Lipids: Current Perspectives 1. [antikvár]

Preface As might be predicted from its title, I have not planned this book to be a comprehensive review of lipid metabolism, its disorders, and their management. Rather, I have asked acknowledged experts in the field to address topics which I judge to be of current interest and importance because of significant advances, continuing controversy, or both. The book falls conveniently into three main sections. In the first, Lipids and lipoproteins, I thought it important to lay a strong foundation for the volume with a review of metabolism together with a critical evaluation of laboratory measurement of lipid and lipoprotein concentrations. There is no doubt that plasma triglycerides are an important risk marker for coronary heart disease (CHD). However, controversy remains concerning the 'independence' of this association. Hopefully a more thorough understanding of the individual triglyceride-rich lipoproteins and their role in atherogenetic processes will provide the way forward together with clinical trial data. Lipoprotein (a) was discovered just over 30 years ago and remains something of an enigma in terms of its metabolism despite the massive research attention devoted to it in the past decade. Interest in modified lipoproteins and atherogenesis stems from the discovery of the scavenger receptor in the 1970s. Oxidative mechanisms became the front runner for in vivo LDL modification in the 1980s and research continues apace in this area which hopefully will lead to new strategies for the prevention of atherosclerosis. Familial combined hyperlipidaemia (FCH) remains poorly understood. It is likely that FCH is a heterogenous disorder and that the clinical phenotype may result from the interaction of different genetic abnormalities and environmental factors. In the clinical situation lipid and lipoprotein abnormalities are found commonly in hypertensives and diabetics and individual chapters are devoted to these important Special patient groups. Unanswered questions surround lipid management in elderly people, children, and women, and these always lead to intense discussion. It is hoped that these chapters will help to clarify current opinion and point to areas where further progress is required. The section on Management covers identification of the individual at risk and secondary prevention. In primary prevention, therapy (particularly drug therapy) is reserved for those judged to be at high risk. Detailed reviews on dietary and drug therapy are provided. The angiographic trials have provided exciting results and a chapter is devoted to these. The position with regard to secondary prevention of CHD and cholesterol lowering is unequivocal, with positive benefit not only in terms of CHD reduction but alsó in overall mortality. Finally, in the 1990s no discussion can be complete without attention to economics and cost-effectiveness. It has been rewarding to work on this project and I would like to acknowledge the excellent support and help from Martin Dunitz the publishers, particularly Alan Burgess. The contributors showed considerable enthusiasm for the book and kept well to tight deadlines ensuring an up-to-date text. I thank them warmly for their cooperation. I do hope that a wide rangé of clinicians, scientists, and other interested individuals will find the book enjoyable and stimulating.