Cardio IQ®

Advanced Cardiovascular TestingUncover Hidden Risk for Heart Attack and Stroke

For Physicians

Residual cardiovascular risk is still significant despite managing traditional risk factors

Studies show that LDL-C cholesterol levels were often not predictive of coronary artery disease (CAD). In a population of over 200,000 patients hospitalized with CAD, almost half had LDL-C levels <100 mg/dL.2

The AHA Get-With-The-Guidelines® initiative analysis2 revealed that a substantial proportion of patients with CHD events were well within guideline-recommended targets for Lipid Panel values.

Even after statin therapy, recent data suggests that residual risk still exists in many patients.3

Are traditional risk factors enough when managing cardiovascular disease?Heart disease continues to be the leading cause of death in the U.S.1

Evolving guidelines continue to focus on traditional factors to manage cardiovascular risk

~50%

at goal 72%

at goal

41%

at goal

Recurrent CHD1st CHD Event

1988 20132001–20041993

ATP I

Primary prevention of coronary heart disease (CHD), with a focus on low-density lipoprotein cholesterol (LDL-C) >160 mg/dL or those with borderline-high LDL 130–159 mg/dL

More intensive management of LDL-C in CHD patients; focus now on LDL-C <100 mg/dL

Primary prevention of CHD; focus continues on LDL-C, but new emphasis on non-HDL-C; suggest option of LDL-C <70 mg/dL in those with CHD

Goal of treatment: Primary/secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in men and women with LDL-C percent reduction targets from the untreated baseline

ATP II ATP III ACC/AHA

LDL-C Levels <100mg/dL

Quest Diagnostics can help improve the management of cardiovascular patientsGain deeper insights into the individual residual risks of your patients

Uncovering hidden risk may benefit those patients with traditional cardiovascular disease (CVD) risk factors:

• Age (men >45 years; postmenopausal women)

• Family history of premature onset of CVD

• Unhealthy diet, excessive alcohol intake, smoking, and stress

• Obesity

• Low HDL-C

Additional risk stratification may be considered for:

• ≥5% Estimated ASCVD Risk

• Established cardiovascular disease, hypertension, or dyslipidemia

• Diabetes

• Metabolic syndrome

Patient types are meant to be illustrative and should not be considered a comprehensive representation.

Plaque Progression Plaque Rupture

Plaque FormationOutward remodeling of arterial wall

Identifying residual risk with emerging biomarkersBiomarkers have been shown to help identify risk and thus have been adopted by several guidelines and societies.4-6

Lipoprotein Risk Factors

Risk Factor Impact on Cardiovascular Disease (CVD)

LDL Particle Number

The Quebec Cardiovascular Study was the first to demonstrate that heart attack can occur when LDL particle number is high and low-density lipoprotein level is low. Greater numbers of cholesterol-containing particles in the blood means more cholesterol deposition in plaque and therefore an increased risk for heart attack.

HDL Subclasses

A low level of large HDL particles may reduce the efficacy of the reverse cholesterol transport process. The large HDL subclass was identified in the Malmö Diet and Cancer Study to be inversely correlated with CHD risk.

LDL Subclasses

Small LDL subclass particles cause plaque buildup to progress much faster because they enter the artery wall more easily than large LDL particles. A predominance of smaller LDL particles, referred to as Pattern B lipid phenotype, represents an atherogenic lipid profile that is associated with CVD.

ApoB ApoB is the primary apolipoprotein attached to all atherogenic particles. It is involved in the metabolism and transport of lipids. A high ApoB number indicates increased risk for heart disease.

Lp(a) Lipoprotein(a) is an inherited protein that is attached to LDL. High levels of lipoprotein(a) increase risk of coagulation and contribute to atherosclerosis.

Sta

ble

Pla

que

Lipid PoolThick

Fibrous Cap

Rup

ture

-pro

ne P

laqu

e

Expanding Lipid Pool

Thin Fibrous Cap

Inflammation Risk Factors

Risk Factor Impact on Cardiovascular Disease (CVD)

MPO(Myeloperoxidase)

MPO is a marker of vascular-specific inflammation within the vessel lumen. Elevations occur due to white blood cell activation in response to fissures, erosions, or degradation of the fibrous cap. MPO is actively involved in atherosclerosis and is considered a near-term risk marker for cardiovascular events.

