Postprandialer Lipoproteinstoffwechsel und kardiovaskuläres Risiko

Zusammenfassung

Erhöhte Plasma-Triglyzeridspiegel sind mit kardiovaskulären Erkrankungen assoziiert. Das Ausmaß dieses Effekts und der molekulare Mechanismus der Atherogenität der Triglyzeride sind jedoch unklar. Es wird angenommen, dass die triglyzeridreichen Lipoproteine selbst nicht atherogen sind, sondern ihre metabolischen Folgen, Restpartikel (Chylomikronen-und VLDL-Remnants), kleine dichte LDL (sdLDL) und erniedrigtes HDL-Cholesterin. In prospektiven Studien wurde gezeigt, dass beim Vergleich der höchsten mit den niedrigsten Subgruppen die Nüchtern-Triglyzeride das adjustierte kardiovaskuläre Risiko (hazard ratio) auf 1,7, und postprandiale Triglyzeride sogar auf bis zu 5 erhöhen können. Neben Gesamtcholesterin, Triglyzeriden, LDL-und HDLCholesterin wäre die Bestimmung postprandialer Triglyzeridwerte durchaus sinnvoll; hierfür existiert aber keine anerkannte standardisierte Methode. In der klinischen Routine kann eine Berechnung des Non-HDL-Cholesterins und in Zukunft möglicherweise auch die Messung des Apolipoprotein-B-Plasmaspiegels eine bessere Einschätzung der Atherogenität des Lipidprofils bei erhöhten Triglyzeriden bieten.

Summary

Elevated serum triglyceride levels are associated with cardiovascular disease. The extent of the triglyceride contribution to the cardiovascular risk and the mechanisms by which triglyceride-rich lipoproteins exert their atherogenicity on the vascular wall are mostly unknown. Most likely, not triglyceride rich particles themselves but cholesterol-rich remnant particles, small dense LDL and decreased HDL cholesterol mediate these effects. Prospective studies have shown that fasting triglyceride levels can increase the adjusted hazard ratios for cardiovascular disease risk up to 1.7, and nonfasting levels in some populations up to 5, comparing highest with lowest subgroups. Besides total cholesterol, triglycerides, LDL and HDL cholesterol, estimation of nonfasting triglycerides may be useful, but there is no widely accepted standardized protocol for a postprandial test. For clinical practice, non-HDL cholesterol and the plasma concentration of apolipoprotein B may reflect the atherogenic lipoprotein subfractions in hypertriglyceridemia best.

Schlüsselwörter

Triglyzeride - postprandial - Diabetes - Dyslipoproteinämie - small dense LDL - Remnants - HDL

Keywords

Triglycerides - postprandial - diabetes - dyslipidemia - small dense LDL - remnants - HDL

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