Hypertriglyceridemia, atherogenic dyslipidemia, and the metabolic syndrome

Am J Cardiol. 1998 Feb 26;81(4A):18B-25B. doi: 10.1016/s0002-9149(98)00033-2.

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.

Publication types

  • Review

MeSH terms

  • Animals
  • Arteriosclerosis / metabolism*
  • Cholesterol, HDL / blood
  • Cholesterol, LDL / blood
  • Coronary Disease / etiology
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Hyperlipidemias / metabolism*
  • Hypertension / complications
  • Hypertriglyceridemia / drug therapy
  • Hypertriglyceridemia / epidemiology
  • Hypertriglyceridemia / genetics
  • Hypertriglyceridemia / metabolism*
  • Hypolipidemic Agents / therapeutic use
  • Insulin Resistance
  • Lipoproteins, LDL / blood
  • Lipoproteins, VLDL / blood
  • Multivariate Analysis
  • Risk Assessment
  • Risk Factors
  • Syndrome
  • Triglycerides / blood

Substances

  • Cholesterol, HDL
  • Cholesterol, LDL
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Hypolipidemic Agents
  • Lipoproteins, LDL
  • Lipoproteins, VLDL
  • Triglycerides