[New methods in lipid research]

Arteriosclerosis is an insidious multifactorial disease. Treatment relies mainly on prevention. Abnormal lipoproteins are major risk factors leading to arteriosclerosis in general and specifically to coronary artery disease. Lipid-related risk factors should be evaluated in a stepwise process. The first step involves screening for raised fasting levels of blood cholesterol and triglycerides. Depending on the initial results, further classification may be required based on the blood levels of high density lipoproteins (HDL). Concentration of low density lipoproteins (LDL) can be calculated from blood cholesterol, triglycerides, and HDL levels. These two parameters, HDL-cholesterol and LDL-cholesterol are essential to evaluate the risk of coronary artery disease. Currently, it is difficult to interpret the results of apolipoprotein AI and B assays since it has not been proved that the evaluation of coronary risk, as defined from HDL-cholesterol and LDL-cholesterol levels, is modified with the incorporation of apolipoprotein values. In addition, assay methods have not been standardized, hindering the use of apolipoprotein levels in evaluating risk. The basic assay methods provide a wide range of results, making it possible to measure subfractions of lipoproteins which would play a protective preventive role against arteriosclerosis. Lipoprotein A1 (LpAI) is protective while Lp(a) is an atherogenic lipoprotein. Both LpAI and Lp(a) are now routine laboratory tests and provide essential information for helping the clinician define the risk of arteriosclerosis and thus to make therapeutic decisions. In the future, genetic markers will undoubtedly provide better means of appreciating the pathophysiological mechanisms of arteriosclerosis and thus the risk of arterial lesions.