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Cardio Diabetes Medicine 2017 357

mia is available but not routinely used as it has not of a Lipid Profile: Clinical and Laboratory Implications Including
been evaluated Flagging at Desirable Concentration Cutpoints-A Joint Consensus
Statement from the European Atherosclerosis Society and European
Type 3 hyperlipidaemia or dysbetalipoproteinaemia Federation of Clinical Chemistry and Laboratory Medicine. Clin Chem.
Apolipoprotein E(ApoE) is a ligand that facilitates re- 2016 Jul;62(7):930-46.
moval of chylomicron remnant particles to the liver 4. Jellinger PS, Handelsman Y, Rosenblit PD, Bloomgarden ZT, Fonseca
through a receptor-mediated mechanism. The gene VA, Garber AJ, Grunberger G, Guerin CK, Bell DSH, Mechanick JI,
Pessah-Pollack R, Wyne K, Smith D, Brinton EA, Fazio S, Davidson
for ApoE exists in 3 isoforms- 2,3 and 4. Each indi- m. american association of clinical endocrinologists and american
vidual inherits 2 genes in any combination, one from college of endocrinology guidelines for management of dyslipidemia
each of the parents. Apo 3,3 is considered as normal. and prevention of cardiovascular disease. Endocr Pract. 2017 Apr;23(-
All others bothheterozygous or homozygous for the Suppl 2):1-87.
2 isoform are likely to have raised TGlevels and the 5. Clinical Lipidology A companion to Braunwald’s heart disease1st Edi-
genotype with the 2,2 isoform is pathological causing tion Christie M Ballantyne Saunders Elsevier SBN 978 1 4160 5469 6
the dysbetalipoproteinaemia syndrome Ultracentrifu-
gation and isolating the beta VLDL and electropho-
retic techniques may reveal the abnormal fraction,
but requires expertise. Electrophoresis using iso elec-
tric focusing helps differenciate the three isoforms. A
ratio of ApoB to total cholesterol below 0.15 has also
been shown to differentiate this condition from oth-
er mixed hyperlipidaemias. Apo E phenotyping using
isoelectric focusing can be set up and/or genotyping
can be made available in specialist laboratories.

No specialist investigations are available to investi-
gate type 4 or type 5 hyperlipidaemia.
It is essential to consider a diagnosis when lipid ab-
normalities present and appropriate investigations
are likely to help with a diagnosis and screening of
family members for an early diagnosis. More elabo-
rate diagnostic markers may be required in managing
these patients as many novel drugs are being investi-
gated and may require more precise diagnosis before
these drugs are administered.

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