Lipoprotein Assessment in the twenty-first Century

Since the start of this century, the concept of "Precision Medicine" has become a major driving force for much of biomedical research. Precision medicine is particularly appli-cable to cardiovascular disease, a common disorder, that is affected by not only an in-dividual's lifestyle choices but also their genetic predisposition and a host of environmental factors. In the future, the clinical laboratory testing will likely provide an increasingly important role in deciding who and how to treat patients for cardiovascular disease. Given that many of the new cardiovascular therapies that are being developed are based on large or complex biological molecules that are expensive to produce, some of the new and advanced diagnostic tests being developed may be justified based on economic considerations. Many of the new "omic" technologies with their multiplex format will also likely penetrate routine diagnostic testing. Already one can measure a standard lipid panel, apoB, lipoprotein particle number, lipoprotein subfractions, GlycA (a marker of inflammation), and many other metabolites in a single NMR test.73,74 The current lipid tests that primarily focus on cholesterol will undoubtedly remain valuable but will likely be augmented in the future by other types of tests as we continue to expand our knowledge of lipoprotein metabolism and cardiometabolic disease.