Varbo Anette, Nordestgaard Børge G
aDepartment of Clinical Biochemistry bThe Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital cFaculty of Health and Medical Sciences, University of Copenhagen, Denmark.
Curr Opin Lipidol. 2014 Aug;25(4):266-73. doi: 10.1097/MOL.0000000000000093.
To review recent advances in the field of remnant cholesterol as a contributor to the development of ischemic heart disease (IHD).
Epidemiologic, mechanistic, and genetic studies all support a role for elevated remnant cholesterol (=cholesterol in triglyceride-rich lipoproteins) as a contributor to the development of atherosclerosis and IHD. Observational studies show association between elevated remnant cholesterol and IHD, and mechanistic studies show remnant cholesterol accumulation in the arterial wall like LDL-cholesterol (LDL-C) accumulation. Furthermore, large genetic studies show evidence of remnant cholesterol as a causal risk factor for IHD independent of HDL-cholesterol levels. Genetic studies also show that elevated remnant cholesterol is associated with low-grade inflammation, whereas elevated LDL-C is not. There are several pharmacologic ways of lowering remnant cholesterol levels; however, it remains to be seen in large randomized clinical intervention trials if lowering of remnant cholesterol, in individuals with elevated levels, will reduce the risk of IHD.
Evidence is emerging for elevated remnant cholesterol being a causal risk factor for IHD. Elevated remnant cholesterol levels likely are part of the explanation of the residual risk of IHD observed after LDL-C has been lowered to recommended levels.
综述残余胆固醇领域的最新进展，其作为缺血性心脏病（IHD）发生发展的一个促成因素。
流行病学、机制和遗传学研究均支持升高的残余胆固醇（=富含甘油三酯脂蛋白中的胆固醇）在动脉粥样硬化和IHD发生发展中起作用。观察性研究显示残余胆固醇升高与IHD之间存在关联，机制研究表明残余胆固醇在动脉壁内积聚，如同低密度脂蛋白胆固醇（LDL-C）积聚一样。此外，大型遗传学研究显示有证据表明残余胆固醇是IHD的一个因果风险因素，独立于高密度脂蛋白胆固醇水平。遗传学研究还表明，残余胆固醇升高与低度炎症相关，而LDL-C升高则不然。有几种降低残余胆固醇水平的药物方法；然而，对于血脂水平升高的个体，降低残余胆固醇是否会降低IHD风险，仍有待大型随机临床干预试验来证实。
越来越多的证据表明，残余胆固醇升高是IHD的一个因果风险因素。残余胆固醇水平升高可能是LDL-C降至推荐水平后仍观察到的IHD残余风险的部分原因。
