Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX, UK.
Systems Immunity University Research Institute, Cardiff University, Cardiff, UK.
Cardiovasc Res. 2022 Feb 21;118(3):716-731. doi: 10.1093/cvr/cvab017.
The prothrombotic state in atrial fibrillation (AF) occurs as a result of multifaceted interactions, known as Virchow's triad of hypercoagulability, structural abnormalities, and blood stasis. More recently, there is emerging evidence that lipoproteins are implicated in this process, beyond their traditional role in atherosclerosis. In this review, we provide an overview of the various lipoproteins and explore the association between lipoproteins and AF, the effects of lipoproteins on haemostasis, and the potential contribution of lipoproteins to thrombogenesis in AF. There are several types of lipoproteins based on size, lipid composition, and apolipoprotein category, namely: chylomicrons, very low-density lipoprotein, low-density lipoprotein (LDL), intermediate-density lipoprotein, and high-density lipoprotein. Each of these lipoproteins may contain numerous lipid species and proteins with a variety of different functions. Furthermore, the lipoprotein particles may be oxidized causing an alteration in their structure and content. Of note, there is a paradoxical inverse relationship between total cholesterol and LDL cholesterol (LDL-C) levels, and incident AF. The mechanism by which this occurs may be related to the stabilizing effect of cholesterol on myocardial membranes, along with its role in inflammation. Overall, specific lipoproteins may interact with haemostatic pathways to promote excess platelet activation and thrombin generation, as well as inhibiting fibrinolysis. In this regard, LDL-C has been shown to be an independent risk factor for thromboembolic events in AF. The complex relationship between lipoproteins, thrombosis and AF warrants further research with an aim to improve our knowledge base and contribute to our overall understanding of lipoprotein-mediated thrombosis.
心房颤动 (AF) 中的血栓形成状态是多种相互作用的结果，被称为血栓形成的 Virchow 三联征，即高凝状态、结构异常和血液淤滞。最近，有越来越多的证据表明，脂蛋白在这一过程中起作用，超出了它们在动脉粥样硬化中的传统作用。在这篇综述中，我们概述了各种脂蛋白，并探讨了脂蛋白与 AF 的关系、脂蛋白对止血的影响，以及脂蛋白在 AF 中的血栓形成中的潜在作用。根据大小、脂质组成和载脂蛋白类别，有几种类型的脂蛋白，即乳糜微粒、极低密度脂蛋白、低密度脂蛋白 (LDL)、中密度脂蛋白和高密度脂蛋白。这些脂蛋白中的每一种都可能含有许多具有不同功能的脂质种类和蛋白质。此外，脂蛋白颗粒可能会被氧化，导致其结构和含量发生改变。值得注意的是，总胆固醇和 LDL 胆固醇 (LDL-C) 水平与 AF 事件之间存在相反的反比关系。这种情况发生的机制可能与胆固醇对心肌膜的稳定作用以及其在炎症中的作用有关。总的来说，特定的脂蛋白可能与止血途径相互作用，促进血小板过度激活和凝血酶生成，并抑制纤维蛋白溶解。在这方面，LDL-C 已被证明是 AF 中血栓栓塞事件的独立危险因素。脂蛋白、血栓形成和 AF 之间的复杂关系需要进一步研究，以提高我们的知识库，并有助于我们全面了解脂蛋白介导的血栓形成。
