As I understand it, keeping the pad flat will actually reduce heat since there is more surface area to dissipate heat over the entire pad. Lifting the pad too much concentrates the heat on a relatively small section of the pad.
Perfectly flat or tilted SLIGHTLY kinda depends on the pad itself with the shape of the pad being the biggest factor. For instance, the Edge pads here at the DC onlone store....I can keep them flat with no problem (most of the time) but on pads like the Lake Country VC pads if you kept them flat only a very small area would be touching the surface. Tilting them up slightly allows more of the surface area to be used. Same goes with the Valugard foam pads I use.