The fact that the study was done "not only in a large number of people but also in 52 countries and a variety of ethnic groups" also adds strength to the findings, McQueen said.
But that very variety could also be a weakness, said Dr. Peter Wilson, who took part in the Framingham study while at Boston University. He is now professor of medicine at Emory University in Atlanta. "It's not like they had a single community or controls from lots of different types all around the world," he reasoned.
Another weakness of the study was that it included people only after they had heart attacks, Wilson said. That means that "you can't talk about lipid [blood fats] risk before you get a heart attack," he said. "This is lipid risk only after you have a heart attack."
Finally, the study was conducted with frozen blood specimens, Wilson noted. "Cholesterol does better in fresh specimens," he said.
Despite those flaws, the new findings do add to indications that apolipoprotein testing has a major clinical role to play in the future, Wilson said. The American College of Cardiology has recently discussed such testing for people with diabetes, he said.
Even if such tests are better than the existing cholesterol tests, it will take time to introduce them into general medical practice, Wilson said. "The point is technology," he said. "Cholesterol tests are all reliable, and we know what they mean. We don't have experience with apolipoproteins in the clinical environment."
Automated apolipoprotein tests now are available, McQueen said. He said he uses them to add information to what is shown by conventional cholesterol testing.
The Uppsala hospital is trying to phase in apolipoprotein tests, Lind said. "We are giving them in tandem, so that people get adjusted to them," he said.<
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