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Clinical Use of Apolipoprotein Quantitation

IN RESPONSE: In our proposed algorithms, HDL cholesterol levels are initially determined as part of the fasting lipid panel. We agree that a decision to use drug therapy because of a low HDL cholesterol level could obviate the need for further apolipoprotein quantitation. However, because drug therapy for a low HDL cholesterol level is not established practice, we feel that the additional data provided by the apo B and Lp(a) levels cold be useful in determining drug therapy for persons with low HDL cholesterol levels. Two unfortunate misprint appeared in our review. As Dr. Padder and colleagues and Dr. Johnson and colleagues pointed out, a 10% decrease in apo B levels was associated with a 22% decrease in coronary artery disease mortality, and a 10% increase in Lp(a) levels was associated with a 3% increase in the risk for coronary artery disease. Finally, we applaud the international efforts to standardize apo A-I and apo B assays and look forward to when they will be fully implemented. We agree that the BUPA data support neither apo A-I nor HDL cholesterol as a measurement for population-based screening for coronary heart disease but cannot readily explain the discrepancy between the findings of this study and those of others.