Abstract
This is the third edition of this book, the second having appeared in 1995. The long gap is because, as the author points out, our national university ratings system does not accept books as evidence of scholarly activity in the sciences (although it does in the arts). This is a pity, and I for one am extremely pleased that Professor Durrington has found time away from the pressures of publishing peer reviewed research to produce this new edition.
The structure of the book is very much what one would anticipate from the title. The opening chapters deal with the metabolism of lipids and lipoproteins and their concentrations in health and disease. Then there are chapters on familial hypercholesterolaemia; ‘common hyperlipidaemia’ (including familial combined hyperlipidaemia, hyperapobetalipoproteinaemia and polygenic hypercholesterolaemia); hypertriglyceridaemia and type III hyperlipoproteinaemia. The treatment of hyperlipidaemia is covered in chapters on diet, lipid-modifying therapy, and national and international recommendations for the management of hyperlipidaemia. The book concludes with accounts of secondary hyperlipidaemia and the genetics of lipoprotein disorders and coronary atheroma.
So, if you can predict the contents from the title, what makes the book such a good thing? Would not it be just as good (or better) to read up on these topics in original papers or reviews?
My answer is that no, it would not. There are a number of specific reasons for this, but in general it is the freedom that a book gives for a broader discussion that makes this one particularly enjoyable. There are numerous examples of this: for example, do you know which lipoproteins cross the blood-brain barrier? Why do the fats of cold water fish contain large quantities of highly unsaturated fatty acids? We all know that the pretzel-like structures in lipoprotein (a) are called ‘kringles’, but what is the derivation of the word kringle? (Sorry, but if you do not know the answers, you will have to read the book.) These slight diversions from the beaten track certainly helped to stimulate my fascination with the subject matter, although the text is actually very clearly written and cogently argued – try reading the section on ‘Low serum cholesterol and non-coronary heart disease death’ for a nice example of the latter.
However, the place where the book format really comes into its own is in the discussion of clinical problems, where there is not always a solid evidence base to support decisions. Here, the author is able to draw on his clinical experience to offer some detailed and common sense advice. (I particularly liked the instruction, in the section on ‘Treatment of children and young adults who are heterozygotes for familial hypercholesterolaemia’, that ‘…no child should be sent to a friend's house clutching a diet sheet.’) An excellent example of this is a section entitled ‘The seven sins of mismanaging severe hypertriglyceridaemia’, which anyone who manages such patients ought to read and reflect on. This is the closest I have come to being completely convinced of the benefits of high-dose antioxidants in recurrent acute pancreatitis associated with severe hypertriglyceridaemia. Picking another example at random (this book is full of fascinating things), the section on statins contains a helpful discussion of their (alleged) side-effects and how to avoid them. And the chapter on familial hypercholesterolaemia actually discusses the difficulties in making the diagnosis, something that other books on hyperlipidaemia (or at least the ones I have consulted) tend to skate over. In short, if you are a lipidologist with a clinical problem that needs solving, try this book first – I do not think you will be disappointed.
The book is well presented in hardback, with mainly black and white illustrations and one set of colour plates. The text is fully referenced, apart from the first two chapters, which have lists of further reading. The cover shows a striking picture of a woman with extensive xanthelasma, taken from an 1851 volume of Guy's Hospital Reports that contained the earliest written account of xanthelasma and xanthoma. I hope I have given an impression of the wealth of material that the book contains – this is not just another re-hash of the facts, but a distillation of the author's knowledge, experience and understanding. It deserves a place on every lipidologist's bookshelf, although I am sure more general readers will benefit from it as well.