Claim: Study suggests a second LDL test
Verdict: REFUTES

Retrieved passages:
title: Lipid hypothesis
text: evidence from numerous and multiple different types of clinical and genetic studies unequivocally establishes that LDL causes ASCVD." There was ongoing contention about the results and meaning of intervention studies undertaken before the introduction of statins. A meta-analysis of cholesterol-lowering trials found that trials that were supportive of the lipid hypothesis were cited almost six times as often as those that were not, and although there was a similar number of trials unsupportive of the hypothesis, none of them were cited after 1970; some of the supportive reviews also exclude and ignore certain trials which were less favorable to the

title: Cholesterol
text: a calculation and assumptions) cholesterol carried by LDL (i.e. Lower Density {than water} Lipids-transported-within-proteins) particles ("which drive arterial disease"). It is recommended to test cholesterol at least every five years if a person has total cholesterol of 5.2 mmol/L or more (200+ mg/dL), or if a man over age 45 or a woman over age 50 has HDL-C values less than 1 mmol/L (40 mg/dL), or there are other drivers heart disease and stroke. Additional drivers of heart disease include diabetes mellitus, hypertension (or use of anti-hypertensive medication), low HDL level, family history of coronary artery disease (CAD) and hypercholesterolemia,

title: Chronic endothelial injury hypothesis
text: the hypertension often seen with atherosclerosis. The role LDL plays suggests two different approaches to treatment and prevention. The first approach involves discouraging the accumulation of LDL by lowering the levels of serum LDL, an idea more closely associated with the lipid hypothesis. A major breakthrough involved the discovery of statins, a class of drugs which help to clear LDL from the bloodstream. It has been demonstrated conclusively that elevated levels of LDL are associated with higher risk of mortality from coronary heart disease (CHD); it has also been shown that statins substantially lower the risk of mortality in patients

title: Apolipoprotein B
text: first becoming obviously symptomatic as heart disease, stroke & many other body wide complications after decades of progression. There is considerable evidence that concentrations of ApoB and especially the NMR assay (specific for LDL-particle concentrations) are superior indicators of vascular/heart disease driving physiology than either total cholesterol or LDL-cholesterol (as long promoted by the NIH starting in the early 1970s). However, primarily for historic cost/complexity reasons, cholesterol, and estimated LDL-cholesterol by calculation, remains the most commonly promoted lipid test for the risk factor of atherosclerosis. ApoB is routinely measured using immunoassays such as ELISA or nephelometry. Refined and automated NMR

title: Lipid profile
text: This screening can be valuable to detect genetic diseases such as familial hypercholesterolemia that can be lethal if not treated early. Traditionally, most laboratories have required patients to fast for 9–12 hours before screening. However, recent studies have questioned the utility of fasting before lipid panels, and some diagnostic labs now routinely accept non-fasting samples. Typically the laboratory measures only three quantities: total cholesterol; HDL; Triglycerides. From these three data LDL may be calculated. According to Friedewald's equation: Other calculations of LDL from those same three data have been proposed which yield some significantly different results. VLDL may be defined

title: Low-density lipoprotein
text: Some in the medical community have suggested the correspondence between Pattern B and CHD is stronger than the correspondence between the LDL number measured in the standard lipid profile test. Tests to measure these LDL subtype patterns have been more expensive and not widely available, so the common lipid profile test is used more often. There has also been noted a correspondence between higher triglyceride levels and higher levels of smaller, denser LDL particles and alternately lower triglyceride levels and higher levels of the larger, less dense (a.k.a. "buoyant") LDL. With continued research, decreasing cost, greater availability and wider acceptance

title: Vertical auto profile
text: Studies report that this comprehensive test is able to identify more than twice the number of patients with lipid abnormalities than the standard lipid panel (cholesterol and triglyceride test). The VAP test directly measures and routinely reports all five lipoprotein classes and sub-classes, including LDL, HDL, intermediate-density lipoprotein (IDL), very low density lipoprotein (VLDL), and lipoprotein (a) [Lp(a)]. The VAP technology also measures and reports LDL particle concentration (LDL-P). The test meets the American Diabetes Association and American College of Cardiology (ADA-ACC) cholesterol guidelines for people at high risk of heart attack and stroke (including people with Type 2 diabetes

