Hypercholesterolemia and Dyslipidemia: Issues for the Clinician.

The current state of the art in the diagnosis and treatment of lipoprotein disorders has progressed beyond the standard "lipid profile," which includes total low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol, along with fasting triglycerides. Incorporating aspects of the atherogenic lipoprotein profile (ALP) (ALP and LDL subclass distribution), HDL subclass distribution, apolipoprotein E isoforms, lipoprotein (a), homocysteine, and high-sensitivity C-reactive protein provides the clinician with the tools to create a more detailed, accurate, and personalized diagnosis of disorders contributing to coronary artery disease in their patients. Sophisticated laboratory tests are available to clinicians through technology transfer programs as exemplified by the Lawrence Berkeley National Laboratory/Berkeley HeartLab, Berkeley, CA, collaboration and allow clinicians access to research quality laboratory tools. This has significant clinical relevance because the presence of these disorders guides treatment that is specific to the disorder(s). Appropriate treatment has been shown to have significantly greater clinical benefit in patient subgroups exhibiting the disorder the therapy is most likely to correct. A single drug or lifestyle therapy plan is no longer appropriate for all patients. The treatment must match the individual disorder(s).