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281 - Lipoproteins reporting: evidences based, decision limits

Autor(s): D. Giavarina

Issue: RIMeL - IJLaM, Vol. 6, N. 4, 2010 (MAF Servizi srl ed.)

Page(s): 281-8

Lipoproteins reporting is inhomogeneous between laboratories and could be a challenge for clinical pathologists both because the clinical question is not unique and because there are many different lipids and lipoproteins that could be measured with variable performances. Moreover, comparison systems cannot be based on the reference intervals theory, but proper decision levels have to be chosen for the evaluation and interpretation of the results. In the cardiovascular disease (CVD) risk evaluation, the risk assessment is a global evaluation and the same lipid concentration could have more or less importance, associated with the other risk factors. The National Cholesterol Education Program-Adult Treatment Panel III suggests reporting different decision levels as desirable, border line-high abnormal and high abnormal. However, it would be better to integrate information derived by lipid concentration with the other risk factor, as age, diabetes, high blood pressure, smoke, reporting the global risk. In the drug monitoring defined decision levels are recommended by authoritative guidelines, with more than one decision limit per test, according to the patient risk. Some problems are given by the continuous update of these limits towards lower levels, more efficient in the CVD prevention, but inducing more aggressive drug therapies. Finally, new lipids or lipoproteins are proposed to substitute total and fractioned cholesterol and triglycerides. Lipoproteins ratios reporting, as total Cholesterol/HDL Cholesterol, seems to be more predictive in the populations with elevated CVD risk and having good performances also in the secondary prevention. The number of atherogenic particles is stronger correlated with CVD than the concentration level of cholesterol contained in the same particles. So, measurement of Apolipoproteins B and A-I seems to be more accurate than the measure of HDL and LDL-Cholesterol concentrations. ApoB/ApoA-I ratio has a higher positive predictive value that every other lipid, lipoproteins or combined panel. Lp(a) has a proved but lower utility, while other tests have less evidence, as l’Apo A-II, Apo B48, Apo C, Apo D e Apo E o Small- LDL Cholesterol. Conclusions. Lipoproteins reporting, particularly in the risk assessment, is a decision making action that could decide for a drug therapy. This decision could be very efficient in patients with elevated CVD risk or inappropriate in subjects with low risk, also if with high lipoproteins levels.

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