[Pathophysiology of lipid transport in plasma]

Atherosclerosis of coronary and peripheral arteries is a major cause of death and disability in civilizations outside the third world. Disturbances of the lipid transport in plasma are a major cause for atherogenesis. The transport of exogenous and endogenous lipids in plasma is facilitated by lipoproteins. The concentration of the various lipoprotein families is subject to complex regulation such as secretion by intestine and liver, intravascular metabolism and clearance by hepatic and extrahepatic receptors of high and low affinity. To understand the pathophysiology of lipid transport and the role of certain lipoproteins as risk factors for atherosclerosis it is important to understand the regulatory mechanisms governing lipoprotein concentrations. Elevated concentrations of certain lipoproteins such as low-density-lipoproteins (LDL) constitute an increased risk for atherosclerosis. This elevation of LDL in plasma can be caused by increased production and/or reduced catabolism. With a better understanding of the pathophysiology of the lipid transport system more rational and precise modalities of both treatment and prevention of atherosclerosis can be expected.