Look Beyond Traditional Cholesterol and Give Your Patients More than a 50/50 Chance1, 2

CholesterolLDLParticle

To learn more about how LDL particle number (LDL-P) by NMR

may help you manage your patients visitMayoMedicalLaboratories.com/LDLP

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LDL Particle Testing by NMR

Traditional Cholesterol May Not Always Represent Cardiovascular Disease Risk2–8

Cholesterol

LDLParticle

Measurement of low-density lipoprotein cholesterol (LDL-C) may not reflect a patient’s true LDL-related risk, due to the variable cholesterol content of LDL particles.

Cholesterol content varies2–8

Discordance increases to almost 1 in 2 individuals in the presence of diabetes mellitus, hypertriglyceridemia, low HDL cholesterol (HDL-C), or low LDL-C.

LDL-C may be low, but residual risk may be present2–8

Two patients with the same LDL-C could have a different LDL particle number (LDL-P). Higher LDL-P indicates higher risk and an opportunity for further LDL management.

LDL-P1806 nmol/L

Charles, 54LDL-C: 94

Edward, 54LDL-C: 94

LDL-P923 nmol/L

CharlesLDL-C: 94

EdwardLDL-C: 94

LDL-Cranges(mg/dL)

CharlesLDL-P: 923

LDL-Pranges(nmol/L)

EdwardLDL-P: 1806

*LDL-P range determinations are from a representative sampling of the general population (n=5362) enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA).5

Low Borderline High

100 mg/dLCholesterol-rich

LDL particles

100 mg/dLCholesterol-depleted

LDL particles

MORE PARTICLES = HIGHER RISK

LDL Cholesterol Balance

800 533 1710 or US Access Code + 507 266 5700MayoMedicalLaboratories.com

Traditional Cholesterol May Not Always Represent Cardiovascular Disease Risk2–8

Incidence of Cardiovascular Events Increases With Elevated LDL-P 5

Clinical Outcomes Track With LDL Particle Number (LDL-P)2–8

Measurement of LDL cholesterol (LDL-C) may not accurately reflect the true burden of atherogenic LDL particles.

— 2008 ADA/ACC Consensus Statement6

LDL-P was deemed reasonable for initial assessment and on-treatment management of CVD risk for many patient populations including those considered to be at intermediate risk.

— 2011 National Lipid Association Expert Panel7

Results from MESA5

The Multi-Ethnic Study of Atherosclerosis (MESA) joins Framingham Offspring7 and other outcome studies in validating the clinical utility of LDL-P by NMR for guiding therapeutic decision making and refining LDL management.

Incidence of Cardiovascular Events Increases With Elevated LDL-P5

In a multi-ethnic study of atherosclerosis among a community-based cohort of 5598 individuals free of clinical cardiovascular disease (CVD) at study onset, cumulative incidence of CVD events tracked with elevated levels of LDL-P, regardless of levels of LDL-C.

MC2775-68

Goal and therapy options

• Lower LDL-P – Statin

• Lower LDL-P further – Titrate statin dosage or use a more potent statin (or) – Statin + ezetimibe/bile acid sequestrants (or) – Statin + ezetimibe + niacin

• Any of the above + lower triglycerides – Treatment option above + niacin, omega-3 fatty acid, fenofibrate

• Any of the above + increase HDL-C – Treatment option above + niacin, fenofibrate, omega-3 fatty acid

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Low Borderline High

LDL-Pranges *(nmol/L):

LDL-Cranges(mg/dL):

Goal for high–risk patients

Goal for intermediate- risk patients

– High blood pressure or – Low high-density on antihypertensive(s) lipoprotein cholesterol (HDL-C)

– High blood sugar – Abdominal obesity

– High triglycerides

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Which Patients Are Appropriate?7

LDL-P by NMR is appropriate for patients being managed with a lipid lowering therapy, intensive lifestyle management or who have at least one of the following criteria:

• Known cardiovascular disease • Coronary heart disease risk equivalents, such as type 2

diabetes mellitus or chronic kidney disease (CKD)• Multiple cardiometabolic risk factors that define metabolic syndrome:

– High blood pressure or on antihypertensive(s)

– High blood sugar

– High triglycerides

– Low high-density lipoprotein cholesterol (HDL-C)

– Abdominal obesity

Therapies to Achieve LDL-P Targets7

LDL-P may aid in determining treatment strategies and clinical decision making for personalized LDL management.

Goal and therapy options • Lower LDL-P

– Statin

• Lower LDL-P further – Titrate statin dosage or use a more potent statin (or) – Statin + ezetimibe/bile acid sequestrants (or) – Statin + ezetimibe + niacin

• Any of the above + lower triglycerides – Treatment option above + niacin, omega-3 fatty acid, fenofibrate

• Any of the above + increase HDL-C – Treatment option above + niacin, fenofibrate, omega-3 fatty acid

Goal forhigh-risk patients

LDL-Cranges(mg/dL)

LDL-Pranges(nmol/L)

For low-risk patients, ideal LDL-C 160 mg/dL, LDL-P 1600 nmol/L.8

Low Borderline High

Goal for intermediate- risk patients

Personalized LDL ManagementLDL-C and LDL-P goals of therapy8

References: 1. Sachdeva A, Cannon CP, Deedwania PC, et al: for the Get With The Guidelines Steering Committee and Hospitals. Lipid levels in patients hospitalized with coronary artery disease: an analysis of 136,905 hospitalizations in Get With The Guidelines. Am Heart J. 2009;157(1):111 -117. 2. deGoma EM, Knowles JW, Angeli F, et al. The Evolution and Refinement of Traditional Risk Factors for Cardiovascular Disease. Cardiology in Review. 2012;20(3):118-128. 3. Cromwell WC, Barringer, TA. Low-Density Lipoprotein and Apolipoprotein B: Clinical Use in Patients with Coronary Heart Disease. Current Cardiology Reports. 2009; 11:468-475. 4. Cromwell, WC, Otvos, JD, Keyes, MJ, et al. LDL Particle Number and Risk of Future Cardiovascular Disease in the Framingham Offspring Study–Implications for LDL Management. J Clin Lipidol. 2007;1(6):583-592. 5. Otvos JD, Mora, S, Shalaurova, I, et al. Clinical implications of discordance between low-density lipoprotein cholesterol and particle number. Clin Lipidol. 2011;5(2):105-113. 6. Brunzell JD, Davidson, M, Furberg CD, Lipoprotein Management in Patients with Cardiometabolic Risk: Consensus statement from the American Diabetes Association and the American College of Cardiology. Diabetes Care. 2008;31(4):811-822. 7. Rosenson RS, Davidson, MH, Pourfarzib R. Underappreciated opportunities for low-density lipoprotein management in patients with cardiometabolic residual risk. Atherosclerosis. 2010:213(1):1-7. 8. Davidson MH, Ballantyne CM, Jacobson TA, et al. Clinical Utility of Inflammatory Markers and Advanced Lipoprotein Testing: Advice From an Expert Panel of Lipid Specialists. J Clin Lipidol. 2011;5(5):338-367.

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