Your healthcare provider has ordered a Boston Heart Cardiac Risk Assessment

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1 Your healthcare provider has ordered a Boston Heart Cardiac Risk Assessment What does that mean for you?

2 Your healthcare provider has determined that you may be at risk for cardiovascular disease (CVD). With a Boston Heart Cardiac Risk Assessment, you ve taken an important step toward prevention and improving your heart health!

3 What is CVD? Cardiovascular disease, or CVD, refers to a number of conditions related to the heart or blood vessels. These include hypertension (high blood pressure), coronary artery atherosclerosis (build up of fatty deposits in blood vessels supplying the heart), cerebrovascular atherosclerosis (build up of fatty deposits in blood vessels supplying the brain) and peripheral vascular disease (blockage of large blood vessels in the legs or arms), to name a few. Such conditions, if not properly treated, may lead to a CVD event such as acute heart failure, myocardial infarction (heart attack), angina (chest pain), thrombosis (abnormal blood clot in a blood One in three Americans over 82,000,000 people suffer from some form of cardiovascular disease.* vessel) or cerebrovascular accident (stroke). Other factors such as smoking, obesity and family history can contribute to the risk of a CVD event. Many forms of CVD can be prevented or treated with healthy lifestyle choices and proper medication. * Heart Disease and Stroke Statistics 2011 Update. A Report From the American Heart Association. Circulation. 2011;123: e18-e209. 3

4 Until now, you ve probably only had a standard lipid panel. The blood tests you may have already had are part of a standard lipid panel, a combination of tests used routinely for many years to evaluate the amounts of fatty substances (lipids) in the blood. This test panel measures many different types of lipids. These include total cholesterol (TC), lowdensity lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TGs). LDL-C is often referred to as bad cholesterol, while HDL-C is good cholesterol. If your LDL-C was elevated, your doctor may have recommended some lifestyle modifications and/or 50% of people who ve had a heart attack have normal cholesterol.* prescribed medication. But lowering your bad cholesterol may not be enough to keep your heart healthy. * Sachdeva A, Cannon CP, Deedwania PC, Labresh KA, Smith SC Jr, Dai D, Hernandez A, Fonarow GC. Lipid levels in patients hospitalized with coronary artery disease: an analysis of 136,905 hospitalizations in Get With The Guidelines. Am Heart J. 2009;157(1): e2. 4

5 Why might you be at risk for CVD? You may have a family history of CVD or other risk factors such as dyslipidemia (abnormal lipid levels in your blood) that predispose you to CVD. A common type of dyslipidemia is elevated LDL-C, so called bad cholesterol. This disorder is often treated with a statin, a cholesterol-lowering medication such as Crestor or Lipitor. Numerous clinical trials, however, have shown that lowering LDL-C reduces your relative risk for a CVD event by an average of 25%. Many patients still go on to experience a heart attack or stroke and many do not survive. The fact is, according to current guidelines and standards of care, even after lowering your LDL-C, blood pressure and other measurements, you may still have a 75% risk of a CVD event. This remaining risk is called residual risk, and is what a Boston Heart Cardiac Risk Assessment will evaluate. 5

6 How is a Boston Heart Cardiac Risk Assessment different? Boston Heart Diagnostics uses a unique approach to assess the 75% residual risk for a CVD event that remains after lowering your LDL-C. This is done using proprietary blood tests, available only through Boston Heart Diagnostics, such as the Boston Heart HDL Map and the Boston Heart You receive a personalized treatment plan tailored just for you. Cholesterol Balance tests. Other specialized tests may also be included in your personal Cardiac Risk Assessment. These blood tests provide additional useful information about factors that may be affecting your heart health, and significantly complement the results of your standard lipid profile. Your blood tests are analyzed in combination with your family history, lifestyle, medications, and existing clinical conditions. Finally, you and your healthcare provider receive a comprehensive risk assessment and individualized patient report all delivered in a thorough, easy-to-understand format. 6

