GLOSSARY

HEART DISEASE & CHOLESTEROL TERMS

Atherogenic: Something that initiates, increases, or accelerates atherosclerosis, such as an atherogenic diet.

Atherosclerosis: The accumulation of plaque in the arteries, which can partially or totally block blood flow. This blockage can lead to a heart attack or stroke.

Cardiovascular Disease (CVD): A general term for diseases of the heart and blood vessels, which can lead to heart attack or stroke. CVD includes coronary heart disease, high blood pressure, congestive heart failure, rheumatic fever and rheumatic heart disease, and congenital cardiovascular defects.

Cholesterol: A soft, waxy substance found among the fats in the bloodstream and in all the body's cells. It is a constituent of all animal fats and oils. Cholesterol is an important part of a healthy body since it is used to form cell membranes, some hormones, and other needed tissues. A high level of cholesterol in the blood, however, is a major risk factor for heart disease.

Cholesterol Test (Routine): Developed in the 1970s, routine cholesterol tests measure total cholesterol, high-density lipoprotein (HDL), and triglycerides, and calculate (rather than directly measure) low-density lipoprotein (LDL). However, the traditional lipid panel has been shown to identify less than half of patients at risk for heart disease. In the Framingham Heart Study, 80 percent of patients who had heart attacks had routine cholesterol test results identical to those who did not experience a heart attack.

Coronary Heart Disease (CHD): A potentially fatal disease caused by the narrowing or blockage of one or more coronary arteries, resulting in decreased blood supply to the heart.

Fibrates: Fibric acid derivatives, including gemfibrozil and fenofibrate. Treatment with a fibrate can result in both a reduction in triglycerides and a marked increase in HDL.

HDL (High-Density Lipoprotein) Cholesterol: The “good” cholesterol. HDL is the protective form of cholesterol. Studies suggest that high levels of HDL (more than 40 mg/dL) reduce the risk of heart attack.

HDL₂: The “best” cholesterol. Low HDL₂ is a risk factor for heart disease in patients with normal total cholesterol and total HDL. It also is an independent risk factor for diabetics with peripheral vascular disease.

HDL₃: The least-protective HDL. Routine cholesterol tests don’t distinguish between HDL₂ and HDL₃.

Heart Attack: Heart attacks occur when an artery leading to the heart is blocked, and blood flow is slowed or stopped. The blockage stops the delivery of oxygen and nutrients to the heart, damaging or killing cells.

IDL (Intermediate-Density Lipoprotein) Cholesterol: “Bad,” non-LDL cholesterol. Elevated IDL is an independent risk factor for heart disease.

LDL (Low-Density Lipoprotein) Cholesterol: The “bad” cholesterol. Too much LDL cholesterol can clog the arteries and increase the risk of a heart attack. LDL is not directly measured in today’s routine cholesterol tests; rather, it is calculated using a method that may be inaccurate if blood triglyceride levels are elevated.

LDL Density Pattern: LDL can be small and dense (“Pattern B”) or large and buoyant (“Pattern A”). Small, dense LDL occurs in 40–50 percent of patients with heart disease. Small, dense LDL is associated with a 3–4.5-fold increased risk for heart disease and a 6.9-fold increased risk for heart attack.

Lipid: A general term for fatty substances that are not soluble in blood.

Lipoprotein(a): A subclass lipoprotein known as the “widow maker” that is an independent risk factor for premature heart disease. People with elevated Lp(a) have up to a 70 percent increased risk of heart disease.

Lipoproteins: Particles made up of fat (lipids) and protein. These are special carriers that transport cholesterol to and from cells.

Metabolic Syndrome: The metabolic syndrome—a constellation of major risk factors, glucose intolerance, life-habit risk factors, and emerging risk factors. A key component of the metabolic syndrome is atherogenic dyslipidemia, or the “atherogenic lipid triad,” which includes elevated triglycerides, small, dense LDL particles, and low HDL cholesterol.

NCEP ATP III Guidelines: The “Third Report of the NCEP Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults,” also known as Adult Treatment Panel (ATP) III, was released in May 2001. The National Cholesterol Education Program (NCEP) is coordinated by the National Heart, Lung, and Blood Institute, part of the National Institutes of Health.

Niacin: When used in high doses, niacin (vitamin B3) is extremely effective in reducing triglycerides, and it raises HDL levels higher than any other anti-cholesterol drug. Niacin also lowers LDL cholesterol and Lp(a). It often is used in combination with other therapies, such as statins.

Statins: A class of drugs used to lower cholesterol. Statins inhibit the liver enzyme hMG CoA reductase, which is used in the manufacture of cholesterol. Examples of commonly used statins include lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor), fluvastatin (Lescol), and atorvastatin (Lipitor).

Stroke: Occurs when an artery supplying blood to the brain is blocked. The damage resulting from insufficient blood flow may include impairment of mental function, muscle function, vision, sensation, or speech, depending on the area of the brain affected. A stroke can lead to permanent disability or death.

Triglycerides: The most common chemical form of fats in food and in the body. People with high triglycerides often have elevated total cholesterol, high LDL (“bad”) cholesterol, and low HDL (“good”) cholesterol. Many people with heart disease also have elevated triglycerides.

Ultracentrifugation: The highly accurate process employed by the VAP™ Cholesterol Test, which separates lighter portions of lipoprotein from heavier portions using centrifugal force in order to measure cholesterol subclasses. During ultracentrifugation, the two density layers contained in the sample blend to form a continuous density gradient, and the lipoproteins present in the serum sample float toward the top of the tube and stop at their characteristic density.

VAP (Vertical Auto Profile) Test: A next-generation cholesterol test developed by Atherotech, Inc., of Birmingham, Ala., that provides direct, detailed measurements of cholesterol subclasses that play important roles in the development of heart disease. The test is simple to perform: A small blood sample is obtained at a physician’s office or lab and sent to Atherotech’s Clinical Laboratory Improvement Act (CLIA)-approved laboratory for processing. Results are generally available within 72 hours after the specimen’s arrival for processing in our lab. The affordable VAP Cholesterol Test is available nationwide through national and regional diagnostic laboratories, and it is reimbursed by many payors, including Medicare.

VLDL (Very Low-Density Lipoprotein): The main carrier of triglycerides. If elevated, VLDL can be an independent risk factor for heart disease.

VLDL₁ and VLDL₂ (buoyant): The main carriers of triglycerides and, when elevated, independent risk factors for heart disease.

VLDL₃: The most dense subfraction of VLDL and constitutes a greater risk for heart disease than VLDL₁ and VLDL₂.

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