predictor of coronary artery disease than LDL itself, and that the ratio of apoB to apoA (a component of HDL) is better than the standard cholesterol ratio of total cholesterol to HDL.
The VAP and most other advanced tests also measure LDL directly instead of estimating it from total cholesterol, HDL and triglycerides using a mathematical equation, as is typically done. In certain cases, direct LDL is more accurate—for example, if you have very high triglycerides or diabetes or are obese. (LDL is often measured directly, anyway, even when it isn’t part of one of these specialized panels.)
There’s much debate about which, if any, of the additional components these specialized tests measure are most important, and for whom. Because the values are not standardized across tests, results cannot be compared—and there’s no consensus, in any case, on what is “normal” or how to use these values in clinical practice. Moreover, it’s not known whether improving the numbers actually reduces coronary risk or prolongs lives.
Still, advanced cholesterol testing may be valuable for people with a family history of premature heart disease and those at intermediate risk for heart disease, especially if they are at borderline-high risk. If you fall into one of those categories, the results may help your doctor decide if you should be considered in a higher risk category and treated accordingly.