Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9047, USA,
Curr Atheroscler Rep. 2014 Mar;16(3):394. doi: 10.1007/s11883-013-0394-9.
Advanced lipid testing has been suggested by some experts to identify patients with substantial residual risk for more aggressive targeting of lifestyle and pharmacologic therapies. It measures the subpopulation of lipoproteins and apolipoproteins, which include lipoprotein (a), apolipoprotein A-I, and apolipoprotein B, and measures of lipoprotein particle composition such as LDL particle (LPL-P) and HDL particle (HDL-P) number and size. Obesity is associated with smaller LDL-P and HDL-P sizes. Moderate weight loss via fasting/calorie restriction is associated with LDL-P size increase, whereas moderate weight loss via endurance exercise is associated with HDL-P size increase. Diets high in carbohydrates are associated with a more atherogenic advanced lipoprotein profile characterized by smaller LDL-P and HDL-P sizes. In summary, lifestyle changes such as weight loss, exercise, and dietary modification correlate with improvement in the profile of advanced lipoproteins. Regrettably, therapies targeting HDL and HDL composition have been disappointing to date.
一些专家建议进行高级血脂检测，以确定具有更大残余风险的患者，从而更积极地针对生活方式和药物治疗进行靶向治疗。它测量脂蛋白和载脂蛋白的亚群，包括脂蛋白(a)、载脂蛋白 A-I 和载脂蛋白 B，以及脂蛋白颗粒组成的测量，如 LDL 颗粒 (LPL-P) 和 HDL 颗粒 (HDL-P) 的数量和大小。肥胖与较小的 LDL-P 和 HDL-P 大小有关。通过禁食/热量限制适度减肥与 LDL-P 大小增加有关，而通过耐力运动适度减肥与 HDL-P 大小增加有关。富含碳水化合物的饮食与更具动脉粥样硬化性的先进脂蛋白谱有关，其特征是 LDL-P 和 HDL-P 大小较小。总之，生活方式的改变，如减肥、运动和饮食调整，与先进脂蛋白谱的改善相关。遗憾的是，迄今为止，针对 HDL 和 HDL 组成的治疗方法一直令人失望。
