OBJECTIVES: To evaluate the effectiveness of a comprehensive lipoprotein profile (VAP) test coupled with an aggressive treatment protocol when compared to a standard lipid profile test in patients with ischemic heart disease (IHD) or congestive heart failure (CHF). METHODS: All WellMed health plan enrollees with a diagnosis of IHD or CHF who had continuous enrollment between July 1, 2006 and June 30, 2008 were identified.  The case group (n=1767) having at least one VAP test during this period was compared with the control group (n=289) having no lipid testing or traditional lipid testing only. Univariate statistics were analyzed to describe the groups, and bivariate statistical tests (t-test or chi-square) examined differences between the two cohorts.  RESULTS: Use of a treatment protocol in conjunction with a VAP test resulted in a significant decrease in LDL (-6.64 mg/dL, <0.001) as well as an increase in HDL (3.95 mg/dL, <0.001). Individuals in the control group saw a significant decrease in LDL (-6.14 mg/dL, 0.002) but did not see a significant change in HDL (-1.21 mg/dL, 0.076). Combination drug therapy was more commonly used for cases when compared to controls (average drug types 2.1 vs. 1.8, 0.0004); particularly, the use of niacin containing products was considerably higher in the case group when compared to the control group (36% vs. 14.4%, <0.0001). Mean total costs in year 1 ($4,308 vs. $5,141, 0.1157) and year 2 ($4,853 vs. $7,413, 0.0255) were lower for cases. CONCLUSIONS: Greater utilization of combination therapy guided by the VAP test appears to better manage IHD and CHF patients to NHLBI ATP III HDL and LDL targets than controls receiving usual care guided by traditional lipid testing. Advanced lipid profile tests appear to offer clinicians better information about their patients’ lipid abnormalities when compared to traditional testing.