School of Medicine, Federal University of Uberlandia (UFU), Uberlandia, Minas Gerais, Brazil.
Texas A&M University, Department of Health and Kinesiology, College Station, TX, United States.
Prog Cardiovasc Dis. 2020 Jul-Aug;63(4):503-509. doi: 10.1016/j.pcad.2020.04.009. Epub 2020 Apr 27.
Lipid profile screening is crucial for the prevention, evaluation and treatment of cardiovascular (CV) disease (CVD). Small dense low-density lipoprotein-cholesterol (sdLDL-C) is an emerging biomarker associated with CVD and several comorbidities. The aim of this literature review is to discuss the potential importance of sdLDL-C as a surrogate biomarker for managing CVD by explaining its pathophysiology and promising treatments. The current synthesis demonstrates the impact of sdLDL-C on CV ailments, which are related to arterial pathologies and dysregulated lipid profiles. Several drug classes used for the treatment of dyslipidemia decrease the sdLDL-C concentrations. For instance, statins, fibrates, ezetimibe, nicotinic acid, resin and orlistat are pharmacological sdLDL-C-lowering agents. Regarding nutritional strategies, simple carbohydrate types, such as fructose, are common in Western diets and should be reduced or avoided due to their potential in increasing synthesis of sdLDL-C subclasses. Dairy products, avocado, pistachios, soy-based diet (except for hydrogenated soybean oil) and corn oil seem to be suitable food choices for a therapeutic diet aiming to control sdLDL-C concentrations. However, thus far dietary supplementation with omega-3 fatty acids is unsubstantiated for decreasing sdLDL-C concentration. In conclusion, coupled with the traditional lipid profile, measurement or even the estimation of sdLDL-C as a routine screening should be encouraged, whereas more insights into the control of sdLDL-C are imperative. Appropriate clinical reference ranges for sdLDL-C are also needed.
血脂谱筛查对于心血管疾病 (CVD) 的预防、评估和治疗至关重要。小而密的低密度脂蛋白胆固醇 (sdLDL-C) 是一种与 CVD 和多种合并症相关的新兴生物标志物。本文旨在通过解释其病理生理学和有前途的治疗方法，讨论 sdLDL-C 作为 CVD 管理替代生物标志物的潜在重要性。目前的综合研究表明，sdLDL-C 对与动脉病理和脂质谱失调相关的心血管疾病有影响。用于治疗血脂异常的几类药物可降低 sdLDL-C 浓度。例如，他汀类药物、贝特类药物、依折麦布、烟酸、树脂和奥利司他是降低 sdLDL-C 的药理学药物。在营养策略方面，果糖等简单的碳水化合物类型在西方饮食中很常见，由于它们有可能增加 sdLDL-C 亚类的合成，因此应减少或避免摄入。乳制品、鳄梨、开心果、大豆饮食（除氢化大豆油外）和玉米油似乎是控制 sdLDL-C 浓度的治疗性饮食的合适食物选择。然而，迄今为止，ω-3 脂肪酸的饮食补充对降低 sdLDL-C 浓度没有依据。总之，除了传统的血脂谱外，还应鼓励对 sdLDL-C 进行测量甚至估计作为常规筛查，而对 sdLDL-C 控制的更多了解则至关重要。还需要适当的 sdLDL-C 临床参考范围。
