Walter, here's a very useful article about what VAP testing looks for.

http://cholesterol.about.com/lw/Health-Medicine/Drugs-and-treatments/The-VAP-Tes
t-Beyond-Traditional-Cholesterol-Testing.htm

Ypu don't seem to have furnished all the components or the lab reference
ranges, though.

  Unfortunately, it calles LDL "bad" cholesterol and HDL "good."
That's stupid stuff.  LDL is what all of our sex hormones and life
sustaining steroids are made from to protect us during illness and
stress, to regulate our electrolytes and to regulate immunity.

It's true that low TGL and high HDL combined is a marker for bouyant,
non atherogenic LDL. It's also true that in large studies, LDL is the
least predictive lipid of CVD and TGLs are the most predictive
individual risk marker.

An HDL/TGL ratio below 3 is considered good.  I have cholesterol and LDL
as high as yours, yet the Harvard risk calculator rates me as below
average risk for my very high HDL and low TGLs.  Your HDL could be
higher, but if your TGLs are under 100, probably not important.

The fact that your pattern leans toward the A pattern is another
indicator that you're on the right track metabolically.

I would suggest two things, one at a time; the first is to get a cheap
blood glucose monitor at Walmart (Relion, the test strips are the
cheapest) and start testing your blood glucose according to this:

http://www.alt-support-diabetes.org/new.php

Next, depending upon your results, consider either taking 150 mg of
silymarin with meals and alpha lipoic acid, time released 300 mg twice
daily.  ALA will reduce insulin resistance, silymarin will lower post
meal glucose.

If your bg is always below 140 (actually, between 85-110 or so at all
times is ideal), then try the stuff in the citations below to lower LDL
and raise HDL.  It does everything a statin does without any of the
damage that statins do:

[Evaluation of the cholesterol-lowering effectiveness of pantethine in
women in perimenopausal age]

[Article in Italian]

Binaghi P, Cellina G, Lo Cicero G, Bruschi F, Porcaro E, Penotti M.

Servizio di Cardiologia, Istitut Clinici di Perfezionamento, Milano.

Cardiovascular diseases are the main cause of death also in women. Their
incidence, rapidly growing in the peri-menopausal period, is related to
serum levels of total cholesterol and its LDL fraction. It was also
shown that the peroxidation of LDL is an additional factor in the
genesis of atherosclerotic vascular disease. As long-term treatments
with synthetic lipid-lowering drugs may cause undesirable side effects,
while pantethine is known to be well tolerated, we treated 24
hypercholesterolemic women (total serum cholesterol greater than or
equal to 240 mg/dl), in perimenopausal age (range: 45-55 years, mean +/-
SD = 51.6 +/- 2.4) with 900 mg/day of pantethine. This is a precursor of
coenzyme A, with an antiperoxidation effect in vivo, and our aim was to
confirm its lipid lowering activity in this particular type of patients.
After 16 weeks of treatment, significant reductions of total
cholesterol, LDL-cholesterol and LDL-C/HDL-C ratio could be observed. No
remarkable changes of the main laboratory parameters (fasting blood
sugar, B.U.N., creatinine, uric acid) were seen. Efficacy percentages of
the treatment were about 80%. None of the patients complained of adverse
reactions due to the treatment with pantethine. In conclusion, we
suggest that pantethine should be considered in the long-term treatment
of lipid derangements occurring in the perimenopausal age.

PMID: 2359503 [PubMed - indexed for MEDLINE]
1: Acta Biomed Ateneo Parmense. 1984;55(1):25-42.     Related Articles, Links

[Hyperlipidemia, diabetes and atherosclerosis: efficacy of treatment
with pantethine]

[Article in Italian]

Arsenio L, Caronna S, Lateana M, Magnati G, Strata A, Zammarchi G.

