Hypertriglyceridemia: A Review Beyond Low-Density Lipoprotein

Abstract

Hypertriglyceridemia is made up of a complex array of dyslipidemias. Difficulties in establishing the independent predictive value of elevated triglycerides in coronary artery disease arise because the triglyceride-rich lipoprotein particles that accumulate are diverse, with differential atherogenic potential, and because hypertriglyceridemia states are typically associated with low high-density lipoprotein cholesterol. When high-density lipoprotein cholesterol is considered in multivariate analysis of the role of hypertriglyceridemia in coronary artery disease, the importance of elevated triglycerides pales, emerging as a statistical second fiddle. However, recent data have affirmed the primary role of triglycerides in the genesis of atherosclerosis. This process involves the overabundance of triglyceride-rich lipoprotein particles, which, paradoxically, can be enriched with cholesterol through the action of cholesterol ester transfer protein. These particles appear to be especially atherogenic. Also, low-density lipoproteins become smaller and denser-small, dense phenotype or pattern B-in hypertriglyceridemia states. This profile is associated with a threefold increase in coronary artery disease risk and is not evident on routine lipid testing. Aggressive management of hypertriglyceridemia requires more detailed lipid analyses to identify patients at risk. In treating hypertriglyceridemia, a risk factor beyond low-density lipoprotein would allow a broader definition of patients at risk for coronary artery disease so that more people would benefit from lipid-lowering initiatives.

Peroxisome proliferator-activated receptor δ promotes very low-density lipoprotein-derived fatty acid catabolism in the macrophage

“…Elevated circulating lipid levels, on the other hand, could become an insult and cause serious health problems (31)(32)(33)(34)(35). In this study, we demonstrate that activation of PPAR␦ by VLDL leads to up-regulation of genes in three major steps of the fat-burning program (Fig.…”

“…Although TG-rich lipoproteins have been implicated as independent risk predictors of atherosclerosis (31)(32)(33)(34)(35)(36), the relevance of regulated macrophage ␤-oxidation in the pathogenesis of this disease is currently unclear. It is possible the reduced fat burden by itself is beneficial.…”

Efeitos de diferentes graus de sensibilidade a insulina na função endotelial de pacientes obesos

“…In addition, clinical and experimental studies have shown that free fatty acids change vasodilatory response of endothelium by inhibiting eNOS and stimulating anion expression by endothelial and vascular cells via NADPH oxidase, thereby lowering NO bioavailability 32 . In spite of the controversy on their role as an independent cardiovascular risk factor 33 , triglycerides are directly related to other non-lipid cardiovascular factors such as microalbuminuria and insulin resistance 34 . The association found in our study suggests a role of triglycerides in endothelial dysfunction and mechanisms of insulin resistance.…”

FR177391, A New Anti-hyperlipidemic Agent from Serratia

“…Elevated plasma TG levels are increasingly recognized as a risk factor for cardiovascular disease, and also commonly embedded in the context of metabolic syndromes, including obesity, diabetes and hypertension [22,23]. Several classes of pharmacological agents aiming at improving hypertriglyceridemia have been developed.…”