Measurement of Lipoproteins: Upping the Game in Characterizing the Lipid Phenotype

Cardiovascular disease (CVD)2 remains a significant cause of morbidity and mortality worldwide. Although significant progress has been made in reducing the prevalence of CVD in the developed world, countries adopting the Westernized high-fat, high-sugar, low-exercise lifestyle have shown an increasing prevalence (1). It is also important to recognize the paradigm shift in understanding the underlying pathophysiology of CVD. The previous model was of a progressive increase in size over time of an atheromatous plaque encroaching on the lumen of a vessel producing, initially, angina due to partial blockage and then, subsequently, complete occlusion (hence ischemic injury). The demonstration that acute plaque rupture/destabilization affecting a nonocclusive and often non–flow-limiting lesion was the mechanism of acute coronary injury (2) has resulted in evidence-based interventions. These evidence-based interventions, derived from the results of large-scale multicenter clinical trials, have significantly reduced the morbidity and mortality for acute myocardial infarction. There has also been significant progress in primary prevention (where there is no known underlying CVD) and secondary prevention (where the individual is known to …