Several changes occur in lipid metabolism during gestation due to hormonal and metabolic changes, which are essential to satisfy the nutritional demands of the maternal-fetal unit development. The gestation shows two distinct periods that begin with fat accumulation, mainly in maternal adipose tissue, and the late phase, characterized by accelerated catabolism, with the increase of fatty acids in the circulation that causes hyperlipidemia, especially the one characterized as hypertriglyceridemia. Maternal hyperlipidemia may be associated with the development of maternal-fetal complications (preterm birth, preeclampsia, vascular complications) and the development of long-term cardiovascular disease. The cardiovascular risk may not only be related to lipoproteins cholesterol content, but also to the number and functionality of circulating lipoprotein particles. This review reports the major changes that occur in lipoprotein metabolism during pregnancy and that are associated with the development of dyslipidemias, lipoprotein atherogenic phenotype, and maternal-fetal unit complications.
Dyslipidemia may influence enzymes and transfer proteins needed to the lipoprotein particle remodeling. Calculated indices and evaluation of lipoprotein particle size have widely been used to predict cardiovascular risk. The aim of this study was to evaluate HDL particle size and LDL particle size estimate based on TG/HDL-C as well as apoB/apoA-I ratio as possible marker and atherogenic indices, respectively, of cardiovascular disease risk in the presence of dyslipidemia. We evaluated 100 individuals of both gender, without treatment with lipid-lowering drugs, 27 normolipidemic and 73 dyslipidemic, such as isolated hypercholesterolemia (n = 16), isolated A. P. C. Santos et al.
25hypertriglyceridemia (n = 17), low HDL-C (n = 26) and mixed dyslipidemia (n = 14). The HDL particle size did not differ between groups. The TG/HDL-C ratio was higher in groups with isolated hypertriglyceridemia (4.2 ± 1.5), low HDL-C (5.2 ± 3.1) and mixed dyslipidemia (5.3 ± 1.6). The apoB/apoA-I ratio was increased in all groups of dyslipidemia (apoB/apoA-I > 0.5) when compared to normolipidemic (apoB/apoA-I = 0.5, p < 0.001). There was a positive linear correlation between the TG/HDL-C ratio and the apoB/apoA-I ratio in low HDL-C group (r = 0.507, p = 0.008, Spearman). The results suggest that the evaluations of lipoproteins particles remodeling markers and the use of calculated indices may contribute to the evaluation of cardiovascular disease risk when dyslipidemia take place.
<p class="MsoNormal" style="text-align: justify; margin: 0cm 0cm 10pt;"><span style="line-height: 11px;">O efeito cardioprotetor da lipoproteína de alta densidade (HDL) é, principalmente, atribuída ao seu papel no transporte reverso do colesterol (RCT), propriedades antioxidativas e antiinflamatórias. Estudos epidemiológicos têm claramente mostrado que o baixo nível do colesterol da HDL é marcador independente de risco para o desenvolvimento da doença arterial coronária. A proteína de transferência de éster de colesterol é uma glicoproteína, predominantemente, produzida no fígado e tecido adiposo, a qual tem importante papel no metabolismo da HDL e RCT. Vários estudos têm mostrado que a atividade aumentada da CETP pode conferir risco de eventos cardiovasculares na presença de hipertrigliceridemia e HDL-C baixo, mas não na presença de perfil lipídico normal. Por outro lado, moléculas derivadas com atividade inibitória da CETP, ex. anacetrapib, diminuem a afinidade da CETP por partículas lipoprotéicas e, inibem a transferência mediada de colesterol, resultando em concentração de HDL-Colesterol elevado e reduções nos níveis de LDL-colesterol. Devido ao inesperado aumento de eventos cardiovasculares e mortalidade causado por um dos medicamentos dessa classe o Torcetrapib, estudos clínicos são necessários para demonstrar se as modificações favoráveis no perfil lipídico induzidas pela inibição da CETP , contribuirão para a proteção contra a aterosclerose. </span></p>
Cardiovascular problems, from which atherosclerosis complications are worth noting, are among the main causes of death worldwide. It is characterized by impaired mechanical and physiological conditions that cause thickening and hardening of coronary, cerebral and peripheral vessels, leading to chronic
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