title: Cholesterol
text: and then every 3–12 months thereafter. A blood sample after 12-hour fasting is taken by a doctor, or a home cholesterol-monitoring device is used to measure a lipid profile, an approach used to estimate a person's lipoproteins, the vastly more important issue because lipoproteins have always been concordant with outcomes though the lipid profile is commonly discordant LDL Particle Number and Risk of Future Cardiovascular Disease in the Framingham Offspring Study. The lipid profile measures: (a) total cholesterol, (b) cholesterol associated with HDL (i.e. Higher Density {than water} Lipids-transported-within-proteins) particles ("which can regress arterial disease"), (c) triglycerides and (d) (by

title: Low-density lipoprotein
text: predict cardiovascular events, many other correlates of these clinical outcomes, such as diabetes mellitus, obesity and smoking, lose most of their predictive accuracy. In the USA, the American Heart Association, NIH, and NCEP provide a set of guidelines for fasting LDL-Cholesterol levels, estimated or measured, and risk for heart disease. As of about 2005, these guidelines were: Over time, with more clinical research, these recommended levels keep being reduced because LDL reduction, including to abnormally low levels, was the most effective strategy for reducing cardiovascular death rates in one large double blind, randomized clinical trial of men with hypercholesterolemia; far

title: Low-density lipoprotein
text: LDL, not measured low-density lipoprotein concentrations, the accurate approach. The feasibility of these figures has been questioned by sceptics, claiming that many members of the AHA and NIH are heavily associated with pharmaceutical companies giving them bias towards lowering cholesterol levels and such guidelines giving rise to increased use of cholesterol lowering medicine such as statins. A study was conducted measuring the effects of guideline changes on LDL cholesterol reporting and control for diabetes visits in the US from 1995 to 2004. It was found that although LDL cholesterol reporting and control for diabetes and coronary heart disease visits improved

title: Low-density lipoprotein
text: Since the later 1990s, because of the development of NMR measurements, it has been possible to clinically measure lipoprotein particles at lower cost [under $80 US (including shipping) & is decreasing; versus the previous costs of >$400 to >$5,000] and higher accuracy. There are two other assays for LDL particles, however, like LDL-C, most only estimate LDL particle concentrations. Direct LDL particle measurement by NMR was mentioned by the ADA and ACC, in a 28 March 2008 joint consensus statement, as having advantages for predicting individual risk of atherosclerosis disease events, but the statement noted that the test is less

title: Familial hypercholesterolemia
text: disorder in two generations simultaneously." "The use of total cholesterol alone may best discriminate between people with and without FH between the ages of 1 to 9 years." Screening of toddlers has been suggested, and results of a trial on 10,000 one-year-olds were published in 2016. Work was needed to find whether screening was cost-effective, and acceptable to families. FH is usually treated with statins. Statins act by inhibiting the enzyme hydroxymethylglutaryl CoA reductase (HMG-CoA-reductase) in the liver. In response, the liver produces more LDL receptors, which remove circulating LDL from the blood. Statins effectively lower cholesterol and LDL levels,

title: LDL receptor
text: on a community cohort study (the Malmo Diet and Cancer study) and four additional randomized controlled trials of primary prevention cohorts (JUPITER and ASCOT) and secondary prevention cohorts (CARE and PROVE IT-TIMI 22). LDL receptor The Low-Density Lipoprotein (LDL) Receptor (LDL-R) is a mosaic protein of 839 amino acids (after removal of 21-amino acid signal peptide) that mediates the endocytosis of cholesterol-rich LDL. It is a cell-surface receptor that recognizes the apoprotein B100, which is embedded in the outer phospholipid layer of LDL particles. The receptor also recognizes the apoE protein found in chylomicron remnants and VLDL remnants (IDL). In