Lp-PLA2 (Lipoprotein-Associated Phospholipase A2)

Lp-PLA2 measures disease activity within the artery wall below the collagen or calcified cap due to activation of macrophages. The AHA and AACE guidelines list Lp-PLA2 as a strong and independent predictor of ASCVD events and may be valuable in identifying patients at increased CVD risk.

hs-CRP (High Sensitivity C-Reactive Protein)

The hs-CRP test is a highly sensitive quantification of CRP, an acute-phase protein released into the blood by the liver during inflammation. hs-CRP is a well-documented clinical marker of cardiac-related inflammation. 2013 ACC/AHA guidelines state hs-CRP may be useful in the evaluation of those at moderate risk for heart disease and determining whether or not more intensive treatment is warranted.

ADMA/SDMA(Asymmetric/Symmetric Dimethylarginine)

ADMA is an L-arginine derivative that inhibits nitric oxide production, an early manifestation of endothelial dysfunction and CVD progression. SDMA is a structural isomer of ADMA, but is primarily excreted in the urine and can indicate reduced renal function.

OxLDL(Oxidized LDL)

OxLDL measures oxidative protein damage of the ApoB subunit on LDL cholesterol. Elevated OxLDL promotes vascular inflammation and is associated with increased risk of metabolic syndrome, CAD, and CHD.

F2-IsoPs(F2-Isoprostanes)

Urinary F2-Isoprostanes (F2-IsoPs) measure oxidative stress in the body, primarily due to lifestyle risk factors. F2-IsoPs contribute to CVD progression through increased risk of vasoconstriction, platelet aggregation, and thrombus formation.

Test Name UnitsResult and Risk Category Result From Risk Category Ranges

Opti mal Moderate High Opti mal Moderate High

Lipid Panel Lab: EZ

CHOLESTEROL, TOTAL mg/dL 166 <200 200-239 >=240

HDL CHOLESTEROL mg/dL 61 >=40 N/A <40

TRIGLYCERIDES mg/dL 81 <150 150-199 >=200

LDL-CHOLESTEROL mg/dL 89 <100 100-129 >129

CHOL/HDLC RATIO calc 2.7 <=3.5 3.6-5.0 >5.0

NON-HDL CHOLESTEROL mg/dL 105 <130 130-159 >159

Apolipoproteins Lab: EZ

APOLIPOPROTEIN B mg/dL 80 <80 80-119 >=120

LIPOPROTEIN (a) nmol/L 77 <75 75-125 >125

Infl ammati on Lab: EZ

HS CRP mg/L 4.5 <1.0 1.0-3.0 >3.0

LP PLA2

nmol/min/mL

120 <=123 N/A >123

MYELOPEROXIDASE (MPO)

pmol/L 550 <470 470-539 >=540

Heart Failure Lab: EZ

PROBNP, N TERMINAL pg/mL 245 <253 N/A >=253

ST2, SOLUBLE ng/mL 30 <=35 N/A >35

Metabolic Markers Lab: EZ

HOMOCYSTEINE, CARDIOVASCULAR

umol/L 12.9 <11.4 N/A >=11.4

HEMOGLOBIN A1c% of total Hgb

5.8 <=5.6 5.7-6.4 >=6.5

VITAMIN D, 25-OH, TOTAL ng/mL 86 >=30 20-29 <20

INSULIN uIU/mL 10.0 <23 N/A >=23

GLUCOSE mg/dL 110 65-99 100-125 >=126

Omega 3 & 6 Fatt y Acids, Plasma Lab: EZ

OMEGA 3 (EPA+DHA) INDEX

% 4.5 >3.2 2.2-3.2 <2.2

For details on reference ranges please refer to the reference range/comment secti on of the report.

Pati ent Informati on Specimen Informati on Client Informati on

Age: 63 Fasti ng: Y Gender: M Collected 07/23/2016 High

Test Name UnitsResult with Risk Category

Result fromRisk Category Ranges

Opti mal Moderate High Opti mal Moderate High

Test Name Result Comments (See Guidance Statements)

Geneti c Cardiovascular Markers Lab: EZ

LPA ASPIRIN GENOTYPE lle/Met Heterozygous carrier: associated with elevated Lp(a) levels and CVD risk and aspirin response in some clinical studies.

KIF6 GENOTYPETrp/Arg Heterozygous carrier: associated with increased CHD risk and

greater CHD event reducti on with atorvastati n and pravastati n therapy in certain clinical studies.

