Methods, systems, and computer program products for analyzing and presenting NMR lipoprotein-based risk assessment results

• US 6,576,471 B2
• Filed: 11/14/2001
• Issued: 06/10/2003
• Est. Priority Date: 02/26/1999
• Status: Expired due to Term

• Current Assignee: LipoScience, Inc. (Laboratory Corporation Of America Holdings), North Carolina State University (University of North Carolina System)
• Original Assignee: LipoScience, Inc. (Laboratory Corporation Of America Holdings)
• Inventors: Otvos, James D.
• Primary Examiner(s): Warden, Jill
• Assistant Examiner(s): GAKH, YELENA G
• Application Number:
  US09/992,068
• Publication Number:
  US 20020087276A1
• Time in Patent Office: 573 Days
• Field of Search: 436/13, 436/16, 436/71, 436/173, 600/300, 128/630
• US Class Current: 436/71
• CPC Class Codes: G01N 2333/775 Apolipopeptides
• CPC Class Codes: G01N 2800/324 Coronary artery diseases, e.g. angina pectoris, myocardial infarction
• CPC Class Codes: G01N 33/92 involving lipids, e.g. cholesterol , lipoproteins, or their receptors steroid hormones G01N33/743
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment
• CPC Class Codes: G16Z 99/00 Subject matter not provided for in other main groups of this subclass
• CPC Class Codes: Y10T 436/104165 Lipid, cholesterol, or triglyceride standard or control
• CPC Class Codes: Y10T 436/106664 Blood serum or blood plasma standard or control
• CPC Class Codes: Y10T 436/24 Nuclear magnetic resonance, electron spin resonance or other spin effects or mass spectrometry

Abstract

A method for analyzing a patient'"'"'s risk of coronary heart disease by determining the presence of NMR-derived or based lipoprotein constituent value abnormalities includes determining the presence of atherogenic dyslipidemia based on the existence of a clustering of lipoprotein constituent abnormalities as defined by predetermined test criteria. Computer program products and automatically produced reports for presenting NMR-derived lipoprotein risk assessment based on patient-specific lipoprotein subclass results present the measurement results adjacent to a segmented reference risk analysis portion. The actual measured results are visually aligned and enhanced within the risk analysis portion to provide easy reference and understanding of the results relative to a risk of developing coronary heart disease.

Claims

1. A computer program product for automatically generating personalized lipoprotein-based information for a plurality of subjects, the computer program product comprising:

a computer readable storage medium having computer readable program code embodied in said medium, said computer-readable program code comprising;

computer readable program code for generating lipoprotein measurement values for a patient'"'"'s blood and/or plasma sample, the lipoprotein measurement values including a plurality of lipoprotein subclass variable measurements, including at least two of;

LDL size, LDL concentration, large HDL concentration, and large VLDL concentration;

computer readable program code for comparing the plurality of patient lipoprotein subclass variable values with respective predetermined test criteria for determining whether the subclass variable values are associated with a higher lower risk of developing coronary heart disease;

computer program code for evaluating the lipoprotein measurement values and generating a reduced target value or values for what represents an optimal or low risk value for selected lipoprotein constituents to provide a patient-specific treatment guideline based on the presence of predetermined risk criteria; and

computer readable program code for automatically generating personalized lipoprotein-based reports for a plurality of patients, wherein the computer program code for generating the report includes computer program code for generating a plurality of risk analysis portions representing lower to higher degrees of risk therein, one for each measured lipoprotein subclass, so that a respective one risk analysis portion is aligned adjacent the corresponding measured subclass lipoprotein value, each of the respective risk analysis portions visually indicating when there is a higher risk of coronary heart disease for the measured value by displaying and/or printing the corresponding degree of risk associated with the measured value within a respective risk analysis portion in a visually accentuated manner to thereby provide a contemporaneous reference guideline for interpretation of the measured value, wherein at least one of the risk analysis portions comprises a plurality of discrete horizontal boxes, each representing a predetermined degree of risk and/or a positive or negative risk association, and wherein the computer readable program code for generating the risk analysis portions comprises computer program code that generates one box with a color enhanced border that is in a different color from the other discrete boxes in that risk analysis portion.

2. A computer program product according to claim 1, further comprising computer readable program code for comparing a plurality of the lipoprotein measurement values to predetermined test criteria to determine the presence of an increased risk of metabolic syndrome or atherogenic dyslipidemia.

3. A computer program product according to claim 1, wherein the computer readable program code for generating lipoprotein measurement values for a patient'"'"'s blood sample comprises computer program code for obtaining NMR-based lipoprotein measurements.

