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  • Review Article
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A diagnostic algorithm for the atherogenic apolipoprotein B dyslipoproteinemias

Nature Clinical Practice Endocrinology & Metabolism volume 4, pages 608–618 (2008)Cite this article

Abstract

Given the high prevalence of the atherogenic forms of apolipoprotein B (apoB) dyslipoproteinemias and the effectiveness of appropriate therapy, we feel that access for all physicians to simple, effective diagnostic aids that enable use of widely available technology is vitally important in clinical lipidology. In this Review, therefore, we present a diagnostic algorithm for the diagnosis of these disorders that is based on concentrations of total cholesterol, triglyceride and apoB. By including apoB values, lipoprotein number and composition can be deduced and each of the classic dyslipoproteinemias identified. All three parameters can be accurately and inexpensively determined in clinical laboratories and, therefore, this algorithm can be used by any physician to make an accurate diagnosis without use of specialist research laboratories. Just as the application of LDL cholesterol measurement moved clinical practice forward from plasma lipids to lipoprotein lipids, we believe that the use of apoB will further advance diagnosis and treatment of dyslipoproteinemias.

Key Points

  • Given the high prevalence of the atherogenic forms of apolipoprotein B (apoB) dyslipoproteinemias and the effectiveness of appropriate therapy, effective diagnostic aids are vitally important in clinical lipidology

  • LDL particles are heterogeneous in composition and, therefore, measurement of serum LDL cholesterol concentrations could underestimate the LDL particle number

  • We have created an algorithm based on total cholesterol, triglyceride and apoB levels; the inclusion of apoB enables the number and composition of lipoproteins to be deduced, and thereby the subtype of apoB dyslipoproteinemia to be identified

  • LDL make up the majority of atherogenic particles in plasma, each containing one molecule of apoB and, therefore, apoB level is determined by LDL particle number

  • All three parameters can be accurately and inexpensively determined in clinical laboratories and, therefore, this algorithm can be used by any physician to make an accurate diagnosis without use of specialist research laboratories

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Figure 1: Algorithm for the diagnosis of apolipoprotein B dyslipoproteinemias.

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Authors and Affiliations

  1. J de Graaf is Associate Professor in the Department of Medicine, Division of General Internal Medicine, Radboud University, Nijmegen Medical Center, Nijmegen, The Netherlands.,

    Jacqueline de Graaf

  2. P Couture is Director of the Residency Training Programme in Internal Medicine and Associate Professor of Medicine in the Lipid Research Centre at Laval University Medical Centre, Québec City, QC, Canada.,

    Patrick Couture

  3. A Sniderman is the Edwards Professor of Cardiology at McGill University and the Director of the Mike Rosenbloom Laboratory for Cardiovascular Research, Montréal, QC.,

    Allan Sniderman

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  1. Jacqueline de Graaf
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Correspondence to Allan Sniderman.

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de Graaf, J., Couture, P. & Sniderman, A. A diagnostic algorithm for the atherogenic apolipoprotein B dyslipoproteinemias. Nat Rev Endocrinol 4, 608–618 (2008). https://doi.org/10.1038/ncpendmet0982

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