Cromwell William C, Otvos James D
LipoScience, Inc., 2500 Sumner Boulevard, Raleigh, NC 27616, USA.
Curr Atheroscler Rep. 2004 Sep;6(5):381-7. doi: 10.1007/s11883-004-0050-5.
The key role played by low-density lipoprotein (LDL) particles in the pathogenesis of coronary heart disease (CHD) is well accepted, as is the benefit of lowering LDL in high-risk patients. What remains controversial is whether we are using the best measure(s) of LDL to identify all individuals who would benefit from therapy. Many studies have shown that, at a given level of LDL cholesterol, individuals with predominantly small LDL particles (pattern B) experience greater CHD risk than those with larger-size LDL. However, it is not clear from this observation that small LDL particles are inherently more atherogenic than large ones because, at a given level of LDL cholesterol, individuals with small LDL have more LDL particles in total. The phenotype of small LDL particle size co-segregates with a cluster of metabolic factors, including elevated triglycerides and reduced HDL cholesterol, and in multivariate analyses has generally been found not to be independently associated with CHD risk. In contrast, LDL particle number measured by nuclear magnetic resonance has consistently been shown to be a strong, independent predictor of CHD.
低密度脂蛋白（LDL）颗粒在冠心病（CHD）发病机制中所起的关键作用已得到广泛认可，降低高危患者的LDL水平所带来的益处也同样如此。仍存在争议的是，我们是否正在使用LDL的最佳测量方法来识别所有能从治疗中获益的个体。许多研究表明，在给定的LDL胆固醇水平下，主要为小LDL颗粒（B型模式）的个体比大尺寸LDL颗粒的个体患CHD的风险更高。然而，从这一观察结果尚不清楚小LDL颗粒本质上是否比大LDL颗粒更具致动脉粥样硬化性，因为在给定的LDL胆固醇水平下，小LDL颗粒的个体总的LDL颗粒更多。小LDL颗粒大小的表型与一系列代谢因素共同出现，包括甘油三酯升高和HDL胆固醇降低，并且在多变量分析中通常发现其与CHD风险无独立关联。相比之下，通过核磁共振测量的LDL颗粒数量一直被证明是CHD的一个强有力的独立预测指标。
