Insights from apoB: from better diagnosis & therapy to the Medusa Hypothesis

This article will review six of the most important insights that have come from the measurement of apolipoprotein B (apoB). Amongst these are critical clinical advances, which include better definition of those at high risk of vascular disease and better definition of the adequacy of statin therapy. There are also major advances in our understanding of the fundamental processes that interact to cause vascular disease. These include a more precise understanding of the determinants of lipoprotein levels and lipoprotein composition in plasma and, even more importantly, an appreciation of the pivotal role excess fatty acid intake and impaired fatty acid trapping by adipose tissue play in the generation of the complex risk profile that is so common in patients with coronary disease. We have designated the constellation of hypertriglyceridemic (hyperTg) hyperapoB, dysglycemia, and elevated levels of markers of prothrombosis and inflammation--all of which are traceable to adipose tissue dysfunction--as the Medusa Hypothesis. The Medusa Hypothesis puts forward a common pathophysiology for the complex and biologically diverse array of factors that have been associated with vascular disease.