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QJM Advance Access originally published online on February 27, 2006
QJM 2006 99(5):277-287; doi:10.1093/qjmed/hcl027
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© The Author 2006. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Review

Apolipoproteins as markers and managers of coronary risk

D.C. Chan and G.F. Watts

From the School of Medicine and Pharmacology, University of Western Australia, Lipid Disorders Clinic, Royal Perth Hospital, Perth, Australia

Address correspondence to Professor G.F. Watts, School of Medicine and Pharmacology, University of Western Australia, Royal Perth Hospital, GPO Box X2213, Perth, WA 6847, Australia. email: gfwatts{at}cyllene.uwa.edu.au

Coronary artery disease (CAD) is a major cause of morbidity and mortality in Western communities. Reliable indices of coronary risk assessment and targets for drug treatment are important to the management of patients. Although plasma LDL cholesterol is well established as a predictor of CAD, it may not be the best circulatory marker. Results from recent epidemiological studies and statin trials suggest that apolipoprotein B-100 (apoB), with or without apoA-I, is superior to LDL cholesterol in predicting coronary events. Measurements of apolipoproteins are internationally standardized, automated, cost-effective and more convenient and precise than those for LDL cholesterol. ApoB may also be preferable to the measurement of non-HDL cholesterol. Measurement of apolipoproteins (apoB and possibly apoA-I) should be routinely added to the routine lipid profile (cholesterol, triglycerides and high-density lipoprotein cholesterol) to assess the atherogenic potential of lipid disorders. This is particularly relevant to dyslipidaemias characterized by an elevation in plasma triglycerides. Apolipoproteins, especially apoB, could also replace the standard ‘lipid profile’ as a target for therapy in at-risk patients.


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