Advanced Lipoprotein Testing and Subfractionation Are Clinically Useful

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 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 risk.1 Advanced lipoprotein tests (ALTs) lend insight into subtle yet important aspects of lipoproteins and atherosclerosis that help to explain the relative failure of the LDL-C–lowering strategy to stem the epidemic of atherosclerosis.2 ALTs can be utilized in 4 basic ways: (1) to enhance the accuracy of atherosclerosis …