Lamarche B, Lewis G F
Department of Medicine, University of Toronto, Ontario.
Can J Cardiol. 1998 Jun;14(6):841-51.
Several lines of evidence have demonstrated that increased plasma cholesterol plays a primary role in the etiology of atherosclerosis and ischemic heart disease (IHD). Our ability to manage IHD adequately based on plasma cholesterol or low density lipoprotein (LDL) cholesterol concentrations is challenged, however, by evidence suggesting that a significant proportion of individuals with IHD or who will eventually develop IHD have desirable cholesterol concentrations. These observations have generated much interest in the scientific community, with the resultant identification of new metabolic risk factors that may help, in the future, to improve our ability to reduce the risk of IHD adequately. This review presents evidence that hypertriglyceridemia, particularly when associated with reduced high density lipoprotein (HDL) cholesterol concentrations and abdominal or visceral obesity, is a highly atherogenic phenotype, one that requires aggressive risk reduction management. Hypertriglyceridemia is frequently associated with elevated plasma apolipoprotein B concentrations, with states of hyperinsulinemia or insulin resistance and with small, dense LDL particles, which may all contribute to increase the risk of IHD further. This evidence suggests that a therapeutic strategy based on the assessment of plasma triglyceride concentrations, along with HDL cholesterol levels and abdominal obesity, may be a cost effective approach to assessing the high atherogenic risk of visceral obesity and insulin resistance. We can no longer afford to focus our attention exclusively on the detection and management of elevated LDL cholesterol concentrations, and need to adopt comprehensive risk reduction strategies in order to lower the incidence of IHD.
多项证据表明，血浆胆固醇升高在动脉粥样硬化和缺血性心脏病（IHD）的病因中起主要作用。然而，有证据表明，相当一部分患有IHD或最终会患上IHD的个体胆固醇浓度处于理想范围，这对我们基于血浆胆固醇或低密度脂蛋白（LDL）胆固醇浓度来充分管理IHD的能力提出了挑战。这些观察结果引起了科学界的广泛关注，随后发现了新的代谢危险因素，这些因素未来可能有助于提高我们充分降低IHD风险的能力。本综述提供的证据表明，高甘油三酯血症，尤其是与高密度脂蛋白（HDL）胆固醇浓度降低以及腹部或内脏肥胖相关时，是一种高度致动脉粥样硬化的表型，需要积极的风险降低管理。高甘油三酯血症常与血浆载脂蛋白B浓度升高、高胰岛素血症或胰岛素抵抗状态以及小而密的LDL颗粒相关，这些都可能进一步增加IHD的风险。这一证据表明，基于评估血浆甘油三酯浓度以及HDL胆固醇水平和腹部肥胖的治疗策略，可能是评估内脏肥胖和胰岛素抵抗的高动脉粥样硬化风险的一种具有成本效益的方法。我们不能再仅仅将注意力集中在检测和管理升高的LDL胆固醇浓度上，而需要采取全面的风险降低策略以降低IHD的发病率。
