Arteriosclerosis is an insidious multifactorial disease. Treatment relies mainly on prevention. Abnormal
lipoproteins are major risk factors leading to
arteriosclerosis in general and specifically to
coronary artery disease.
Lipid-related risk factors should be evaluated in a stepwise process. The first step involves screening for raised fasting levels of blood
cholesterol and
triglycerides. Depending on the initial results, further classification may be required based on the blood levels of
high density lipoproteins (HDL). Concentration of
low density lipoproteins (
LDL) can be calculated from blood
cholesterol,
triglycerides, and HDL levels. These two parameters,
HDL-cholesterol and
LDL-cholesterol are essential to evaluate the risk of
coronary artery disease. Currently, it is difficult to interpret the results of
apolipoprotein AI and B assays since it has not been proved that the evaluation of coronary risk, as defined from
HDL-cholesterol and
LDL-cholesterol levels, is modified with the incorporation of
apolipoprotein values. In addition, assay methods have not been standardized, hindering the use of
apolipoprotein levels in evaluating risk. The basic assay methods provide a wide range of results, making it possible to measure subfractions of
lipoproteins which would play a protective preventive role against
arteriosclerosis.
Lipoprotein A1 (LpAI) is protective while Lp(a) is an atherogenic
lipoprotein. Both LpAI and Lp(a) are now routine laboratory tests and provide essential information for helping the clinician define the risk of
arteriosclerosis and thus to make therapeutic decisions. In the future,
genetic markers will undoubtedly provide better means of appreciating the pathophysiological mechanisms of
arteriosclerosis and thus the risk of arterial lesions.