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Principles and Management of Lipid Disorders: A Primary Care Approach
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Albert Oberman, Robert A. Kreisberg, and Yaakov Henkin. 323 pages. Baltimore: Williams and Wilkins; 1992. $49.00.
Amid a plethora of lipid disorder books, I suspected that this volume was a clone: reiterating the National Cholesterol Education Panel's dictum on lipids and atherosclerosis. My impression immediately changed when I saw the five section cartoons. Unlike silly patient brochure cartoons, these tongue-in-cheek depictions hit the points home. For example, a doctor detective discovers an Achilles tendon xanthoma on a familial hypercholesterolemic patient. This cartoon appealed to me because the lipid-related physical examination is often overlooked.
Today books are often outdated by prepublication time; therefore it is satisfying to find a text in this rapidly evolving field that is current and addresses controversies such as the potential association of lowering of cholesterol levels to violent deaths. Several theories on interactions of lipoproteins and other atherosclerotic factors are presented for the "lipid hypothesis." Contemporary topics such as the role of lipids in fibrinolysis and thrombosis are presented.
The sections "A Scientific Basis for Treatment," "Pathophysiology," and "Clinical Concepts" are well researched and articulated, especially the chapter titled "Laboratory Measurements," which discusses statistical variation, factors affecting lipid measurements, and the analytic techniques. The section "Guidelines for Treatment" had weaknesses: The chapter "Nondrug Therapies of Lipid Disorders" covers diet and lifestyle admirably, with the exception of the vague discussion on dietary responders and nonresponders. The following chapters, "Pharmacologic Therapy of Lipid Disorders" and "A Practical Approach to Patient Management," are like other lipid reviews: Conventional therapy is presented well, with good case studies providing a sound approach for the majority of patients, but therapeutic controversies and difficult management problems are weakly presented.
A lack of direct references throughout was annoying. Reference lists follow each chapter, but topics for each reference are not given. Interchapter redundancy suggests separate authors wrote different chapters and were then unable to edit previously presented material.
This book is extremely useful for physicians needing to understand and treat lipid disorders, and they will find it enjoyable to read. In this age of information barrage, a book that is not a strain to digest is welcome indeed.
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