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Hypertriglyceridemia, atherogenic dyslipidemia, and the metabolic syndrome
1Department of Clinical Nutrition, Center for Human Nutrition, University of Texas Southwestern Medical Center at Dallas, 75235-9052, USA.
Insights
High triglyceride levels are linked to increased coronary artery disease risk and other health issues. Effective treatment requires addressing multiple factors beyond just lowering LDL cholesterol.
Area of Science:
- Cardiovascular Medicine
- Metabolic Disorders
- Lipidology
Background:
- High serum cholesterol, particularly low-density lipoprotein (LDL), is a known coronary artery disease (CAD) risk factor.
- LDL-lowering therapies have proven effective in reducing CAD risk.
- Elevated serum triglycerides (hypertriglyceridemia) are common in high-risk patients, but their causal role in CAD requires further elucidation.
Purpose of the Study:
- To explore the association between hypertriglyceridemia and coronary artery disease (CAD).
- To identify hypertriglyceridemia as a marker for atherogenic factors.
- To discuss the clinical implications and challenges in treating hypertriglyceridemia.
Main Methods:
- Review of existing evidence linking hypertriglyceridemia to CAD risk.
- Identification of hypertriglyceridemia as a marker for atherogenic factors.
- Discussion of the components of the lipid triad and metabolic syndrome.
Main Results:
- Hypertriglyceridemia is associated with increased CAD risk.
- It serves as a marker for atherogenic factors like triglyceride-rich lipoproteins, the lipid triad, and metabolic syndrome.
- The lipid triad includes high triglycerides, small LDL particles, and low HDL cholesterol.
Conclusions:
- Hypertriglyceridemia is a significant marker for increased cardiovascular risk.
- A comprehensive treatment strategy is needed, targeting atherogenic lipoproteins, the lipid triad, and metabolic syndrome.
- Developing effective therapeutic regimens for hypertriglyceridemia remains a research challenge.
Abstract:
The importance of high serum cholesterol, especially a high level of low-density lipoprotein (LDL) cholesterol, as a risk factor for coronary artery disease is well established. Likewise, efficacy for decreasing risk for coronary artery disease by LDL-lowering therapy has recently been documented through clinical trials. However, many high-risk patients manifest elevated serum triglyceride levels, and the role of hypertriglyceridemia in causation of coronary artery disease remains to be elucidated. Nonetheless, there is growing evidence that hypertriglyceridemia is a marker for increased risk for coronary artery disease; in fact, it can serve as a marker for several atherogenic factors. These factors include increased concentrations of atherogenic triglyceride-rich lipoproteins; the atherogenic lipoprotein phenotype, or lipid triad; and the metabolic syndrome. The lipid triad consists of elevated serum triglycerides, small LDL particles, and low high-density lipoprotein (HDL) cholesterol. The metabolic syndrome includes the coexistence of the lipid triad, elevated blood pressure, insulin resistance (plus glucose intolerance), and a prothrombotic state. Many previous studies indicate that hypertriglyceridemia is strongly associated with all of these atherogenic factors. The clinical approach to treatment of patients with hypertriglyceridemia thus requires a broad-based strategy that includes reduction of atherogenic triglyceride-rich lipoproteins, reversal of the lipid triad, and favorable modification of the metabolic syndrome. The development of therapeutic regimens to effect these changes poses a challenge for future research on the problem of hypertriglyceridemia.