Lipid risk factors and atherosclerosis: what do we measure?

Coronary atherosclerotic disease remains the major cause of mortality and morbidity in western societies. Despite significant reductions in the incidence of death associated with the disorder over the last 30 years, especially in the United States, there is an urgent need to identify more clearly the underlying causative agents so that primary and secondary prevention programs can be implemented. A number of lipid parameters such as total and LDL-cholesterol have withstood long-term evaluation, and have met all the criteria necessary to designate them as playing a causative role in coronary atherosclerosis. These two parameters, especially LDL-cholesterol, is now the focus of a number of public health initiatives in various countries. The role of HDL-cholesterol is still not yet certain, while that of triglycerides is still clouded. A host of newer lipid associated (apolipoprotein) parameters are currently under investigation and it will be a number of years before any of these could be designated in the same class as LDL-cholesterol. Among the apolipoprotein measurements, Apo B appears to be the most promising in terms of meeting requirements to elevate it from risk factor to causative agent.