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首页> 外文期刊>Circulation research: a journal of the American Heart Association >Triglyceride-Rich Lipoproteins and Atherosclerotic Cardiovascular Disease New Insights From Epidemiology, Genetics, and Biology
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Triglyceride-Rich Lipoproteins and Atherosclerotic Cardiovascular Disease New Insights From Epidemiology, Genetics, and Biology

机译：富有甘油三酯的脂蛋白和动脉粥样硬化心血管疾病来自流行病学，遗传学和生物学的新见解

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Scientific interest in triglyceride-rich lipoproteins has fluctuated over the past many years, ranging from beliefs that these lipoproteins cause atherosclerotic cardiovascular disease (ASCVD) to being innocent bystanders. Correspondingly, clinical recommendations have fluctuated from a need to reduce levels to no advice on treatment. New insight in epidemiology now suggests that these lipoproteins, marked by high triglycerides, are strong and independent predictors of ASCVD and all-cause mortality, and that their cholesterol content or remnant cholesterol likewise are strong predictors of ASCVD. Of all adults, 27% have triglycerides > 2 mmol/L (176 mg/dL), and 21% have remnant cholesterol > 1 mmol/L (39 mg/dL). For individuals in the general population with nonfasting triglycerides of 6.6 mmol/L (580 mg/dL) compared with individuals with levels of 0.8 mmol/L (70 mg/dL), the risks were 5.1-fold for myocardial infarction, 3.2-fold for ischemic heart disease, 3.2-fold for ischemic stroke, and 2.2-fold for all-cause mortality. Also, genetic studies using the Mendelian randomization design, an approach that minimizes problems with confounding and reverse causation, now demonstrate that triglyceride-rich lipoproteins are causally associated with ASCVD and all-cause mortality. Finally, genetic evidence also demonstrates that high concentrations of triglyceride-rich lipoproteins are causally associated with low-grade inflammation. This suggests that an important part of inflammation in atherosclerosis and ASCVD is because of triglyceride-rich lipoprotein degradation and uptake into macrophage foam cells in the arterial intima. Taken together, new insights now strongly suggest that elevated triglyceride-rich lipoproteins represent causal risk factors for low-grade inflammation, ASCVD, and all-cause mortality.
机译：在过去的多年中，对富甘油酯的脂蛋白的科学兴趣在过去的多年中，这些脂蛋白导致动脉粥样硬化血管疾病（ASCVD）是无辜的旁观者的信念。相应地，临床建议从不需要减少水平，没有关于治疗的建议。流行病学的新洞察力现在表明，由高甘油三酯标记的这些脂蛋白是强烈的，是ASCVD和全导致死亡率的强烈和独立的预测因子，并且它们的胆固醇含量或残余胆固醇同样是ASCVD的强预测因子。在所有成年人中，27％具有甘油三酯> 2mmol / L（176mg / dl），21％具有残余胆固醇> 1mmol / L（39mg / dl）。对于具有6.6mmol / L（580mg / dl）的少量甘油三酯的一般群体的个体，与水平为0.8mmol / L（70mg / dl），风险为心肌梗死的5.1倍，3.2倍对于缺血性心脏病，缺血性卒中3.2倍，对于全导致死亡率为2.2倍。此外，使用孟德尔随机化设计的遗传研究，一种方法可以最大限度地减少混淆和逆转原因的问题，现在证明了富有的甘油三酯的脂蛋白与ASCVD和全导致死亡率有关。最后，遗传证据还表明，高浓度的富甘油三酯的脂蛋白是因果关系而与低级炎症有关。这表明动脉粥样硬化和ASCVD中炎症的重要部分是因为富有甘油三酯的脂蛋白降解和摄入动脉内膜中的巨噬细胞泡沫细胞。一起携带新的见解现在强烈建议富含富甘油三酯的脂蛋白，代表低级炎症，ASCVD和全导致死亡率的因果危险因素。

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