4. A computer program product according to claim 1, wherein the lipoprotein measurement values include NMR equivalents of the major lipoprotein constituents of total cholesterol as well as the plurality of lipoprotein subclass constituents, wherein the computer program code is configured to arrange the total cholesterol values above the subclass constituent values in the report, and wherein the major lipoprotein constituents include LDL concentration in cholesterol equivalents, HDL concentration in cholesterol equivalents, and triglycerides.

5. A computer program product according to claim 1 wherein the at least two subclass values comprise each of the subclass values for LDL size, LDL concentration, large HDL concentration, and large VLDL concentration.

6. A computer program product according to claim 1, wherein the computer program code for generating the reports comprises computer program code for generating linear horizontal line graphs representing lower to higher degrees of coronary heart disease risk in a plurality of the subclass risk analysis portions so that the relative risk associated with the measured value is graphically represented according to predefined risk criteria associated with statistical data for the general population to establish for the respective subclass values a relative continuum of low to high risk to visibly indicate the level of risk associated therewith.

7. A computer program product according to claim 1, wherein the computer program code for generating the reports includes computer program code for:

analyzing the lipoprotein measurements and providing at least three different lipoprotein result summary segments, a lipid profile segment and a lipoprotein-subclass profile segment, and a separate metabolic abnormality summary segment, wherein the lipid profile segment presents values for total cholesterol, LDL cholesterol, HDL cholesterol, and Triglycerides, wherein the subclass profile segment presents the results of the lipoprotein measurements for the level and size of LDL particles, the level of large HDL, and the level of large VLDL, and wherein the metabolic abnormality summary segment presents the patient'"'"'s risk identification for having a metabolic abnormality.

8. A computer program product according to claim 1, wherein the computer readable program code for generating the reports comprises computer program code for arranging the measured lipoprotein values such that the lipoprotein measurement values are substantially vertically aligned relative to one another, and wherein the computer program code for generating the risk analysis portion for LDL particle size generates three discrete boxed segments of risk categories, one associated with lower risk for Pattern A, one associated with intermediate risk for Pattern AB, and one associated with higher risk for Pattern B.

9. A computer program product according to claim 1, wherein the computer program code for generating lipoprotein measurement values for a patient'"'"'s blood sample comprises computer program code for obtaining NMR-based lipoprotein measurements, and wherein the computer readable program code for comparing the NMR-based lipoprotein measurement values to predetermined test criteria to determine the presence of atherogenic dyslipidemia includes computer program code for comparing the measurement values to predetermined test criteria to determine the presence of small LDL, a low level of large HDL, and an elevated level of large VLDL, whereby the determination is made based on the positive test criteria match of at least two of the conditions.

10. A computer program product according to claim 1, further comprising computer program code for monitoring the patient'"'"'s lipoprotein measurements over time by automatically comparing data successive personalized patient reports from respective selected patients to identify a decrease, an increase or stability in at least one selected lipoprotein subclass constituent value over time to thereby monitor the trend or impact of drug therapy or other treatment.

11. A computer program product according to claim 1, wherein the computer code for evaluating processes data associated with selected parameters from both the patient'"'"'s medical and behavioral history.

12. A computer program product according to claim 1, further comprising computer program code for adjusting the predetermined test criteria as well as the associated risk analysis portions for a particular patient relative to the general population based upon the existence of or susceptibility to an identified high-risk medical condition in the patient.

13. A computer program product according to claim 1, wherein the measured lipoprotein subclass measured values are presented in columnated numerical format as a quantitative number adjacent a corresponding columnated textual label identifying the corresponding subclass variable value.

14. A computer program product according to claim 1, further comprising computer program code for electronically generating the report and transmitting the report via email to a physician or clinic.

15. A computer program product according to claim 2, wherein the computer program code for generating the report comprises computer program code for generating a selectable box adjacent parameters associated with an increased risk of metabolic syndrome or atherogenic dyslipidemia and visually accentuating the box when the increased risk is determined to be present.

16. A computer program product according to claim 2, wherein the computer readable program code for generating the risk analysis portions in the reports includes computer readable program code for presenting a plurality of the measured lipoprotein subclass values as a series of horizontally extending line graphs which graphically represents the subclass value in a relative continuum of low to high risk, the continuum of low to high risk being defined according to predefined risk criteria associated with statistical data for the general population.

17. A computer program product according to claim 11, wherein the computer program code evaluates and identifies data that defines whether the patient is diabetic.

