Atherosclerosis and Remnant Lipoproteinemia

Atherosclerosis is the development of complex lipid-laden lesions in the vasculature with the potential to contribute to cardiovascular events including myocardial infarction, stroke and peripheral vascular disease. The normal endothelial cell phenotype is anti-atherogenic, with injury, endothelial cell tight junctions are weakened, allowing egress of lipoproteins into the sub endothelial space, leading to decreased vasodilatory nitric oxide secretion, and finally decrease in flow mediated dilation (FMD). The risk of experiencing a cardiovascular event is 13% lower per 1% higher FMD. Elevated serum LDL is strongly related to the development of atherosclerotic diseases. Epidemiologic studies reveal that hypertriglyceridemia is also associated with atherosclerosis independent of other coronary risk factors. This is a challenge to distinguish high-risk patients from all subjects with hypertriglyceridemia. Atherosclerotic diseases with high triglyceride levels can be found in patients with familial combined hyperlipidemia, diabetes mellitus, and metabolic syndrome, in which triglyceride-rich lipoproteins, especially chylomicron remnants and VLDL remnants, accumulate in the circulating blood and contribute in atherosclerosis. Many researchers have focused on these remnant lipoproteins as atherogenic particles. Remnant lipoprotein (RLP) not only increases in abnormality of lipoprotein metabolism, it is also associated with the progression of atherosclerosis, and coronary artery disease (CAD).