The hypolipidemizing effects of Pantethine were investigated by the
Authors in 37 hypercholesterolemic and/or hypertriglyceridemic patients.
Of these, 21 were also diabetic, in a satisfying glucidic compensation,
in order to verify the action of this drug also in this metabolic
condition. The study was carried out for three months and during this
period the patients were given Pantethine at the dose of 600 mg/die
orally. At the 30th, the 60th, the 90th day of treatment the following
parameters were controlled: cholesterolemia, HDL cholesterol,
apolipoproteins A and B, triglyceridemia, systolic and diastolic
arterial pressure, uricemia, body weight. Thirty days after suspending
the treatment, the parameters were controlled again to detect a possible
"rebound" effect. The results were analyzed on the whole case-record,
subdividing the patients in dislipidemic and diabetic-dislipidemic, and
on the basis of the Fredrickson's classification. Pantethine induced in
all groups a quick and progressive decrease of cholesterolemia,
triglyceridemia, LDL cholesterol and Apolipoproteins B with increased
HDL cholesterol and Apolipoproteins A. After suspending the treatment,
there is a clear inversion of the state of these parameters. The Authors
conclude that the present work shows that Pantethine, a natural and
atoxic substance, an important component of Coenzyme A, is efficacious
in determining a clear tendency towards normalization of the lipidic values.

PMID: 6232801 [PubMed - indexed for MEDLINE]
1: Atherosclerosis. 1984 Jan;50(1):73-83.     Related Articles, Links

Controlled evaluation of pantethine, a natural hypolipidemic compound,
in patients with different forms of hyperlipoproteinemia.

Gaddi A, Descovich GC, Noseda G, Fragiacomo C, Colombo L, Craveri A,
Montanari G, Sirtori CR.

Pantethine (P), the stable disulphate form of pantetheine, major
component and precursor of coenzyme A, was evaluated within a
double-blind protocol (8 weeks for P or for a corresponding placebo) in
29 patients, 11 with type IIB hyperlipoproteinemia, 15 with type IV, and
3 with an isolated reduction of high density lipoprotein cholesterol
(HDL-C) levels. In type IIB patients, P (300 mg t.i.d.) determined a
highly significant lowering of plasma total and low density lipoprotein
(LDL) associated cholesterol (-13.5% for both parameters). In the same
patients, HDL-C levels increased about 10% at the end of treatment.
Switching from P to placebo was associated with a rapid return to the
baseline cholesterolemia. Both in type IIB and type IV patients, plasma
triglyceride levels were reduced around 30%, when P was given as the
first treatment; when it was preceded by placebo, reductions were less
striking (respectively, -17.8% for type IIB and -13.0% for type IV, at
the end of P treatment). HDL-C levels were not increased by P, either in
type IV, and in the patients with low HDL cholesterolemia. In type IV,
LDL cholesterol levels showed a variable response to P: they tended to
increase when below 132 mg/dl, prior to treatment, and to be reduced
when above this level. This study provides evidence for a significant
hypocholesterolemic effect of P, a natural compound free of overt side
effects. It also indicates that P may raise HDL-C levels in type IIB
patients, while moderately reducing triglyceridemia.

Publication Types:
•    Clinical Trial
•    Controlled Clinical Trial

PMID: 6365107 [PubMed - indexed for MEDLINE]
1: Int J Clin Pharmacol Ther Toxicol. 1986 Nov;24(11):630-7.     Related
Articles, Links

Lipoprotein changes induced by pantethine in hyperlipoproteinemic
patients: adults and children.

Bertolini S, Donati C, Elicio N, Daga A, Cuzzolaro S, Marcenaro A,
Saturnino M, Balestreri R.

Following a brief outline of current knowledge concerning
atherosclerosis and its treatment, the authors describe the results
obtained by treating with pantethine (900-1200 mg daily for 3 to 6
months) a series of 7 children and 65 adults suffering from
hypercholesterolemia alone or associated with hypertriglyceridemia
(types IIa and IIb of Fredrickson's classification). Pantethine
treatment produced significant reduction of the better known risk
factors (total cholesterol, LDL-cholesterol, triglycerides, and apo-B)
and a significant increase of HDL-cholesterol (signally HDL2) and
apolipoprotein A-I. The authors conclude with a discussion of these
results and of the possible role of pantethine in the treatment of
hyperlipoproteinemia, in view of its perfect tolerability and
demonstrated therapeutic effectiveness.

