Vertical auto profile
|This article relies too much on references to primary sources. (June 2013)|
The VAP (vertical auto profile) test is a cholesterol, lipid and lipoprotein test. The name "VAP test" was coined by the privately held cardio-diagnostic company Atherotech to identify their direct-measurement method, which categorizes not just total cholesterol, high-density lipoproteins (HDL), and low-density lipoproteins (LDL), but all lipids and subclasses, with an LDL measurement accuracy unaffected by triglycerides.
Atherotech claims their VAP test has a unique ability to identify far more areas of risk to patients than the standard lipid panel, specifically because it reports 15 separate components versus four in the standard cholesterol test. Their study reported that the more comprehensive test was 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 LDL, including the LDL particle size pattern. It also measures very low density lipoprotein (VLDL), intermediate-density lipoprotein (IDL) and lipoprotein(a) [Lp(a)].
The test was intended to meet 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 mellitus). The ADA-ACC consensus statement establishes measurement and treatment guidelines for apoB in addition to LDL and non-HDL in high-risk patients. The VAP test was the first cholesterol profile to comply with updated National Cholesterol Education Program ATP III recommendations for LDL measurement.
Lack of agreement among various tests
However, a study by Ensign et al. in 2006 show poor agreement among four methods commonly used to assess LDL subfractions or particles, including ultracentrifugation–vertical auto profile (VAP), gradient gel electrophoresis (GGE), nuclear magnetic resonance (NMR), and tube gel electrophoresis (TGE). It "suggests that triglyceride measurement is as useful for predicting LDL pattern as any of the far more elaborate and expensive technologies", including VAP. The study also showed poor agreement among the tests on LDL-C.  
- "VAP Cholesterol Testing". Life Extension. May 2013. Retrieved 2013-06-15.
- "Are Measurements of LDL Particles Ready for Prime Time?". Clinical Chemistry. September 2006. Retrieved 2013-06-15.
- Ensign, W.; Hill, N.; Heward, C. B. (2006). "Disparate LDL Phenotypic Classification among 4 Different Methods Assessing LDL Particle Characteristics". Clinical Chemistry 52 (9): 1722–1727. PMID 16740651. doi:10.1373/clinchem.2005.059949.
- Mora, S. (2009). "Advanced Lipoprotein Testing and Subfractionation Are Not (Yet) Ready for Routine Clinical Use". Circulation 119 (17): 2396–2404. PMC 2735461. PMID 19414657. doi:10.1161/CIRCULATIONAHA.108.819359.
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