Lipids as a coronary risk factor: analysis of hyperlipidaemias

Despite difficulties with epidemiological data, there is little doubt that triglyceride-rich lipoproteins are important factors in the induction of human atherogenesis, although the mechanisms remain elusive. A statistical association exists between small chylomicron remnant concentrations and fasting triglyceride levels and a stronger link is found between the larger chylomicron remnants and larger very low density lipoproteins. The link between concentrations of chylomicron remnants and disease progression is not explained by any relationship to the high density lipoprotein system but rather reflects the direct atherogenic action of the small chylomicron remnants themselves. Dense low density lipoprotein (LDL) triglyceride concentration seems to be more strongly correlated with disease severity in young post-infarction patients than LDL cholesterol concentration. There has been much recent interest in the process of LDL oxidation which re-routes LDL from normal receptors to the scavenger receptor pathway. In this regard, it was interesting to find a strong inverse correlation between low LDL vitamin E content and arterial stenosis. The relationship between dense LDL and coronary disease may depend on several different pathways all of which implicate the triglyceride-rich lipoproteins in the pathogenesis of coronary artery disease.