9p21 GENOTYPE Homozygous carrier (rs10757278 and rs133049). Increased 9p21 associated CVD risk.

rs10757278 gg

rs1333049 cc

APO E GENOTYPE 3/3 Apo E3 Carrier. Most common (normal) genotype.

LPA INTRON 25 GENOTYPE tt Homozygous noncarrier.

CYP2C19 GENOTYPE *2 Intermediate Metabolizer.

4q25 AF RISK GENOTYPE Noncarrier: No increased 4q25 associated risk of atrial fi brillati on or cardioembolic stroke.

rs2200733 cc

rs10033464 gg

4myheart Diet & Exercise Coaching Program: Need help achieving and maintaining an opti mal weight? Managing stress? Trying to improve physical fi tness levels? The 4myheart program provides support and personalized lifestyle guidance to help improve heart health. Please talk to your provider, visit 4myheart.com or call 1.800.432.7889 opt 2 to learn more.

Medical Informati on for Healthcare Providers: If you have any questi ons about any of the tests in our Cardio IQ off ering, please call 1-800-432-7889 opt 3 to speak to a clinical liaison. For frequently asked questi ons, you can also visit us at htt p://educati on.QuestDiagnosti cs.com/faq/FAQ134

Lipoprotein Subfracti ons Lab: EZ

LDL PATTERN Patt ern A A N/A B

LDL PEAK SIZE Angstrom 220.1 >222.5 218.2-222.5 <218.2

High Terti le cut-points are based on a reference range populati on. Risk of CVD events is based on a reanalysis (unpublished) of the data presented in Musunuru et al. ATVB 2009;29:1975-80.

Low Risk Intermediate Risk Elevated Risk7.5%

<=1% 5% 7.5% >=10%

¨

Your Risk: 16.4%Your Goal

ATHEROSCLEROTIC CARDIOVASCULAR DISEASE (ASCVD) RISK EVALUATION

10-Year ASCVD Risk Assessment (%) Lab: EZ

10-year ASCVD risk categories: > or =7.5% elevated risk; 5% to <7.5% intermediate risk; and <5% lower risk. Risk esti mates for an ASCVD event (nonfatal MI, CHD death, or stroke) during the next 10 years are intended for pati ents currently free of clinical ASCVD; Risk was esti mated using the Pooled Cohort Equati ons; see Guidelines for ethnic group-specifi c considerati ons. [Stone et al. Circulati on 2013; Goff et al. Circulati on 2013]This pati ent-specifi c 10-year ASCVD risk goal is based on the pati ent’s age, sex, and ethnicity and opti mal levels for other risk factors. This risk goal is calculated using the Pooled Cohort Equati ons. [Goff et al. Circulati on 2013]

Lifeti me ASCVD Risk Assessment (%) Lab:EZ

NOT CALC % Not Calc: 10-year and/or lifeti me risk/goal is not calculated because the required pati ent risk factors have not been provided (age, sex, race, systolic blood pressure, blood pressure medicati on use, diabetes, and smoker status) or because a pati ent value is not in the range accepted by the calculator: total cholesterol (130-320 mg/dL) HDL cholesterol (20-100 mg/dL), systolic blood pressure (90-200 mm HG), age (20-59 years, lifeti me risk; 40-79 years, 10-year risk).