7 Know the facts about CVD * 7 Each year, over 1,000,000 Americans have a new or recurrent coronary attack. The mortality rate from coronary attacks is about 40%. That means more than 2,000 Americans die of CVD each day that s one death every 39 seconds! Every year, about 800,000 Americans have a new or recurrent stroke. Stroke is the leading cause of serious, long-term disability in the United States. About every 40 seconds, someone in the United States has a stroke, and every 4 minutes, someone dies of a stroke. CVD claims more lives each year than cancer, chronic lower respiratory disease and accidents combined. If all forms of major CVD were eliminated, life expectancy would rise almost 7 years. In contrast, if all forms of cancer were eliminated, the estimated gain would be 3 years. * Heart Disease and Stroke Statistics 2011 Update. A Report From the American Heart Association. Circulation. 2011; 123: e18-e209. Centers for Disease Control and Prevention. National Center for Health Statistics (NCHS). Accessed May 10, 2013.

8 Boston Heart Cardiovascu To help assess your CVD risk or other health conditions, your healthcare provider may order some of these tests. Test name Boston Heart Proprietary Tests Boston Heart HDL Map TM Boston Heart Cholesterol Balance TM Statin Induced Myopathy (SLCO1B1) Genotype Other Advanced Risk Markers Small Dense LDL Cholesterol (sdldl-c) Lipoprotein(a) [Lp(a)] Apolipoprotein B (apob) High Sensitivity C-Reactive Protein (hs-crp) Lipoprotein-Associated Phospholipase A 2 (LpPLA 2 ) Homocysteine (Hcy) Visit bostonheartdiagnostics.com for more information on our complete test offering. 8

9 lar Risk Tests What does this test measure and why is it important? There are many different types of HDL particles found in HDL-C. Some are associated with increased CVD risk whereas others are cardioprotective. The Boston Heart HDL Map distinguishes the good from the bad and will identify which specific particles are in your blood. The Boston Heart Cholesterol Balance test provides valuable information about cholesterol production and absorption in the body. The information from these two tests enables your healthcare provider to prescribe the most effective treatment strategy for reducing your CVD risk. The Statin Induced Myopathy (SLCO1B1) Genotype identifies individuals who may have trouble metabolizing a group of medications called statins. Knowing this information determines if you are at higher risk of developing muscle aches, spasms, and pain associated with statin therapy, and helps your healthcare provider select a statin and dose that is least likely to cause complications. This group of specialty tests help identify the causes of the residual risk (described on page 5) of a CVD event after LDL-C lowering. High blood levels of the cholesterol found in smaller, denser LDL (sdldl-c) particles are associated with atherosclerosis the build-up of fatty materials in arteries increasing the risk for CVD events. Lp(a) is an LDL-like particle with a protein known as apo(a) attached to it. An elevated level of Lp(a) is an independent risk factor for heart attack and other cardiovascular diseases. ApoB is a marker for the number of cholesterol carrying particles in the blood that cause atherosclerosis. Elevated levels are significant predictors of heart disease and are a more reliable indicator of CVD risk than LDL-C. CRP is produced in response to inflammation and excess deposition of cholesterol and other fats in the liver and other tissues. High levels predict CVD events, and CRP is a useful monitoring tool after initiating treatment. LpPLA 2 is an enzyme produced by a type of white blood cell that causes inflammation in artery walls. Increased blood levels are associated with increased atherosclerosis. This test is also known as the PLAC test. Homocysteine is an amino acid that is produced by the body from the breakdown of methionine, an essential amino acid we receive from protein-rich foods. High levels of homocysteine are linked to a variety of specific health problems and are associated with increased risk for cardiovascular disease, peripheral artery disease, stroke and osteoporosis.

