Abstract
Lipoprotein-related risk of cardiovascular disease (CVD) can be adequately predicted in subjects with elevated total cholesterol and low-density lipoprotein (LDL-)cholesterol using the available guidelines. However, individuals with dyslipidemia can have normal total- and LDL-cholesterol concentrations. Many statin-treated patients remain at high residual risk of CVD despite achieving LDL goals. The small dense LDL phenotype, frequently presenting with hypertriglyceridemia and low high-density lipoprotein (HDL-)cholesterol (lipid triad), may contribute to failure to identify and treat high-risk individuals. Therefore, calculated non-HDL-cholesterol is recommended as secondary therapeutic target to LDL-cholesterol in patients with hypertriglyceridemia and mixed dyslipidemia. On-treatment apolipoprotein B adds prognostic information to LDL- and non-HDL-cholesterol by indicating the total number of atherogenic lipoproteins, regardless of their cholesterol content. Risk may be higher than indicated in the risk estimation systems in additional subjects with elevated lipoprotein(a) and homocysteine concentrations. To improve the (post-)post-analytical phase of lipid tests, aiming for maximal health outcome effectiveness of test interpretation and utilization, laboratory professionals should deliver clinical added value services by providing readily interpreted and guideline-adjusted test reports, interpretative commenting, proactive reflex testing or recommending additional tests, and joining multidisciplinary cooperations in guideline development and cost/benefit studies.
About the author
Dr. Michel Langlois, born October 13, 1967 studied Medicine at the University of Ghent, Belgium and specialized in Laboratory Medicine with emphasis on clinical chemistry and cardiovascular diagnostics. He presented his PhD thesis on the haptoglobin polymorphism in 1997, followed by his postdoctoral research on iron metabolism and oxidative stress in 1998 – 2001. Since 2001, he continued his activities in clinical chemistry and lipidology at AZ St-Jan hospital, Bruges, combined with a position of Professor at Ghent University (since 2009). Prof. Langlois is current President of the Royal Belgian Society of Clinical Chemistry (RBSCC), Vice-President of the Belgian Lipid Club (Belgian Atherosclerosis Society), and member of the European Federation of Clinical Chemistry and Laboratory Medicine (EFCC) Working Groups “Cardiac Markers” and “Guidelines”. For his research in risk biomarkers of atherosclerosis he received 9 scientifi c awards. Prof. Langlois is Editorial Board member of the journal Clinica Chimica Acta and a scientifi c reviewer for many other international journals including CCLM.
©2012 by Walter de Gruyter Berlin Boston