PMID: 3098691 [PubMed - indexed for MEDLINE]

Pantethine reduces plasma cholesterol and the severity of arterial
lesions in experimental hypercholesterolemic rabbits.

Carrara P, Matturri L, Galbussera M, Lovati MR, Franceschini G, Sirtori CR.

Pantethine (P), a coenzyme A precursor, was administered to
cholesterol-fed rabbits (0.5% cholesterol diet + 1% pantethine) for 90
days. At the end of treatment, plasma total cholesterol levels were
reduced 64.7% and the HDL/total cholesterol ratio increased in P-treated
animals; a significant rise of the apo A-I/A-II ratio was detected in
HDL. VLDL lipid and protein levels were, on the other hand, reduced by
P. The cholesterol-ester content of both liver and aortic tissues was
not significantly affected by P. Although the total aortic area with
evident plaques was reduced only 18.2%, the microscopical examination of
sections from the major vessels of P-treated animals, showed a reduction
in the severity of lesions, both in the aorta and in the coronary
arteries. These findings suggest that P, in addition to significantly
lowering plasma cholesterol levels in rabbits on an experimental diet,
may modify lipid deposition in major arteries, possibly by affecting
lipoprotein composition and/or exerting an arterial protective effect.

PMID: 6442152 [PubMed - indexed for MEDLINE]
Clin Ther. 1986;8(5):537-45.     Related Articles, Links

Effectiveness of long-term treatment with pantethine in patients with
dyslipidemia.

Arsenio L, Bodria P, Magnati G, Strata A, Trovato R.

A one-year clinical trial with pantethine was conducted in 24 patients
with established dyslipidemia of Fredrickson's types II A, II B, and IV,
alone or associated with diabetes mellitus. The treatment was well
tolerated by all patients with no subjective complaints or detectable
side effects. Blood lipid assays repeated after 1, 3, 6, 9, and 12
months of treatment revealed consistent and statistically significant
reductions of all atherogenic lipid fractions (total cholesterol,
low-density lipoprotein cholesterol, and apolipoprotein B) with parallel
increases of high-density lipoprotein cholesterol and apolipoprotein A.
The results were equally good in patients with uncomplicated
dyslipidemia and in those with associated diabetes mellitus. The authors
conclude that pantethine (a drug entity related to the natural compound,
pantetheine) represents a valid therapeutic support for patients with
dyslipidemia not amenable to satisfactory correction of blood lipids by
diet alone.

PMID: 3094958 [PubMed - indexed for MEDLINE]
Acta Biomed Ateneo Parmense. 1987;58(5-6):143-52.     Related Articles, Links

[Clinical use of pantethine by parenteral route in the treatment of
hyperlipidemia]

[Article in Italian]

Arsenio L, Bodria P, Bossi S, Lateana M, Strata A.

Servizio di Malattie del Ricambio e Diabetologia, Ospedali Riuniti, Parma.

Recent investigations have confirmed the effectiveness and the excellent
tolerability of pantethine, a derivative of pantetheine, an essential
part of the acetylation coenzyme CoA, administered P.O., in normalizing
the blood lipid concentrations of patients with hyperlipidemias. A group
of 18 patients with hyperlipidemias (9 M, 9 F), with an average age of
52.6 years, was submitted to pantethine parenteral treatment. After a 20
days wash-out, pantethine (400 mg/day; BID) was administered
intramuscularly, for 20 days. Total cholesterol, triglycerides,
HDL-cholesterol, apo A-1 and B lipoprotein, uric acid in serum,
glycemia, CBC, B.U.N., creatininemia, E.S.R., SGOT, SGPT, bilirubinemia,
cardiac frequency, blood pressure and body weight were controlled before
and after treatment. The drug showed to have a therapeutic effectiveness
by a rapid and significant improvement in the blood lipid pattern with
reduction of total cholesterol, triglycerides and apo-B lipoprotein and
increase of HDL-cholesterol and apo A-1 lipoprotein. The tolerability of
pantethine at the stated dosage and mode of administration was
invariably excellent, with non complaints or visible side effects
imputable to the test drug. BUN, creatininemia, glycemia, SGOT, SGPT,
bilirubinemia, E.S.R., CBC, cardiac frequency and blood pressure
readings showed no noteworthy changes throughout the study.

