[Plasma lipoproteins in humans: metabolism and relation to atherosclerosis]

For a better understanding of atherogenesis it is important to consider the results from basic research in pathophysiology, pathobiochemistry and clinical research with special focus on the endothelium, the smooth muscle cells, macrophages, platelets and the plasma lipoproteins. The penetration of low-density lipoproteins through the endothelium, the contact of these particles with the potential foam cells, the effect of various cellular migratory and growth factors, the prostaglandin system and the hormonal status are important factors in the mechanisms leading to the formation of the atherosclerostic plaque. Disturbances in lipid metabolism are rarely recognized by signs such as formation of xanthomata. Even the measurement of plasma lipids does not always allow conclusions to be drawn with regard to the complicated relationship between lipoprotein concentrations and their potential risk. To estimate this risk biochemical and clinical interpretation must be performed individually and under consideration of various factors. This also holds true for the choice of therapeutical management. The therapy of lipid metabolism has to be an approach to the therapy of atherosclerosis with reduction of elevated low-density lipoprotein concentrations as the most important goal. Therapeutic management should be individually assessed, taking all known risk factors into account.