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(Circulation. 2009;119:2383-2395.)
© 2009 American Heart Association, Inc.

Controversies in Cardiovascular Medicine

Are advanced lipoprotein testing and subfractionation clinically useful?

Advanced Lipoprotein Testing and Subfractionation Are Clinically Useful

H. Robert Superko, MD

From the Center for Genomics and Human Health, Atlanta, Ga.

Correspondence to H. Robert Superko, MD, Center for Genomics and Human Health, 5669 Peachtree Dunwoody Rd NE, Suite 315, Atlanta, GA 30342. E-mail Robert.Superko@celera.com

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Advanced lipoprotein testing and subfractionation have been used for scientific medical investigations in humans for >50 years. Original work from the Framingham Heart Study and the Lawrence Livermore Study, which was conducted at the University of California, first suggested the clinical utility of such advanced testing and provided the groundwork for future research. In the subsequent >50 years, clinical trials have documented that aspects of these tests contribute insight into the atherogenic process that is independent of standard lipid test results. Multiple lifestyle and pharmacological treatment studies have been conducted that reveal significant differences in response to treatment based on lipoprotein subclass classification. These changes in lipoprotein subclass distribution have been linked to differences in arteriographic outcome. Standard tests of low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) misidentify coronary heart disease (CHD) risk status in a substantial portion of the population. Tests of apolipoprotein concentrations are superior to standard LDL-C tests, and it can be argued that they should replace standard lipoprotein cholesterol testing. Advanced lipoprotein tests that were previously available only from university research laboratories are now provided by several commercial laboratories. Although clinical utility has been demonstrated, on the basis of research laboratory quality tests, caution is advised relative to quality control issues and commercial laboratory testing.

Response by Mora on p 2395

	History and Recent Changes

 
Over the past 2 decades, evidence has revealed that standard lipoprotein measurements of triglycerides, total cholesterol, LDL-C, and HDL-C fail to identify many lipoprotein abnormalities that contribute to CHD and peripheral vascular disease . . . [Full Text of this Article]

This article has been cited by other articles:

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