18. A computer program product according to claim 11, wherein the computer program code processes data in the patient'"'"'s history to determine whether the patient has been diagnosed with CHD.

32. A computer program product according to claim 2, wherein the computer program code for generating the report includes program code for visually accentuating at least one box generated in a risk assessment panel that is separate from the risk analysis portions of the lipoprotein subclass constituent values when an increased risk of metabolic syndrome or atherogenic dyslipidemia is determined to be present.

19. A computer program product for providing patient specific NMR-measured lipoprotein information, the computer program product comprising:

a computer readable storage medium having computer readable program code means embodied in said medium, said computer-readable program code means comprising;

computer readable program code for obtaining NMR-measurements for a plurality of lipoprotein subclass constituents including at least LDL particle size, LDL concentration, and large HDL concentration;

computer readable program code for determining a coronary heart disease risk level associated with each of the plurality of NMR-measured lipoprotein subclass measurements;

computer program code for evaluating the lipoprotein measurement values and generating a reduced target value or values for what represents an optimal or low risk value for selected lipoprotein constituents to provide a patient-specific treatment guideline based on the presence of predetermined risk criteria; and

computer readable program code for automatically generating a lipoprotein report for a plurality of patients with data corresponding to patient specific NMR-measured lipoprotein subclasses, the computer readable program code for generating the reports including computer readable program code for generating, for each reported measured subclass value, an adjacently positioned associated risk analysis portion according to predetermined risk criteria associated with the measured subclass value, with the risk for a measured value to be represented in the risk analysis portion in at least one of (i) a color-accentuated manner;

(b) a different selected font relative to adjacent portions of the report;

(c) bolded;

(d) italicized;

(e) circled;

(f) boxed;

(g) underlined; and

(h) highlighted to thereby provide a contemporaneous reference guideline for interpretation of the measured lipoprotein subclass value.

20. A computer program product according to claim 19, wherein the computer readable program code means for generating the risk analysis portion presents the LDL particle size value as one of:

Pattern A corresponding to lower risk, Pattern B corresponding to higher risk, and Pattern AB corresponding to an intermediate risk; and

wherein said LDL subclass value is identified in said risk analysis portion by visually enhancing the specified pattern associated with the patient-specific LDL subclass value, and wherein, for at least one risk analysis portion, the computer program code for generating the report generates a plurality of spaced apart predetermined risk segments having an associated border, the risk segments corresponding to lower or negative to higher or positive degrees of risk, and wherein the computer program code causes the border of the risk segment associated with the measured subclass value to be drawn in a color-accentuated manner.

21. A computer program product according to claim 19, further comprising computer program code for evaluating the lipoprotein measurement values to adjust and present a patient-specific goal that is more conservative than for the general population for certain of the measured lipoprotein values based on the presence or absence of predetermined risk criteria.

22. A computer program product according to claim 19, further comprising computer program code for electronically generating the report and transmitting the report via email to a physician.

23. A computer program product according to claim 19, wherein the NMR-measured values include levels of the major lipoprotein constituents of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides, and the subclass lipoprotein values associated with LDL size, the level of LDL particles, the level of large HDL cholesterol, and the level of large VLDL.

24. A computer program product according to claim 19, further comprising computer program code for adjusting the predetermined risk criteria in the risk analysis portion used to estimate the defined risk associated with the risk analysis portions based upon the existence of or susceptibility to an identified high-risk medical condition in the patient relative to the predetermined risk criteria used for the general population.

25. A computer program product according to claim 19, wherein the plurality of NMR-measured lipoprotein subclass variable values further includes data corresponding to large VLDL concentration.

26. A computer program product according to claim 19, further comprising computer readable program code for defining predetermined test criteria that define an increased risk of metabolic syndrome and/or atherogenic dyslipidemia and computer readable program code for comparing a plurality of the NMR-measured lipoprotein values to the predetermined test criteria to determine the presence of an increased risk of metabolic syndrome or atherogenic dyslipidemia.

27. A computer program product according to claim 19, further comprising computer program code for monitoring the patient'"'"'s lipoprotein measurements over time by automatically comparing data successive personalized patient reports from respective selected patients to identify a decrease, an increase or stability in at least one selected lipoprotein subclass constituent value over time to thereby monitor the trend or impact of drug therapy or other treatment on the lipoprotein values.

28. A computer program product according to claim 19, further comprising computer program code for adjusting the predetermined risk criteria and corresponding levels of risk associated with the measured lipoprotein subclass values relative to the general population as presented in the associated risk analysis portions of the display format based upon the existence of or an identified susceptibility to an at-risk medical condition of the patient.

