The role of lipoproteins and apolipoproteins in prediction of coronary heart disease risk.
Recent consensus conferences are recommending dietary intervention to lower serum cholesterol in a substantial portion of the population. These recommendations are based on analyses of serum cholesterol in clinical research laboratories which were under rigorous quality control. Sources of biological and analytical variation in serum cholesterol, which may be greater in the routine clinical laboratory or cholesterol screening programme than in a research laboratory, must be recognized by the physician and health care workers for effective use of the diagnostic information and monitoring of treatment procedures in a potentially large segment of the population. The estimation of lipoprotein cholesterol concentrations now offers a more precise measure of risk and should be considered for individuals at modest risk of premature cardiovascular disease on the basis of total cholesterol with a strong family history of cardiovascular disease but mild serum cholesterol elevations (5.2-6.2 mmol/L). The combined estimation of low and high density lipoproteins provides a more accurate estimate of cardiovascular disease risk than total serum cholesterol if the methodology for their estimation is under rigorous quality control. There is strong evidence that genetic variation in apolipoprotein structure provides a significant contribution to variation in serum cholesterol values. The two most common allelic apolipoprotein variants, apo E and apo (a), cause significant effects on serum cholesterol for a substantial portion of the population. Furthermore apo (a), which shows extensive sequence homology with plasminogen, may promote the deposition of lipoprotein (a) in the artery and interfere with fibrinolytic processes following inappropriate thrombus formation.(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Biochemistry, Dalhousie University, Halifax, Nova Scotia.
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Breckenridge
D001053:Apolipoproteins / Q000097:blood*; D002784:Cholesterol / Q000097:blood; D003327:Coronary Disease / Q000097:blood*; D006801:Humans; D008074:Lipoproteins / Q000097:blood*; D012307:Risk Factors
D001053:Apolipoproteins; D008074:Lipoproteins; D002784:Cholesterol