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Adipositas - Ursachen, Folgeerkrankungen, Therapie 2009; 03(03): 115-122
DOI: 10.1055/s-0037-1618673
Adipositas und Lipidstoffwechselstörungen
Schattauer GmbH

Atherogenese bei Adipositas

Atherogenesis and adiposity
J. Thiery
1   Institut für Laboratoriumsmedizin, Klinische Chemie und Molekulare Diagnostik, Universitätsklinikum Leipzig
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Publication History

Publication Date:
22 December 2017 (online)

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Zusammenfassung

Bei Adipositaspatienten finden sich abnorme Plasmalipoproteine, die in der Zirkulation persistieren und in der Gefäßwand leicht zu inflammatorisch wirksamen Partikeln modifiziert werden können. Sie tragen wahrscheinlich wesentlich zu der Entstehung und schnellen Progression der Atherosklerose bei diesen Patienten bei. Hierzu zählen VLDL und Chylomikronen-Remnant-Partikel, small dense LDL, sowie glykierte LDL. Die bei Adipositas auftretenden abnormen Lipoproteine sind leicht oxidierbar, sie zeigen eine erhöhte Affinität zu den Scavenger-Rezeptoren der Makrophagen und induzieren eine chronische Inflammation der Gefäßwand. Als Surrogatmarker für die Konzentrationsbestimmung atherogener Lipoproteine bei Adipositas und die erhöhten Triglyzeridkonzentrationen kann heute die Apolipoprotein-B-Plasmakonzentration herangezogen werden. Die klinische Wertigkeit einer isolierten Bestimmung der besonders atherogenen small dense LDL wird zurzeit mit einem neuen homogenen Messverfahren untersucht. Der klinische Nutzen einer Bestimmung glykierter LDL für die Risikoeinschätzung der Atherosklerose bleibt abzuwarten. Es bleibt abschließend festzuhalten, dass bei Adipositaspatienten eine Reihe abnormer Lipoproteine mit besonders atherogenen Eigenschaften auftreten können. Therapeutische Strategien in der Behandlung der Adipositas müssen daher immer auch eine Normalisierung der Dyslipid ämie und eine möglichst vollständige Reduktion der abnormen Lipoproteine einschließen.

Summary

Patients suffering from adiposity show hypertriglyceridemia, low HDL and abnormal plasma lipoprotein particles, which contribute to the fast progression atherosclerosis. The lipoprotein metabolism in adiposity is frequently characterized by the appearance of cholesterol enriched small dense Low Density Lipoproteins (sdLDL), glycated LDL and the persistence of VLDL and chylomicron remnant particles in the circulation. The abnormal lipoproteins show reduced resistance to oxidation. They are bound with high affinity to scavenger receptors of macrophages. They show specific atherogenic properties and enhance the inflammatory process in the arterial wall. Therefore, abnormal plasma lipoproteins associated with adiposity increase the risk for coronary heart disease, stroke and peripheral atherosclerosis. There is still a debate, which plasma lipid marker predict best the coronary risk in adiposity and metabolic syndrome. Apolipoprotein B levels may be used as a surrogate marker for all atherogenic lipoproteins. A more specific approach may be the quantification of small dense LDL cholesterol levels using novel high-throughput assays. The clinical utility of glycated LDL analysis is still unclear. In summary, abnormal lipoproteins are strongly involved in the progression of atherosclerosis in patients with adiposity. Strategies of adiposity treatment should include the normalization of lipoprotein abnormalities in this high risk patient group.

Schlüsselwörter

sdLDL - Remnants - glykierte LDL - Atherosklerose - LDL-Oxidation - Adipositas - Inflammation

Keywords

sdLDL - remnants - glycated LDL - atherosclerosis - adiposity - LDL-oxidation - inflammation
 

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