29. A computer program product according to claim 21, wherein the computer code for evaluating processes data from selected parameters input from both the patient'"'"'s medical and behavioral history.

30. A computer program product according to claim 21, further comprising computer program code for evaluating data that identifies whether the patient is diabetic.

31. A computer program product according to claim 21, wherein the computer program code for evaluating processes data in a patient history electronic file to identify whether the patient has already been diagnosed with CHD.

33. A computer program product for providing patient specific NMR-measured lipoprotein information, the computer program product comprising:

a computer readable storage medium having computer readable program code means embodied in said medium, said computer-readable program code means comprising;

computer readable program code for obtaining NMR-measured measurements for a plurality of lipoprotein subclass constituents including at least LDL particle size, LDL concentration, and large HDL concentration;

computer readable program code for determining a coronary heart disease risk level associated with each of the plurality of NMR-measured lipoprotein subclass measurements;

computer program code for evaluating the lipoprotein measurement values and generating a reduced target value or values for what represents an optimal or low risk value for selected lipoprotein constituents to provide a patient-specific treatment guideline based on the presence of predetermined risk criteria; and

computer readable program code for automatically generating a lipoprotein report for a plurality of patients with data corresponding to patient specific NMR-measured lipoprotein subclasses, the computer readable program code for generating the reports including computer readable program code for generating, for each reported measured subclass value, an adjacently positioned associated risk analysis portion that visually accentuates when there is an increased risk of coronary heart disease associated with the respective lipoprotein subclass measurement to thereby provide a contemporaneous reference guideline for interpretation of the measured lipoprotein subclass value, wherein the computer readable program code means for generating the risk analysis portion presents the LDL particle size value as one of;

Pattern A corresponding to lower risk, Pattern B corresponding to higher risk, and Pattern AB corresponding to an intermediate risk; and

wherein said LDL subclass value is identified in said risk analysis portion by visually enhancing the specified pattern associated with the patient-specific LDL subclass value, and wherein the computer readable program code for generating the risk analysis portion includes computer readable program code for presenting each of a plurality of the measured subclass values as a horizontally extending linear bar graph which graphically represents the subclass value relative to a continuum of low to high risk, the continuum of low to high risk being defined according to predefined risk criteria associated with statistical data for the general population.

34. A computer program product for automatically generating personalized lipoprotein-based assessed risk of coronary heart disease information for a plurality of subjects, the computer program product comprising:

a computer readable storage medium having computer readable program code embodied in said medium, said computer-readable program code comprising;

computer readable program code for generating NMR-based lipoprotein measurement values for a patient'"'"'s blood plasma or serum sample, the NMR-based lipoprotein measurement values comprising a plurality of lipoprotein constituent values including a constituent value for LDL particle concentration;

computer readable program code for comparing the LDL particle concentration with predetermined test criteria for determining whether the LDL particle concentration is elevated;

computer readable program code for comparing a plurality of NMR-based lipoprotein subclass constituent values to predetermined test criteria associated with abnormal lipoprotein values to determine if there is a clustering of abnormal values for a plurality of different selected lipoprotein subclass constituents according to predetermined test criteria to determine the presence of a metabolic abnormality or atherogenic dyslipidemia;

computer program code for evaluating the lipoprotein measurement values and generating a reduced target value or values for what represents an optimal or low risk value for selected lipoprotein constituents to provide a patient-specific treatment guideline based on the presence of predetermined risk criteria; and

computer readable program code for assessing a patient'"'"'s risk of coronary heart disease based on the presence of at least one of an elevated LDL particleconcentration and/or the metabolic abnormality or atherogenic dyslipidemia.

35. A computer program product according to claim 34, wherein the NMR based lipoprotein constituent values include the major lipoprotein constituents of total cholesterol, LDL concentration in cholesterol equivalents, HDL concentration in cholesterol equivalents, and triglycerides.

36. A computer program product according to claim 34, wherein the computer program code for comparing the plurality of NMR-based lipoprotein subclass constituent values to predetermined test criteria associated with abnormal lipoprotein values to determine if a clustering of abnormal values exist to determine the presence of a metabolic abnormality or atherogenic dyslipidemia does not consider NMR based lipoprotein constituent values for LDL particle concentration or LDL-cholesterol.

