Learn about Singulex tests and ways to help improve heart health

Specialized Singulex blood tests can help uncover hidden cardiovascular disease risk that other tests may miss.Understanding your Singulex test results can help you learn about the current state of your heart and blood vessels, and how you can improve your cardiovascular health. To make things clearer, the Singulex Clinical Laboratory report color-codes results: “green” for normal, “yellow” for some risk, and “red” for high risk. If you have red or yellow results, you can take action to change many of them.

Take action to improve your heart healthYou can significantly lower your risk for cardiovascular disease by taking your medication as directed and by making some new “heart healthy” lifestyle habits.

Live healthierImprove your sleep quality

Choose heart-healthy foods and/or reduce portion size

Develop an activity routine that you enjoy, and stick with it

Reduce your stress as much as possible, and learn ways to manage the stress you can’t avoid

Take advantage of SingulexWellness™, a personalized counseling and education program that helps you improve your heart health by providing:

» Access to Clinical Health Educators – registered nurses who are experts in heart-healthy nutrition, medication reminders, exercise, weight and stress management

» Guidance and support in developing a personalized Wellness Action Plan that will help you stick to your healthier lifestyle choices

©2014 Singulex, Inc. Singulex®, SgxHD®, and SingulexWellness™ are trademarks or registered trademarks of Singulex, Inc.

97-0095-04

Risk Categories

high some normal

* Singulex Clinical Laboratory. Singulex proprietary lab developed tests were developed and performance characteristics were determined by Singulex. These tests have not been cleared or approved by the U.S. Food and Drug Administration

Change your red and yellow scores to green

over time

INSURANCE COVERAGEIf a claim for your Singulex laboratory testing services is submitted to your insurance company, you may receive a statement called an Explanation of Benefits (EOB) from your insurer. The EOB documents the way in which your claim was processed. The EOB is NOT a bill and you do not need to make payment based upon the information it contains. You should, however, retain a copy for your records.

Occasionally, your insurance company may issue a check payment directly to you instead of Singulex. If you do receive such a check, please sign the back of the check and write “Payable to Singulex”. Please send the check to our Billing Department, along with a copy of the EOB.

www.singulex.com 1.800.400.4344

Questions?Singulex, Inc.

Attn: Billing Dept Dept CH 19669

Palatine, IL 60055

Sample Test Report

Apo B (apolipoprotein B) is found on the surface of LDL. High levels have been shown to better predict increased heart and blood vessel disease risk than LDL measurements alone.

Apo A1 (apolipoprotein A1) is found on the surface of HDL, and is related to cholesterol removal. Therefore, a high level of Apo A1 may help lower your heart disease risk.

IMPROVEMENT SUGGESTIONS

Lifestyle changes such as regular physical activity, maintaining healthy weight, limiting carbohydrates, sugar and alcohol, and developing a heart healthy diet may help lower levels of dyslipidemia results. Your doctor can also discuss certain medications or supplements that may help.

Specialized blood tests from Singulex can play a key role in your heart healthEach Singulex test measures a different area of heart and blood vessel health

LDL (low density lipoprotein) – High LDL indicates that you have too much “bad cholesterol,” which increases your risk for cardiovascular disease (CVD).

HDL (high density lipoprotein) – Low HDL indicates increased risk because HDL (the “good” cholesterol) plays an important role in carrying cholesterol out of arteries to the liver for removal from the body.

Adiponectin* is a heart-protective hormone that may help fight inflammation. Low levels are related to obesity (especially abdominal fat), increased inflammation, heart disease, and type 2 diabetes.

Leptin* is a hormone that regulates normal appetite and energy use. High levels can indicate an increased risk of type 2 diabetes and heart disease. Maintaining a high-protein/low-carbohydrate diet may lower levels.

Cortisol is a hormone that controls blood sugar, inflammation, and immune response. Constant stress can lead to regularly high levels, increasing risk for type 2 diabetes and heart disease. Getting more sleep, reducing stress and addressing sleep apnea may help lower cortisol levels.

Ferritin – High levels can mean too much iron in the body, which can contribute to inflammation and increased risk for heart disease and type 2 diabetes. This condition can be improved by reducing consumption of red meat and “iron-fortified” foods or vitamins (cereals, energy bars, etc.).

Glucose – A high glucose (blood sugar) level can mean there is significant risk of type 2 diabetes and heart disease.

HbA1c (hemoglobin A1c) measures average blood sugar over the past 3 months. An elevated HbA1c may prompt your doctor to do more tests for type 2 diabetes.

Cystatin C – High levels of Cystatin C are an early sign of kidney problems, as well as a risk factor for heart disease, heart attack, and stroke. Medications may be prescribed and blood pressure control suggested to lower levels.

Insulin is a hormone that controls the level of glucose in your blood. Elevated fasting insulin levels may mean that your body is having a difficult time controlling your blood sugar, which can put you at increased risk for type 2 diabetes and heart disease.

*Singulex Clinical Laboratory. Singulex proprietary lab developed tests were developed and performance characteristics were determined by Singulex. These tests have not been cleared or approved by the U.S. Food and Drug Administration

*Singulex Clinical Laboratory. Singulex proprietary lab developed tests were developed and performance characteristics were determined by Singulex. These tests have not been cleared or approved by the U.S. Food and Drug Administration

*Singulex Clinical Laboratory. Singulex proprietary lab developed tests were developed and performance characteristics were determined by Singulex. These tests have not been cleared or approved by the U.S. Food and Drug Administration

Vitamin D – Low levels of Vitamin D, or “Vitamin D deficiency,” can occur in people who are obese or have dark skin, as well as those with poor diets or limited exposure to the sun. This deficiency decreases the body’s ability to process calcium and increases inflammation, which can contribute to high blood pressure, and increase the risk of heart attack, heart failure, and low bone density. Safe sun exposure, a diet high in vitamin D, and supple-ments may help Vitamin D levels.

