Book Review

Principles and Management of Lipid Disorders: A Primary Care Approach

N Engl J Med 1993; 328:1283-1284April 29, 1993

Article

Principles and Management of Lipid Disorders: A Primary Care Approach
By Albert Oberman, Robert A. Kreisberg, and Yaakov Henkin. 323 pp. Baltimore, Williams and Wilkins, 1992. $49. ISBN: 0-683-06623-4

The basic premise for writing this book is a good one. Since the evidence is now so strong that several of the dyslipidemias are related to the development of atherosclerosis, which is known to be a reversible disorder, and since these dyslipidemias are so very common, it is the primary care physician who will be mainly responsible for identifying and treating patients with these disorders.

In the first two thirds of this book the authors present in detail the evidence supporting the hypothesis that abnormalities of lipoprotein metabolism are related to the development of atherosclerosis; review normal lipoprotein transport and metabolism; and describe standard classifications of the primary and secondary lipid disorders. These sections are well written but often contain more detail than is necessary for the effective identification and care of patients with these maladies. For example, the authors include rather extensive discussions of ultracentrifugal separation of lipoproteins, the various apoproteins and their functions, and techniques of lipid measurement -- information of value primarily to specialists in lipid disorders. They do provide a very nice reading list at the end of each chapter, but they often refer to important studies in the body of the text without providing appropriate references for further study. There are several appealing features in this book -- for example, a very respectable discussion of the various factors that influence lipid values, such as smoking, stress, and physical activity; an analysis of the influence of growth, sex, and age on lipid levels; and an extensive and readable account of the secondary dyslipidemias.

The guidelines for treatment, which occupy the last 100 pages, are very readable. The principles of diet are well outlined, although the practicality of and compliance with such diets are less well emphasized. Several case histories are given for the reader to work out along with the authors. The section on educational resources for physicians and patients is especially welcome.

I believe this book can serve medical students and house officers in primary care as a good reference and introduction to the field. It is especially strong on the relation of hypercholesterolemia to coronary artery disease and the physiology of lipoprotein metabolism. It is not detailed or referenced enough for the expert in the field. For the primary care physician, practical management issues are often hidden in the broad sweep of the book, and there are not always sufficient guidelines on the pitfalls of diagnosis and therapy. Finally, a distinct section should have been reserved for a discussion of the few times when referral of the patient to an expert is warranted.

Robert Scheig, M.D.
Buffalo General Hospital, Buffalo, NY 14203