Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Cardiology Department, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania.
Int J Mol Sci. 2023 Apr 3;24(7):6669. doi: 10.3390/ijms24076669.
Cardiovascular disease (CVD) impacts hundreds of millions of people each year and is the main cause of death worldwide, with atherosclerosis being its most frequent form of manifestation. Low-density lipoproteins (LDL) have already been established as a significant cardiovascular risk factor, but more recent studies have shown that small, dense LDLs are the ones more frequently associated with a higher overall risk for developing atherosclerotic cardiovascular disease. Ever since atherogenic phenotypes were defined for the first time, LDL subfractions have been continuously analyzed in order to identify those with a higher atherogenic profile that could further become not only high-accuracy, effective prognostic biomarkers, but also treatment targets for novel lipid-lowering molecules. This review sets out to comprehensively evaluate the association between various LDL-subfractions and the risk of further developing major adverse cardiovascular events, by assessing both genetical and clinical features and focusing on their physiopathological characteristics, chemical composition, and global ability to predict long-term cardiovascular risk within the general population. Further research is required in order to establish the most beneficial range of LDL-C levels for both primary and secondary prevention, as well as to implement LDL subfraction testing as a routine protocol, separately from the general assessment of the other traditional cardiovascular risk factors.
心血管疾病（CVD）每年影响数亿人，是全球主要的死亡原因，其中动脉粥样硬化是最常见的表现形式。低密度脂蛋白（LDL）已被确定为心血管疾病的一个重要危险因素，但最近的研究表明，小而密的 LDL 与发生动脉粥样硬化性心血管疾病的总体风险增加更为相关。自从首次定义动脉粥样硬化表型以来，一直在不断分析 LDL 亚组分，以确定那些具有更高动脉粥样硬化特征的 LDL 亚组分，这些 LDL 亚组分不仅可以成为高精度、有效的预后生物标志物，还可以成为新型降脂分子的治疗靶点。本综述通过评估遗传和临床特征，并重点关注其生理病理特征、化学成分以及在普通人群中预测长期心血管风险的整体能力，全面评估了各种 LDL 亚组分与进一步发生主要不良心血管事件风险之间的关联。需要进一步研究，以确定一级和二级预防的 LDL-C 水平的最佳范围，并将 LDL 亚组分检测作为常规方案实施，而不是将其与其他传统心血管危险因素的一般评估分开。
