Handbook of Lipoprotein Testing

2nd ed, edited by Nader Rifai, G. Russell Warnick, and Marek H. Dominiczak, 819 pp, with illus, Washington, DC, American Association for Clinical Chemistry, 2000.This second edition continues a tradition of increasingly diverse updates in this expanding field of interest. Methods for Clinical Laboratory Measurement of Lipids and Lipoprotein Risk Factors in 1991 and Laboratory Measurement of Lipids and Lipoproteins and Apolipoproteins in 1994 were followed by the first edition of this handbook in 1997. The fourth book in the series updates not only with a discussion of the lipid-related topics in previous versions, but also with some nonlipid atherosclerotic risk factors.This 819-page soft-covered book has its 38 chapters divided into 3 major sections. The first is “Atherosclerosis and its Prevention” (8 chapters). This section reviews the pathophysiology of the atherosclerotic process, pre-analytical variation of the lipid components, and the diagnosis and treatment of lipid disorders. In addition to the usual risk factors, this section has a brief overview of homocysteine and high-sensitivity C-reactive protein. The second section (26 chapters), “Laboratory Aspects of Lipids, Lipoproteins, and Apolipoproteins,” constitutes the bulk of the handbook. The topics range from more common—the analysis of the traditional lipid moieties through apolipoproteins and lipid oxidation—to less common aspects—lecithin-cholesterol transferase protein, low-density lipoprotein (LDL) receptors, and nonesterified fatty acids. The discussion of some lipid constituents focuses almost entirely on clinical issues, with only a few sentences or a paragraph indicating the methodologies available. On the other hand, some citations describe the analytical steps in a very detailed fashion—including the technique of washing cuvets. Of particular interest is the in-depth discussion of small, dense LDL particles—their clinical significance and analysis. The third section (4 chapters), “Standardization and Regulatory Issues,” covers the difficult issues involved with standardizing the simpler lipid constituents (cholesterol and triglycerides) as well as the great need for reliable materials and methods for more complex constituents. Matrix effects, which often confound the analyses, are also considered.There are 68 contributors to this tome, including many luminaries in the lipid field. Among them are a pioneer of cholesterol assays, Bennie Zak; the Centers for Disease Control's Gerald Cooper; and Russ Warnick, innovator in many areas of lipid determinations. Most chapters have lists of reasonably up-to-date references, some as recent as 2000. The chapter on lipoprotein (Lp) (a) is notable for its extensive list of 346 references. The authors should be especially commended for not overemphasizing the clinical importance of some specific markers until evidence-based studies are available. An example is in chapter 16, with its review of 16 studies of atherosclerotic risk related to LDL particle size. The author concludes that the complexity of factors involved “make it difficult to determine an ‘independent’ risk of CHD [coronary heart disease] associated with small, dense LDL.” Likewise, in the chapter on lipoprotein (a), the authors in their summary state, “Currently the majority of measurements of Lp (a) concentration reported in clinical studies in the literature is confounded by isoform size, making it difficult to come to a sound conclusion regarding the role of Lp (a) concentration in disease.”In spite of its title, this volume should not be expected to be a source of detailed methodology, the so-called recipes that are needed to set up assays in the laboratory. Other sources must be used. However, the breadth of subject matter and depth of the discussions require that every hospital laboratory and pathology resident program have this text available as a resource.