Your Risk

>=35

Test Name Results Results From Reference Range/Comments

Metabolic Markers (conti nued) Lab: SLI

VITAMIN D, 25-OH, D3 10 See below ng/mLReference Range: Not established

VITAMIN D, 25-OH, D2 76 See below ng/mLReference Range: Not established

Omega 3 & 6 Fatt y Acids, Plasma (conti nued) Lab: EZ

OMEGA 6/OMEGA 3 RATIO 12.0 5.7-21.3

EPA/ARACHIDONIC ACID RATIO 0.2 0.2 OR LESS

ARACHIDONIC ACID 8.5 5.2-12.9%

EPA 1.5 0.2-1.5%

DHA 3.0 1.2-3.9%

DIABETES RISK EVALUATION

Glucose value and assessment Lab:EZ

HbA1c value and assessment Lab:EZ

8 Year Diabetes Risk (%) Lab:EZ

NORMAL PRE-DIABETES DIABETES

Result consistent with increased risk for diabetes65 100 126 >=225

¨

NORMAL PRE-DIABETES DIABETES

Result consistent with increased risk for diabetes

<=4.5 5.7 6.5 >=8.0

¨

¨

110 mg/dL

5.8% of total Hgb

6%

OTHER DETAIL

<=3 5 10 15 20 25 30

Foods High in Omega-3*

Fish Oils Nuts and Seeds Grains and Beans

Salmon Walnut Walnuts Soybeans

Mackerel Soybean Flax seeds Tofu

Sardines Flax Pecans

Swordfi sh Canola

Bluefi sh Cod liver

Crab Olive

Cod Sardine

Scallops

*Adapted from htt p://www.tuft s.edu/med/nutriti on-infecti on/hiv/health_omega3.html March 13, 2012

The APPROXIMATE 8-year Percentage Risk esti mate is based upon the assessment of adults ages 30-79 in the Framingham study (Wilson PW, Meigs JB, Sullivan L, Fox CS, Nathan DM, D’Agosti no RB Sr. 2007 Predicti on of incident diabetes mellitus in middle-aged adults: the Framingham Off spring Study Arch Intern Med. 167:1068-74). An esti mate will not be provided if HbA1c and/or glucose indicate that the pati ent has diabetes. If fasti ng conditi ons were not met, use cauti on when interpreti ng the glucose test result and the 8-year Percentage Risk.

Personal Factors

Component Result Component Result

HEIGHT FEET 5 ft SYSTOLIC BLOOD PRESSURE 140 mm Hg

HEIGHT INCHES 8 in DIASTOLIC BLOOD PRESSURE 85 mm Hg

WEIGHT 155 lbs TREATMENT FOR HIGH B.P. YES

CALCULATED BMI 23.6 DIABETES NO

AFRICAN AMERICAN NO PARENTAL HISTORY OF DIAB NO

CURRENT SMOKER YES

Lipoprotein Subfracti ons Lab: EZ

LDL PARTICLE NUMBER nmol/L 1203 <1138 1138-1409 >1409

LDL SMALL nmol/L 236 <142 142-219 >219

LDL MEDIUM nmol/L 373 <215 215-301 >301

HDL LARGE nmol/L 9454 >6729 6729-5353 <5353

Test results are shown in “Optimal,” “Moderate,” or “High” risk categories, and are color-coded to display progressive risk values.

Historic results of previous tests are provided with the Cardio IQ report to help monitor patient progress.

Managing residual risk with advanced insightsAdvanced cardiovascular testing provides actionable information to individualize treatment options:

• Initiate/intensify statin therapy

• Identify opportunities for adjunct therapy

• Set diet, exercise, and lifestyle targets

The Cardio IQ® Enhanced Lab Report

Offering key insights for individualized patient treatment

This example represents the resulting report for an order of Advanced Lipid Panel with Inflammation, which includes:

Cardio IQ Lipid Panel with Reflex to Direct LDL

Cardio IQ Ion Mobility

Cardio IQ Apo B

Cardio IQ Lp(a)

Cardio IQ hs-CRP

Cardio IQ Lp-PLA2

Test Results Relative Risk Treatment Options‡§ Goal‡§

Elevated LDL Cholesterol

1.6x7 • Diet and exercise• Statins, ezetimibe, bile acid

sequestrants (BAS), PCSK9 inhibitors

LDL Cholesterol <100 mg/dLLDL Cholesterol reduction 30% to <50%Moderate-intensity statin dose groupLDL Cholesterol reduction >50% High-intensity statin dose group

Elevated Triglycerides

1.7–4.0x7 • Diet and exercise• Fibrates, high-dose omega-3 fatty

acids, nicotinic acid

Triglycerides <150 mg/dL

Elevated LDL Particle Number

1.4–2.3x8*,9,10 • Diet and exercise• Statins, ezetimibe, BAS, PCSK9

inhibitors

<1138 nmol/L

Elevated Small LDL Particles

1.3–2.1x8*,9,10

1.5x (sdLDL)11• Diet and exercise• Address excess LDL-P or ApoB • Consider therapies to address insulin

resistance (e.g., Metformin)

Small <142 nmol/LsdLDL ≤40.0 mg/dL

Elevated Medium LDL Particles

1.4–2.2x8*,9,10 • Diet and exercise• Address excess LDL-P or ApoB • Consider therapies to address insulin

resistance (e.g., Metformin)