37. A computer program product for automatically generating personalized lipoprotein-based assessed risk of coronary heart disease information for a plurality of subjects, the computer program product comprising:

a computer readable storage medium having computer readable program code embodied in said medium, said computer-readable program code comprising;

computer readable program code for generating NMR-based lipoprotein measurement values for a patient'"'"'s blood plasma or serum sample, the NMR-based lipoprotein measurement values comprising a plurality of lipoprotein constituent values including a constituent value for LDL particle concentration;

computer readable program code for comparing the LDL particle concentration with predetermined test criteria for determining whether the LDL particle concentration is elevated;

computer readable program code for comparing a plurality of NMR-based lipoprotein subclass constituent values to predetermined test criteria associated with abnormal lipoprotein values exist to determine if a clustering of abnormal values exist to determine the presence of a metabolic abnormality or atherogenic dyslipidemia;

computer readable program code for assessing a patient'"'"'s risk of coronary heart disease based on the presence of at least one of an elevated LDL particle concentration and/or the metabolic abnormality or atherogenic dyslipidemia; and

computer program code for automatically generating a report of the risk assessment for each patient sample, the computer program code for generating the report including computer program code for;

(a) arranging each of the obtained lipoprotein subclass constituent values in a viewable format which positions the lipoprotein subclass constituent values as a quantified number adjacent to a corresponding risk analysis portion such that a respective risk analysis portion for each lipoprotein subclass constituent value is positioned in side by side alignment with the corresponding lipoprotein subclass constituent value to act as a contemporaneous guide, the risk analysis portion having a plurality of segments a respective one of which characterizes the quantified lipoprotein subclass constituent value'"'"'s determined risk level;

(b) displaying the NMR-measured subclass constituent risk result corresponding to the actual constituent value within the respective risk analysis portion such that the risk associated with the lipoprotein constituent value is readily apparent; and

(c) providing a metabolic abnormality or metabolic syndrome and/or atherogenic dyslipidemia summary identifying whether a clustering of abnormal measured lipoprotein subclass constituent values for selected different lipoprotein subclass constituents exists according to predetermined test criteria and indicating which of the plurality of the measured lipoprotein subclass constituent values are abnormal.

38. A computer program product according to claim 37, further comprising computer program code for defining a target or optimal value that is a reduced target value set at about or below about a 20^th percentile value for at-risk patients relative to the general population.

39. A computer program product according to claim 38, wherein the computer program code for generating the report includes computer program code for:

providing at least three different result summary segments, a lipid profile segment and a lipoprotein-subclass profile segment, and a separate metabolic abnormality summary segment, wherein the lipid profile segment presents the results of the lipoprotein measurements for total cholesterol, LDL concentration cholesterol equivalent, HDL concentration cholesterol equivalent, and Triglycerides, wherein the subclass profile segment presents the results of the lipoprotein measurements for concentration and size of LDL particles, large HDL, and large VLDL, and wherein the metabolic abnormality summary segment presents the patient'"'"'s risk identification of a metabolic abnormality.

40. A computer program product according to claim 37, wherein the computer program code further associates the lipoprotein constituent values for LDL particle concentration number, the level of large HDL, and the level of large VLDL triglyceride with a risk analysis portion which includes at least three discrete segments, and wherein the computer program code that generates the discrete segments identifies the respective measured lipoprotein constituent value as having a particular risk level associated therewith.

41. A computer program product according to claim 37, further comprising computer program code for adjusting the predetermined risk criteria and corresponding levels of risk representing an increased risk and/or optimal or low risk level relative to the general population based upon the existence of or susceptibility to an identified high-risk medical condition in the patient.

42. A computer program product according to claim 40, wherein the computer program code for generating the at least three discrete segments define a first desirable, negative, or low risk segment, a second borderline or intermediate risk segment, and a third positive, increased and/or high risk segment.

43. A computer program product according to claim 40, wherein the computer program code for generating the discrete segments arranges and aligns the risk analysis portions to present the higher risk segments in a substantially vertically aligned manner, and wherein the computer program product further comprises computer program code for arranging the measured values for the lipoprotein constituents within respective boxes, each box disposed proximate to and laterally offset from its corresponding discrete segments of its respective risk analysis portion such that the measured values are arranged in vertical alignment proximate one side of the report and the risk analysis portions are arranged about the opposing side of the report.

