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PROGRESS IN THE TRANSITION FROM MEASURING LIPIDS TO APOPROTEINS IN THE CLINICAL LABORATORY

Burnett, John R.

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Pathology - Journal of the RCPA: 2010 - Volume 42 - Issue - p S19
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LDL is the major atherogenic lipoprotein particle in plasma. Current guidelines recommend measurement of a fasting lipid profile for cardiovascular risk assessment. In routine clinical practice, the Friedewald formula is used to estimate LDL cholesterol, but it has limitations. Direct measures of LDL cholesterol are available, but they are not standardised and are not as good as β quantification; a labour intensive, time consuming and expensive process that requires ultracentrifugation. Each particle of VLDL, IDL, LDL and Lp(a) contains a single molecule of apoB. Hence, plasma apoB concentrations reflect the total number of atherogenic particles in the circulation. The measurement of apoB is standardised and simple to perform in routine clinical laboratories, does not require fasting and is not inherently expensive. Accumulating evidence suggests that apoB is superior to LDL cholesterol in predicting cardiovascular risk. Achieving a target level of apoB may therefore be a more important therapeutic objective than a target level of LDL cholesterol. Plasma apoB is comparable to that of the apoB:apoA‐I ratio and is a better marker of cardiovascular risk than lipids, lipoproteins and lipid ratios. At this juncture, none of the major treatment guidelines have yet formally incorporated apoB (or apoA‐I) into their recommendations. It remains to be shown as to whether the use of apoB will improve outcomes when used in routine clinical care.

© 2010 Royal College of Pathologists of Australasia