Vaverková H
III. interní klinika LF UP a FN, Olomouc.
Vnitr Lek. 1996 Mar;42(3):191-6.
The author presents an account on the main lipid risk factors of ischaemic heart disease. She emphasizes the causal role of cholesterol and low density lipoproteins (LDL), incl. the VLDL subclass and oxidized LDL in the pathogenesis of atherosclerosis. The atherogenic action of elevated concentrations of triacylglycerols is discussed (the importance of heterogenity of lipoproteins rich in triacyglycerols, postprandial hypertriacylglycerolaemia, combination with low concentrations of high density lipoproteins (HDL) and prothrombogenic changes). The protective role of HDL is mediated not only by their participation in the reverse cholesterol transport but also other antiatherogenic changes (antioxidant, increased prostacycline secretion, effect on the vascular tonus). Low HDL cholesterol concentrations in subjects with ischaemic heart disease indicate not only loss of these protective properties but also a pathological metabolism of lipoproteins rich in triacylglycerols with which they are metabolically associated. The author emphasizes the antiatherogenic importance of the sub-population HDL2 and of lipoprotein particles Lp AI. Lipoprotein (a) is another independent risk factor of ischaemic heart disease. The genetic determination and ratio of factors of the external environment in the variability of concentrations of all these lipid risk factors in the population is discussed.
作者介绍了缺血性心脏病的主要脂质危险因素。她强调了胆固醇和低密度脂蛋白（LDL）的因果作用，包括极低密度脂蛋白亚类和氧化型LDL在动脉粥样硬化发病机制中的作用。文中讨论了高浓度三酰甘油的致动脉粥样硬化作用（富含三酰甘油的脂蛋白异质性的重要性、餐后高甘油三酯血症、与低浓度高密度脂蛋白（HDL）的联合以及促血栓形成变化）。HDL的保护作用不仅通过其参与胆固醇逆向转运介导，还通过其他抗动脉粥样硬化变化（抗氧化、前列环素分泌增加、对血管张力的影响）介导。缺血性心脏病患者中HDL胆固醇浓度低不仅表明这些保护特性丧失，还表明与它们代谢相关的富含三酰甘油的脂蛋白存在病理代谢。作者强调了HDL2亚群和脂蛋白颗粒Lp AI的抗动脉粥样硬化重要性。脂蛋白（a）是缺血性心脏病的另一个独立危险因素。文中讨论了人群中所有这些脂质危险因素浓度变化的遗传决定因素和外部环境因素的比例。