44. A computer program product for automatically generating personalized lipoprotein-based assessed risk of coronary heart disease information for a plurality of subjects, the computer program product comprising:

a computer readable storage medium having computer readable program code embodied in said medium, said computer-readable program code comprising;

computer readable program code for generating NMR-based lipoprotein measurement values for a patient'"'"'s blood plasma or serum sample, the NMR-based lipoprotein measurement values comprising a plurality of lipoprotein constituent values including a constituent value for LDL particle concentration;

computer readable program code for comparing the LDL particle concentration with predetermined test criteria for determining whether the LDL particle concentration is elevated;

computer readable program code for comparing a plurality of NMR-based lipoprotein subclass constituent values to predetermined test criteria associated with abnormal lipoprotein values to determine if there is a clustering of abnormal values to determine the presence of a metabolic abnormality or atherogenic dyslipidemia; and

computer readable program code for assessing a patient'"'"'s risk of coronary heart disease based on the presence of at least one of an elevated LDL particleconcentration and/or the metabolic abnormality or atherogenic dyslipidemia, wherein the computer program code for assessing a patient'"'"'s risk of coronary heart disease includes computer program code that identifies the presence of both an elevated LDL particle concentration and the determination of an increased risk for having the metabolic abnormality, metabolic syndrome and/or atherogenic dyslipidemia, and wherein the computer program code for comparing a plurality of NMR-based lipoprotein subclass constituent values to predetermined test criteria associated with abnormal lipoprotein values to determine if there is a clustering of abnormal values for a plurality of different selected lipoprotein subclass constituents exists to determine the presence of a metabolic abnormality or atherogenic dyslipidemia lack a LDL particle concentration value.

45. A computer program product for automatically generating personalized lipoprotein-based assessed risk of coronary heart disease information for a plurality of subjects, the computer program product comprising:

a computer readable storage medium having computer readable program code embodied in said medium, said computer-readable program code comprising;

computer readable program code for generating NMR-based lipoprotein measurement values for a patient'"'"'s blood plasma or serum sample, the NMR-based lipoprotein measurement values comprising a plurality of lipoprotein constituent values including a constituent value for LDL particle concentration;

computer readable program code for comparing the LDL particle concentration with predetermined test criteria for determining whether the LDL particle concentration is elevated;

computer readable program code for comparing a plurality of NMR-based lipoprotein subclass constituent values to predetermined test criteria associated with abnormal lipoprotein values to determine if there is a clustering of abnormal values for a plurality of different selected lipoprotein subclass constituents to determine the presence of a metabolic abnormality or atherogenic dyslipidemia;

computer readable program code for assessing a patient'"'"'s risk of coronary heart disease based on the presence of at least one of an elevated LDL particle concentration and/or the metabolic abnormality or atherogenic dyslipidemia; and

computer program code for evaluating the lipoprotein measurement values and generating different values or ranges of values for the predetermined risk criteria that establishes the estimated risk level for at least one selected subclass constituent relative to the general population for a patient-specific treatment guideline based on the presence of predetermined risk criteria.

46. A computer program product according to claim 45, wherein the computer program code for evaluating and generating the different values or ranges of values to provide the estimated risk level for the patient-specific treatment guideline processes data from selected parameters from both the patient'"'"'s medical and behavioral history.

47. A computer program product according to claim 45, wherein the computer program code for evaluating to generate specific treatment guideline uses data that identifies whether the patient is diabetic.

48. A computer program product according to claim 45, wherein the computer program code for evaluating to generate specific treatment guideline processes data that identifies whether the patient has been diagnosed with CHD.

49. A computer program product for automatically generating personalized lipoprotein-based assessed risk of coronary heart disease information for a plurality of subjects, the computer program product comprising:

a computer readable storage medium having computer readable program code embodied in said medium, said computer-readable program code comprising;

computer readable program code for generating NMR-based lipoprotein measurement values for a patient'"'"'s blood plasma or serum sample, the NMR-based lipoprotein measurement values comprising a plurality of lipoprotein constituent values including a constituent value for LDL particle concentration;

computer readable program code for comparing the LDL particle concentration with predetermined test criteria for determining whether the LDL particle concentration is elevated;

computer readable program code for comparing a plurality of NMR-based lipoprotein subclass constituent values to predetermined test criteria associated with abnormal lipoprotein values to determine if there is a clustering of abnormal values associated with a plurality of different selected lipoprotein subclass constituents to determine the presence of a metabolic abnormality, metabolic syndrome, and/or atherogenic dyslipidemia;

computer readable program code for assessing a patient'"'"'s risk of coronary heart disease based on the presence of at least one of an elevated LDL particle concentration and/or the metabolic abnormality, syndrome and/or atherogenic dyslipidemia; and

computer program code for electronically generating the report and transmitting the report via email to a physician.