Atherosclerosis, diabetes and lipoproteins

Abstract

The enormous burden of vascular disease is likely to expand rapidly as sedentary obesity and diabetes increase. Although cholesterol plays a major role in atherosclerosis and LDL is the major carrier of cholesterol in the blood, the importance of the postprandial triglyceride-rich lipoproteins in the development of atherosclerosis is gaining recognition. The role of HDL-cholesterol is also receiving more attention. These changes have been forced upon us by the realization that statins, which primarily lower LDL-cholesterol, only reduce the risk of atherosclerosis by 30%, suggesting that 70% of the risk still has to be explained and treated. In diabetes, abnormality in the metabolism of the triglyceride-rich lipoproteins and the inter-relationship with HDL-cholesterol appears to be of primary importance in atherosclerotic risk. Postprandial studies are difficult to carry out, which is one reason why large studies have not so far been performed. The important new findings in chylomicron metabolism suggest new treatments for the future.

Keywords::

• ApoB48
• atherosclerosis
• diabetes
• intestinal lipoproteins
• lipoproteins
• postprandial
• triglycerides

Financial & competing interests disclosure

Gerald H Tomkin has received lecture and/or advisory fees from MSD, Johnson and Johnson, Eli Lilly and Surface Logix Inc., and research grants from Takeda, Merck, Lypha and Fournier. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.