title: Lipid hypothesis
text: the cholesterol hypothesis." The review has been criticized for cherry picking data and confirmation bias. Nine of the authors are members of THINCS. The National Health Service noted that "the review searched only a single literature database, excluded studies only available in non-English language, and excluded studies where the title and abstract did not appear to contain information on the link between LDL and mortality in older adults." Several medical experts responded to the review claiming it had a number of "serious weaknesses" and was contradicted by robust experimental data from clinical trials. Professor Jeremy Pearson Associate Medical Director of

title: Low-density lipoprotein
text: more effective than coronary angioplasty/stenting or bypass surgery For instance, for people with known atherosclerosis diseases, the 2004 updated American Heart Association, NIH and NCEP recommendations are for LDL levels to be lowered to less than 70 mg/dL, unspecified how much lower. This low level of less than 70 mg/dL (higher than Tim Russert's value shortly prior to his heart attack) was recommended for primary prevention of 'very-high risk patients' and in secondary prevention as a 'reasonable further reduction'. Lack of evidence for such a recommendation is discussed in an article in the Annals of internal medicine. It should also

title: Low-density lipoprotein
text: and actual rates of atherosclerosis progression. Direct LDL measurements are also available and better reveal individual issues but are less often promoted or done due to slightly higher costs and being available from only a couple of laboratories in the United States. In 2008, the ADA and ACC recognized direct LDL particle measurement by NMR as superior for assessing individual risk of cardiovascular events. Chemical measures of lipid concentration have long been the most-used clinical measurement, not because they have the best correlation with individual outcome, but because these lab methods are less expensive and more widely available. The lipid

title: Low-density lipoprotein
text: widely available, is more expensive [about $13.00 US (2015 without insurance coverage) from some labs which use the Vantera Analyzer]. Debate continues that it is "...unclear whether LDL particle size measurements add value to measurement of LDL-particle concentration", though outcomes have always tracked LDL particle, not LDL-C, concentrations. Using NMR, as pioneered by researcher Jim Otvos and the North Carolina State University academic research spin-off company LipoScience, the total LDL particle concentrations, in nmol/L plasma, are typically subdivided by percentiles referenced to the 5,382 men and women, not on any lipid medications, who are participating in the MESA trial. The

title: Lipid profile
text: types: Current recommendations for cholesterol testing come from the Adult Treatment Panel (ATP) III guidelines, and are based on many large clinical studies, such as the Framingham Heart Study. For healthy adults with no cardiovascular risk factors, the ATP III guidelines recommend screening once every five years. A lipid profile may also be ordered at regular intervals to evaluate the success of lipid-lowering drugs such as statins. In the pediatric and adolescent population, lipid testing is not routinely performed. However, the American Academy of Pediatrics and NHLBI now recommend that children aged 9–11 be screened once for severe cholesterol abnormalities.

title: High-density lipoprotein
text: rates for heart disease. Higher native HDL levels are correlated with better cardiovascular health, but it does not appear that further increasing one's HDL improves cardiovascular outcomes. The remainder of the serum cholesterol after subtracting the HDL is the non-HDL cholesterol. The concentration of these other components, which may cause atheroma, is known as the non-HDL-C. This is now preferred to LDL-C as a secondary marker as it has been shown to be a better predictor and it is more easily calculated. HDL is the smallest of the lipoprotein particles. It is the densest because it contains the highest proportion

title: Low-density lipoprotein
text: of other "lipoprotein subclass analysis" assay methods, including NMR spectroscopy, research studies have continued to show a stronger correlation between human clinically obvious cardiovascular events and quantitatively measured particle concentrations. Blood tests commonly report LDL-C: the amount of cholesterol which is estimated to be contained with LDL particles, on average, using a formula, the Friedewald equation. In clinical context, mathematically calculated estimates of LDL-C are commonly used as an estimate of how much low density lipoproteins are driving progression of atherosclerosis. The problem with this approach is that LDL-C values are commonly discordant with both direct measurements of LDL particles