Medium <215 nmol/L

Suboptimal Large HDL

1.8x (Large HDL)8*

1.9x (HDL2b)12

• Diet and exercise• May consider nicotinic acid

Large HDL >6729 nmol/LHDL2b >26% (Males); HDL2b >28% (Females)

Elevated ApoB Particles

2.0–2.5x13 • Diet and exercise• Statins, ezetimibe, BAS, PCSK9

inhibitors

ApoB <80 mg/dL

Elevated Lp(a)

1.5–5.3x14 • More aggressive lowering of LDL‡ or ApoB • Consider nicotinic acid

Lp(a) < 75 nmol/L

Elevated F2-Isoprostanes

1.8-2.6x15,16 • Diet, exercise, and smoking cessation• Assure optimal LDL‡ levels

F2-Isoprostanes <0.86 ng/mg creatinine

Elevated OxLDL 3.5-4.3x17,18 • Diet and exercise• Address LDL‡ and insulin sensitivity

OxLDL <60 U/L

Elevated ADMA/SDMA

1.4x (ADMA)19 • Diet and exercise• Statins• Assure major CVD risk factor goals are

achieved

ADMA <100 ng/mLSDMA 73-135 mg/mL

Elevated hs-CRP 2.3-2.9x20,21 • Diet and exercise• Address etiology• Consider subclinical CAD or insulin

resistance

hs-CRP <1 mg/L

Elevated Lp-PLA2 2.0x22† • Diet and exercise• More aggressive lowering of LDL‡

or ApoB • Consider omega-3 fatty acids

Lp-PLA2 ≤123 nmol/min/mL

Elevated MPO 2.0-2.4x23,24† • Diet and exercise• Assure major CVD risk factor goals

are achieved

MPO <470 pmol/L

* Expected risk of highest tertile versus lowest tertile assuming measure is normally distributed and risk increases linearly.

† The risk associated with elevated Lp-PLA2 or MPO levels is substantially increased in patients when either Lp-PLA222 or MPO23 is elevated with CRP.

‡ Includes LDL-C and LDL-P.

§ The treatment considerations are provided for informational purposes only and are not intended as medical advice. A physician’s test selection and interpretation, diagnosis, and patient management decisions should be based on his/her education, clinical expertise, and assessment of the patient.For more information on treatment options and goals per test, please see the Test Guide and/or Test Summary posted within the specific test’s section at QuestDiagnostics.com/TestCenter.

Other cardiometabolic testing

We offer additional advanced CVD tools for personalization of risk management in your patients. Options include deeper insight into functional areas important in managing CVD risk patients, such as inflammation status, myocardial stress, cardiometabolic state, and cardiovascular genetics.

Ordering Information

Test Name Test Code* CPT Code(s)*

Cardio IQ Advanced Lipid Panel with Inflammation** 94220(X) 80061, 83704, 82172, 83695, 86141, 83698

