Do Triglyceride-Rich Lipoproteins Equal Low-Density Lipoproteins in Risk of ASCVD?

IF 5.7 2区医学 Q1 PERIPHERAL VASCULAR DISEASE

Current Atherosclerosis Reports Pub Date : 2023-11-01 Epub Date: 2023-09-28 DOI:10.1007/s11883-023-01153-8

Benjamin N Wadström, Anders B Wulff, Kasper M Pedersen, Børge G Nordestgaard

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引用次数: 0

Abstract

Purpose of review: Recent large clinical trials have failed to show that triglyceride-rich lipoprotein-lowering therapies decrease the risk of atherosclerotic cardiovascular disease (ASCVD). In this review, we reconcile these findings with evidence showing that elevated levels of triglyceride-rich lipoproteins and the cholesterol they contain, remnant cholesterol, cause ASCVD alongside low-density lipoprotein (LDL) cholesterol.

Recent findings: Results from observational epidemiology, genetic epidemiology, and randomized controlled trials indicate that lowering of remnant cholesterol and LDL cholesterol decrease ASCVD risk by a similar magnitude per 1 mmol/L (39 mg/dL) lower non-high-density lipoprotein cholesterol (remnant cholesterol+LDL cholesterol). Indeed, recent guidelines for ASCVD prevention recommend the use of non-high-density lipoprotein cholesterol instead of LDL cholesterol. Current consensus is moving towards recognizing remnant cholesterol and LDL cholesterols as equals per 1 mmol/L (39 mg/dL) higher levels in the risk assessment of ASCVD; hence, triglyceride-rich lipoprotein-lowering therapies should also lower levels of non-HDL cholesterol to reduce ASCVD risk.

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富含甘油三酯的脂蛋白与ASCVD风险中的低密度脂蛋白相等吗？

综述目的：最近的大型临床试验未能表明富含甘油三酯的脂蛋白降低疗法可以降低动脉粥样硬化性心血管疾病（ASCVD）的风险。在这篇综述中，我们将这些发现与证据相一致，这些证据表明，富含甘油三酯的脂蛋白及其所含胆固醇（残余胆固醇）水平的升高与低密度脂蛋白（LDL）胆固醇一起导致ASCVD。最近的发现：观察性流行病学、遗传流行病学和随机对照试验的结果表明，每降低1 mmol/L（39 mg/dL）的非高密度脂蛋白胆固醇（残余胆固醇+LDL胆固醇），降低残余胆固醇和LDL胆固醇可使ASCVD风险降低类似程度。事实上，最近的ASCVD预防指南建议使用非高密度脂蛋白胆固醇代替LDL胆固醇。目前的共识是，在ASCVD的风险评估中，残余胆固醇和低密度脂蛋白胆固醇水平每升高1 mmol/L（39 mg/dL）相当；因此，富含甘油三酯的脂蛋白降低疗法也应该降低非高密度脂蛋白胆固醇水平，以降低ASCVD的风险。

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来源期刊

Current Atherosclerosis Reports 医学-

CiteScore

9.00

自引率

3.40%

发文量

审稿时长

6-12 weeks

期刊介绍： The aim of this journal is to systematically provide expert views on current basic science and clinical advances in the field of atherosclerosis and highlight the most important developments likely to transform the field of cardiovascular prevention, diagnosis, and treatment. We accomplish this aim by appointing major authorities to serve as Section Editors who select leading experts from around the world to provide definitive reviews on key topics and papers published in the past year. We also provide supplementary reviews and commentaries from well-known figures in the field. An Editorial Board of internationally diverse members suggests topics of special interest to their country/region and ensures that topics are current and include emerging research.