PMID: 2970754 [PubMed - indexed for MEDLINE]

1: Vopr Pitan. 1987 Mar-Apr;(2):15-7.     Related Articles, Links

[Therapeutic efficacy of pantothenic acid preparations in ischemic heart
disease patients]

[Article in Russian]

Borets VM, Lis MA, Pyrochkin VM, Kishkovich VP, Butkevich ND.

The therapeutic effectiveness of the pantothenic acid drugs:
calciipantothenas and pantethine, was studied in 182 patients with
coronary heart disease and stable angina of effort. It is shown that
both the drugs produce favourable effects on certain parameters of
hemodynamics, on the metabolism of lipids, riboflavin and ascorbic acid.
It is recommended that the administration of calciipantothenas in a dose
of 300 mg/day, during 3 weeks, be included into the combined treatment
of coronary patients with no manifest disorders of lipid metabolism.
Patients with manifest hyperlipidemia should be administered pantethine
in a dose of 500 mg/day.

PMID: 3590676 [PubMed - indexed for MEDLINE]

1: Clin Nephrol. 1986 Feb;25(2):70-4.     Related Articles, Links

Pantethine improves the lipid abnormalities of chronic hemodialysis
patients: results of a multicenter clinical trial.

Donati C, Barbi G, Cairo G, Prati GF, Degli Esposti E.

In the course of a post-marketing surveillance program on the
effectiveness and tolerability of pantethine in the treatment of
hyperlipidemia, the effects of the drug were explored in 31 patients
with dyslipidemia undergoing chronic hemodialysis. The mean duration of
treatment was 9 months (min. 7 months, max. 24 months), with oral doses
of 600 to 1200 mg of pantethine daily (mean daily dosage 970 mg).
Improvement was noted in terms of total blood cholesterol in the 7
patients with basal hypercholesterolemia (p less than 0.01) and highly
significant reduction of serum triglycerides. No variations of
HDL-cholesterol or total Apo-A were detected. None of the patients
experienced any adverse effects from the treatment. In the light of
extensive experience with the drug, plus the results of this study, the
authors conclude by stressing the importance of an effective and readily
tolerated product, such as pantethine, for the treatment of dyslipidemia
in patients on chronic hemodialysis.

Publication Types:
•    Clinical Trial

PMID: 3516477 [PubMed - indexed for MEDLINE]
1: Artery. 1987;15(1):1-12.     Related Articles, Links

Lowering effect of pantethine on plasma beta-thromboglobulin and lipids
in diabetes mellitus.

Eto M, Watanabe K, Chonan N, Ishii K.

Second Department of Internal Medicine, Asahikawa Medical College, Japan.

Pantethine in a dosage of 600 mg for the first 3 months, and in a dosage
of 1200 mg for the second 6 months was given to 16 diabetics in whom
plasma beta-thromboglobulin was raised (greater than 50 ng/ml). Plasma
beta-TG levels decreased significantly with pantethine treatment for 9
months. Plasma triglyceride, total cholesterol, apo E and apo CII levels
decreased significantly after 9 months. Plasma LDL-C and atherogenic
index (LDL-C/HDL-C ratio or apo B/apo AI ratio) tended to decrease with
treatment. It is concluded that administration of pantethine may be
beneficial in the prevention of diabetic angiopathy because of its
lowering effect on plasma beta-TG, lipids and apolipoproteins.

