Triglyceride-Rich Lipoprotein Metabolism: Key Regulators of Their Flux

Area of Science:

• Cardiovascular Medicine
• Lipid Metabolism
• Atherosclerosis Research

Background:

• Optimal statin therapy leaves a significant residual risk (up to 50%) for arteriosclerotic cardiovascular disease.
• This residual risk is linked to both immunological factors and lipid disturbances, particularly triglyceride-rich lipoproteins (TRLs).

Purpose of the Study:

• To review the metabolism of TRLs and their remnants.
• To highlight the role of apolipoproteins, lipoprotein lipase, and their regulators in TRL metabolism.
• To discuss the impact of TRL remnants on atherogenesis and current therapeutic strategies.

Main Methods:

• Narrative review of TRL metabolism pathways.
• Summary of apolipoprotein functions and lipoprotein lipase regulation.
• Analysis of TRL fluxes in post-prandial states and their catabolism.

Main Results:

• TRLs and their remnants, rich in cholesterol, accumulate due to ineffective triglyceride catabolism and contribute to atherogenesis.
• Apolipoproteins, angiopoietin-like proteins, and apo CIII play crucial roles in TRL partitioning during metabolic cycles.
• Current therapeutic options and trial outcomes for managing TRL remnants are summarized.

Conclusions:

• TRL remnants represent a significant, modifiable target for reducing residual cardiovascular risk.
• Further research is needed to establish a gold standard for measuring TRL remnants.
• Understanding TRL metabolism is critical for developing novel atherogenesis therapies.