Includes:Cardio IQ Lipid Panel with Reflex to Direct LDL** 92061(X) 80061

Cardio IQ Lipoprotein Fractionation, Ion Mobility 91604(X) 83704

Cardio IQ Apolipoprotein B 91726(X) 82172

Cardio IQ Lipoprotein (a) 91729(X) 83695

Cardio IQ hs-CRP 91737(X) 86141

Cardio IQ Lp-PLA2 94218(X) 83698

Cardio IQ MPO 92814 83876

Cardio IQ ADMA/SDMA 94153 82542

Cardio IQ OxLDL 92769 83520

Cardio IQ F2-Isoprostane/Creatinine 92771 82542/82570

References

1. Benjamin EJ, Virani SS, Callaway CW, et al.On behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics 2018 update: a report from the American Heart Association. Circulation. DOI: 10.1161/CIR.0000000000000558. 2. Sachdeva A, Cannon CP, Deedwania PC, et al. on behalf of the Get-With-The-Guidelines (GWTG) Steering Committee and Hospitals. AHJ. 2009;157:111-117.e2.(1) 3. Reith C and Armitage J. Management of residual risk after statin therapy. Atherosclerosis. 2016;245:161-170 4. Third Report of the National Cholesterol Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel IIl) Final Report. Circulation. 2002;106(25):3143-3412. 5. 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;5:338-367. 6. Brunzell JD, Davidson M, Furberg CD, et al. Lipoprotein management in patients with cardiometabolic risk: consensus statement of the American Diabetes Association and the American College of Cardiology Foundation. Diabetes Care. 2008;31(4):811-822. 7. Miller M, Stone N, Ballantyne C, et al. Triglycerides and cardiovascular disease: a scientific statement from the American Heart Association. Circ. 2011;123:2292-2333. 8. Musunuru K, Orho-Melander M, Caulfield MP, et al. Ion mobility analysis of lipoprotein subfractions identifies three independent axes of cardiovascular risk. Arterioscler Thromb Vac Biol. 2009;29:1975-80. 9. Melander O, Shiffman D, Caulfield MP, et al. Low-density lipoprotein particle number is associated with cardiovascular events among those not classified into statin benefit groups. J Am Coll Cardiol. 2015;65(23):2571-2573. 10. Mora S, Caulfield MP, Wohlgemuth J, et al. Atherogenic lipoprotein subfractions determined by ion mobility and first cardiovascular events after random allocation to high-intensity statin or placebo. The justification for the use of statins in prevention: an intervention trial evaluating rosuvastatin (jupiter) trial. Circulation. 2015;132:2220-2229. 11. Hoogeveen R, Gaubatz J, Sun W, et al. Small dense low-density lipoprotein-cholesterol concentrations predict risk for coronary heart disease. Arterioscler Thromb Vasc Biol. 2014:34:00-00. 12. Williams PT and Feldman DE. Prospective study of coronary heart disease vs HDL2, HDL3, and other lipoproteins in Gofman’s Livermore Cohort. Atherosclerosis. 2011;214(1):196-202. 13. Sniderman AD, Williams K, Contois JH, et al. A meta-analysis of low density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein b as markers of cardiovascular risk. Circ Cardiovasc Qual Outcomes. 2011;4:337-345. 14. Nordesgaard B, Chapman MJ, Ray K, et al. Lipoprotein(a) as a cardiovascular risk factor: current status. Eur Heart J. 2010;31:2844-2853. 15. Kim JY, Hyun YJ, Jang Y, et al. Lipoprotein-associated phospholipase A2 activity is associated with coronary artery disease markers of oxidative stress: a case-control study. Am J Clin Nutr. 2008;88:630-637. 16. Roest M, Voorbij HAM, Van der Schouw YT, et al. High levels of urinary F2-isoprostanes predict cardiovascular mortality in postmenopausal women. J Clin Lipidol. 2008;2:298-303. 17. Meisinger C, Baumert J, Khuseyinova N, et al. Plasma oxidized low-density lipoprotein, a strong predictor for acute coronary heart disease events in apparently healthy, middle-aged men from the general population. Circulation. 2005;112:651-657. 18. Holvoet P, De Keyzer D, and Jacobs DR. Oxidized LDL and the metabolic syndrome. Future Lipidol. 2008;3(6):637-649. 19. Willeit P, Freitag DF, Laukkanen JA, et al. Asymmetric dimethylarginine and cardiovascular risk: systematic review and meta-analysis of 22 prospective studies. J Am Heart Assoc. 2015;4e001833. 20. Ridker PM, Cushman M, Stampfer MJ, et al. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med. 1997;336:973-979. 21. Ridker PM, Rifai N, Rose L, et al. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med. 2002;347:1557-1565. 22. Heslop CL, Frohlich JJ, and Hill JS. Myeloperoxidase and C-reactive protein have combined utility for long-term prediction of cardiovascular mortality after coronary angiography. J Am Coll Cardiol. 2010;55:1102-1109. 23. Cushman M, Judd S, Kissela, et al. Lipoprotein-associated phospholipase A2 (Lp-PLA2) activity and coronary heart disease risk in a biracial cohort: The reasons for geographic and racial differences in stroke (REGARDS) Cohort. Atherosclerosis. 2015;241:e1-e31. [Abstract] 24. Wong ND, Gransar H, Narula J, et al. Myeloperxoidase, subclinical atherosclerosis, and cardiovascular disease events. J Am Coll Cardiol. 2009;2(9):1093-1099.

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* Test codes may vary by location. Please contact your laboratory for more information. The CPT codes provided are based on AMA Guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed.

** Lipid Panel components may be ordered separately: Cholesterol, Total 91717(X)/334 (CPT 82465); Triglycerides 91718(X)/896 (CPT 84478); HDL Cholesterol 91719(X)/608 (CPT 83718). If triglyceride result is >400 mg/dL, Direct LDL Cholesterol will be performed at an additional charge (CPT 83721).