PMID: 2963604 [PubMed - indexed for MEDLINE]
1: Ter Arkh. 1991;63(11):58-60.     Related Articles, Links

[The use of pantothenic acid preparations in treating patients with
viral hepatitis A]

[Article in Russian]

Komar VI.

Calcium pantothemate in the daily dose 300 mg and 600 mg and pantetheine
in the dose 90 mg and 180 mg per os were applied for 3-4 weeks in
combined therapy of 156 patients with viral hepatitis A. In addition to
the positive clinico-biochemical effect, these drugs produced an
immunomodulatory action and a beneficial effect on the level of blood
serum immunoglobulins and the phagocytic activity of peripheral blood
neutrophils. Pantetheine provided the most pronounced therapeutic effect.

PMID: 1810066 [PubMed - indexed for MEDLINE]
1: Clin Ter. 1989 Mar 31;128(6):411-22.     Related Articles, Links

[Pantethine, diabetes mellitus and atherosclerosis. Clinical study of
1045 patients]

[Article in Italian]

Donati C, Bertieri RS, Barbi G.

After a review of the clinical studies on the treatment of diabetic
patients with pantethine, the authors discuss the results obtained in a
postmarketing surveillance (PMS) study on 1045 hyperlipidemic patients
receiving pantethine (900 mg/day on average). Of these patients, 57 were
insulin-dependent (Type I) and 241 were non insulin-dependent (Type II)
diabetics. Beyond the epidemiological considerations made possible by a
PMS study, the authors show that pantethine brought about a
statistically significant and comparable improvement of lipid metabolism
in the three groups of patients, with very good tolerability. Pantethine
should therefore be considered for the treatment of lipid abnormalities
also in patients at risk such as those with diabetes mellitus.

PMID: 2524328 [PubMed - indexed for MEDLINE]
1: Vopr Pitan. 1983;(1):45-9.     Related Articles, Links

[Pantothenic acid metabolic disorder and its relation to the change in
energy processes in patients with ischemic heart disease and hypertension]

[Article in Russian]

Borets VM, Ovchinnikov VA, Mironchik VV, Moiseenok AG, Lis MA.

Pantothenic acid metabolism and the status of energy processes in
leukocytes were examined in 171 patients with hypertension and coronary
heart disease. It was shown that the patients' body supply with the
vitamin decreased as the disease progressed and heart failure
supervened. The deficiency of pantothenic acid was shown to be
interrelated with the impairment of energy processes. Application of
pantothenate in a dose of 200 mg a day for two weeks led to the
increased content of pantothenic acid and to normalization of energy
processes.

PMID: 6837001 [PubMed - indexed for MEDLINE]
1: Angiology. 1987 Mar;38(3):241-7.     Related Articles, Links

Effect of oral treatment with pantethine on platelet and plasma
phospholipids in IIa hyperlipoproteinemia.

Prisco D, Rogasi PG, Matucci M, Paniccia R, Abbate R, Gensini GF, Neri
Serneri GG.

In a single-blind, crossover, completely randomized study, the effects
of oral treatment with pantethine or placebo on fatty acid composition
of plasma and platelet phospholipids were investigated in 10 IIa
hyperlipoproteinemic patients. A significant decrease of total
cholesterol and total phospholipids was observed both in plasma and in
platelets after a twenty-eight-day treatment. In plasma, pantethine
induced a decrease of the ratio sphingomyelin/phosphatidylcholine.
Moreover, a relative increase of n3-polyunsaturated fatty acids both in
plasma and in platelet phospholipids and a decrease of arachidonic acid
in plasma phospholipids were observed. These results indicate that
pantethine can affect plasma and platelet lipid composition with
possibly favorable influences on the determinants of cell membrane fluidity.

Publication Types:
•    Clinical Trial
•    Randomized Controlled Trial

PMID: 3551695 [PubMed - indexed for MEDLINE]