10 Boston Heart Cardiovascu Test Name Standard Lipid Panel Total Cholesterol (TC) Direct Low-Density Lipoprotein Cholesterol (LDL-C) High-Density Lipoprotein Cholesterol (HDL-C) Triglycerides (TGs) Non-HDL Cholesterol (Non-HDL-C) Very Low-Density Lipoprotein Cholesterol (VLDL-C) Apolipoprotein A-I (apoa-i) Genetic Tests Apolipoprotein E (ApoE) Factor II Factor V Clopidogrel Response Statin Induced Myopathy (SLCO1B1) Genotype (See Proprietary Tests) Other tests available from Boston Heart Diagnostics are those that assess kidney, muscle, liver and thyroid function, as well as the metabolism of glucose (sugar) in your body, all of which may affect your heart health. N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP) 25-hydroxy Vitamin D Visit bostonheartdiagnostics.com for more information on our complete test offering. 10

11 lar Risk Tests continued What Does This Test Measure and Why Is It Important? A standard lipid panel identifies problems related to cholesterol and triglyceride levels in blood. Abnormalities of cholesterol and triglycerides are associated with increased risk for developing CVD. Although LDL-C is a common test in a standard lipid panel, at Boston Heart Diagnostics, it is directly measured (versus calculated). A direct measurement of LDL-C provides a more accurate result than an estimated LDL-C determined by calculation. Non-HDL-C and VLDL-C are additional routine calculations included in this panel. The information from these tests enables your healthcare provider to prescribe the most effective treatment strategy for reducing your CVD risk. ApoA-I is the protein found in the good cholesterol (HDL particles) in your blood. Low levels in your blood mean you are at increased risk of heart disease. Conversely, high levels decrease your risk. ApoE is a protein found in some types of lipoproteins. The ApoE genetic test identifies different forms (or genotypes) of the ApoE gene. It provides useful information about how your body absorbs fatty substances in the intestine and liver, as well as your risk of developing CVD, and age-related cognitive function decline. Factor II and V are proteins essential for blood clotting. Tests that measure mutations (genetic changes) in these proteins help determine if you are at higher risk of forming blood clots. The Clopidogrel Response genetic test (CYP2C19) identifies which patients may have trouble metabolizing a medication called clopidogrel (PLAVIX ) to its active form in the body or those who may metabolize it too rapidly. Knowing this is important because the information helps determine if you need normal, higher or lower doses of clopidogrel. NT-proBNP is a hormone that is released into the blood due to decreased function of heart muscle. High levels are a very significant predictor of CVD events and outcome. 25-hydroxy vitamin D is a hormone precursor that promotes bone, calcium and phosphorus metabolism. Low levels are associated with muscle weakness and fatigue, significant bone loss, osteoporosis and increased risk of fractures. Studies have linked vitamin D deficiency to increased risk of metabolic syndrome, diabetes, and heart disease.

12 Take action to reduce your risk. Your Boston Heart Cardiac Risk Assessment results in a personalized treatment plan that is tailored just for you. By working with your healthcare provider and sticking to your plan, together you can predict, prevent, manage and reverse your risk of CVD for a longer, healthier life! If you need financial help, call us. At Boston Heart Diagnostics, our mission is to improve heart health. That s why we ve developed our Patient Assistance Support Services (PASS), a program intended to provide access to our laboratory services for all patients, regardless of their financial circumstances. Customer Service Representatives are available to help you learn more about the benefits of our PASS program, how to participate and to develop a personalized solution based on your individual circumstances. Please contact our Customer Service Department at , option 5, or via at Or visit our website at bostonheartdiagnostics.com to learn more. 175 Crossing Blvd., Suite 100 Framingham, MA p) f ) e) w) bostonheartdiagnostics.com 2013 Boston Heart Diagnostics Corporation. All rights reserved. The Boston Heart Diagnostics logo, Boston Heart HDL Map and Boston Heart Cholesterol Balance are trademarks of Boston Heart Diagnostics. PLAVIX is a registered trademark of Sanofi-Aventis. Crestor is a registered trademark of AstraZeneca. Lipitor is a registered trademark of Pfizer. Boston Heart Diagnostics reserves the right to change this document at any time without notice and disclaims liability for editorial, pictorial or typographical errors Printed in USA

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