PTH (parathyroid hormone) – High PTH levels are most often seen with kidney disease and/or low vitamin D levels, and are related to increased risk for type 2 diabetes, heart disease, and heart disease-related death. Considerations should address the cause of increased PTH, which can mean treating low vitamin D.

TSH (thyroid stimulating hormone), T3/Free T3 (triiodothyronine), T4/Free T4 (thyroxine) – Abnormal values of these thyroid tests can mean that there are changes in cholesterol and protein digestion that can lead to increased heart disease risk. Medications may help balance the hormones.

Uric Acid – High levels of uric acid increase heart disease risk, and can be caused by kidneys not getting rid of waste efficiently, or by a purine-heavy diet (purines are found in some meats, seafood and alcohol and form uric acid when broken down in the body). Lowering dietary purines or taking medications may help lower uric acid levels.

Testosterone – Low testosterone in men is related to increases in abdominal fat, blood pressure and cholesterol, all factors involved in increasing heart disease risk. The opposite is true in women, for whom high testosterone levels may be related to increased heart disease risk.

SHBG (sex hormone binding globulin) is a protein that attaches to testosterone and turns it off. Measuring the unattached testosterone that is active allows physicians to initiate and monitor appropriate therapy.

IMPROVEMENT SUGGESTIONS

Considerations for improving cardio- metabolic test results include weight management, regular physical activity, a heart healthy diet, quitting smoking and in some cases a low-carbohydrate diet. Discuss with your doctor if certain medications my be right for you.

CARDIOMETABOLIC TESTS These tests assess your risk for developing type 2 diabetes and heart disease. Managing diabetes and pre-diabetes is critical for maintaining heart health

FUNCTIONAL CARDIAC TESTSThese tests measure how well your heart muscle is working

Endothelin* can cause blood vessels to tighten, which can raise blood pressure. A high level may predict how far along blood vessel disease has progressed, and may also be related to chronic heart failure, kidney disease, sleep apnea, and diabetes.

Homocysteine – High levels can be a risk marker for heart disease. This can also mean that your vitamin levels of B12 and B6 are too low.

Inflammation is the body’s natural response to injury or infection. However over time inflammation may lead to cholesterol-rich build-up (called plaque) in the arteries. This build-up can block arteries and trigger a heart attack or stroke, or cause other problems in the body.

INFLAMMATION TESTSThese tests show how inflammation may be impacting your blood vessel health

HDL2b* (high density lipoprotein 2b) is the largest of the HDL particles and the most effective at carrying cholesterol out of the arteries to the liver for removal. Low levels indicate increased heart disease risk.

Lp(a)* [lipoprotein (a)] is an inherited cholesterol-carrying particle. A high level is a big risk factor for heart disease. Lifestyle changes usually do not affect Lp(a) levels, but medications may be considered.

Triglycerides – If you regularly eat more calories than you burn or are eating a diet high in carbohydrates, your triglycerides (a type of fat) can climb to unhealthy levels, increasing your risk for heart disease and diabetes.

sdLDL* (small dense LDL) can enter artery walls more easily, causing increased inflammation and heart disease risk. High levels are common for those at risk for diabetes.

IL-6* (interleukin- 6), IL-17A* (interleukin- 17A), and TNF-α* (tumor necrosis factor- alpha) are released into the bloodstream during the process of inflammation, which may cause plaque build-up in the arteries. If left untreated, this build-up can increase your risk of having a heart attack or stroke.

Lp-PLA2 (lipoprotein-associated phospholipase A2) – A high result is a warning that inflammation and “rupture-prone” plaque may be present in your arteries. Rupture-prone plaque is more likely to break off in blood vessels, and is a major cause of sudden heart attacks and strokes.

hs-CRP (high-sensitivity c-reactive protein) – A high result is another warning sign of inflammation in your body, which may cause plaque build-up in your arteries, increasing your risk of a heart attack or stroke.

IMPROVEMENT SUGGESTIONS

Considerations for improving inflammation test results include maintaining a healthy weight, regular physical activity, keeping blood pressure within normal range, managing stress and quitting smoking. Discuss with your doctor if certain medications may be right for you.

Cardiac Troponin-l* is released into the bloodstream when your heart muscle is injured or stressed. This test is able to find and measure small amounts of cardiac troponin, potentially revealing early damage to the heart muscle that can be repaired or sometimes reversed.

NT-proBNP (N-terminal pro b-type natriuretic peptide) is released into the blood stream when heart muscle cells are overly stretched because they are working too hard. High levels of NT-proBNP may prompt your doctor to do additional testing to determine the cause.

IMPROVEMENT SUGGESTIONS

Addressing the causes of damage or stress to the heart, regular physical activity, maintaining a heart healthy weight and diet, improving sleep quality, drinking more water and quitting smoking may improve functional cardiac test results. Your doctor can also recommend certain medications.

DYSLIPIDEMIA TESTS These tests measure the size and amount of fat and protein parts (lipoproteins) in your blood, such as cholesterol