What's the best lipoprotein test?

This is a frequent question from Track Your Plaque Members and others interested in improving their heart disease prevention program beyond that of simple-minded cholesterol testing.

I obtain lipoprotein testing every day on patients. I can tell you with the confidence of having done thousands of these tests that plain, old-fashioned cholesterol testing is like relying on riding a scooter to work compared to an 8-cylinder modern automobile. The scooter might get you there, but any rain, snow, or long distance to travel and you can just forget it.

All too often, lipoprotein testing uncovers abnormalities that standard cholesterol testing simply fails to uncover.

So, among the various lipoprotein tests available, which is best?

There are three commercial tests available today:

1) Gel electropheresis (GGE)--often known by its "brand" name as the Berkeley lipoprotein profile, after Berkeley HeartLabs. GGE uses a gel with an electric field applied to cause lipoproteins to migrate, based on particle size and charge.

2) Vertical auto-profile (VAP)--a form of centrifugation, or high-speed spinning of blood plasma to separate lipoprotein particles.

3) Nuclear magnetic resonance (NMR)--the idea of putting plasma in an NMR (also known as MRI) device to characterize blood proteins.

All three tests do an excellent job. All are competitively priced. All have validating data--lots of it--to justify their broad use (though health insurers, in their vast wisdom, would still have you believe that the tests are "experimental").

But is one better?

Having done many of all three (though least of VAP), I am partial to Liposcience's NMR. (By the way, I receive no fees from Liposcience to use their test, nor to promote it in any way.)

I believe NMR is superior in a few ways:

1) I believe that the LDL particle number is the best way to truly quantify LDL, better than apoprotein B and "direct" LDL.

2) It provides what I believe to be more accurate small LDL measures.

3) It provides intermediate-density lipoprotein (IDL), a post-prandial, or after-eating, measure not available on the other two.

Perhaps I'm biased because I use the NMR most frequently. But I've used it because I felt it yielded superior, more clinically believable, data.

In truth, all three laboratories do an excellent job and you'd be served fine by obtaining any of the three. But my heart goes to NMR.

Comments (5) -

  • Anonymous

    5/30/2007 3:41:00 AM |

    Thank you for clarifying which test to use.  

    I personally find this information very helpful.

    My previous testing was done at Berkeley.

    How often do you suggest retesting be done?  Yearly or ??

    Thank you.


  • Dr. Davis

    5/30/2007 11:30:00 AM |

    In the Track Your Plaque program, we advocate lipoprotein testing at the beginning to diagnose the full extent of causes of coronary plaque, and then again when correction is believed to have been achieved. Standard lipids are used in between to assess response. Of course, this is just one way we've used that we've become comfortable with.

  • Anonymous

    1/24/2009 12:51:00 AM |

    The VAP does provide IDL on their profile.

    What sort of external validation does NMR have on their methods?

  • Charlotte jess

    9/27/2010 12:35:23 PM |

    Randox provide a kit which tests for the full lipid profile - a group of tests comprising triglycerides, total cholesterol, HDL and LDL cholesterol. The lipid profile is used, together with other risk factors, to assess a person's risk of cardiovascular disease (CVD).

    It is very important to get the balance between the protective HDL and the destructive LDL right in order to reduce the risk of CVD. This can be achieved either through dietary and lifestyle changes or treatment with cholesterol reducing drugs called statins.

    All Randox cholesterol tests, including small LDL, are direct enzymatic clearance tests, and as such are highly accurate even in lipaemic samples.

    For more information click here http://www.randox.com/lipid%20profile.php

  • buy jeans

    11/3/2010 2:56:03 PM |

    Having done many of all three (though least of VAP), I am partial to Liposcience's NMR. (By the way, I receive no fees from Liposcience to use their test, nor to promote it in any way.)