Serum low-density lipoprotein as a dietary responsive biomarker of cardiovascular disease risk: Consensus and confusion
Serum low-density lipoprotein as a dietary responsive biomarker of cardiovascular disease risk: Consensus and confusion
复制标题
血清低密度脂蛋白作为心血管疾病风险的饮食反应性生物标志物：共识与困惑
DOI：
10.1111/nbu.12282
复制
发表时间：
2017
影响因子：
3.3
通讯作者：
Griffin B
中科院分区：
文献类型：
--
作者：
Griffin B
30多年来，饱和脂肪酸（SFA）的替代一直是我们膳食指南的支柱，以帮助预防心血管疾病（CVD）。然而，支持这一指南的潜在证据现在因明显缺乏证据而受到争议，主要来自Meta分析，证明饱和脂肪与CVD死亡率之间存在直接关系。这可以通过以下事实来解释，即膳食SFA和CVD之间的关系不是直接的，而是间接的，并通过某些SFA在某些食物中的低密度脂蛋白胆固醇（LDL-C）升高作用来介导。有超过100年的证据表明血清胆固醇升高与CVD有关，并支持目前的共识，即血清LDL与CVD发病率和死亡率有因果关系。然而，LDL作为CVD风险的生物标志物的作用，如通过其胆固醇含量（LDL-C）测量的，经常与其转化为小而致密的LDL颗粒导致CVD的可能性增加而对心血管代谢风险的贡献相混淆。血清LDL作为CVD的生物标志物的临床效用是突出的，尽管通过其胆固醇质量（LDL-C）的增加、其小颗粒尺寸或这些颗粒的过量。最重要的是在低密度脂蛋白发展的早期阶段识别和改变这些特征，并通过适当和持续的饮食和生活方式改变来降低相关的心血管疾病风险。
The replacement of saturated fatty acids (SFA) has been the mainstay of our dietary guidelines to help prevent cardiovascular disease (CVD) for over 30 years. However, the underlying evidence to support this guideline is now held in contentious disrepute on the grounds of an apparent lack of evidence, largely from meta‐analyses, for a direct relationship between saturated fat and CVD mortality. This can be explained by the fact that the relationship between dietary SFA and CVD is not direct, but indirect and mediated through the low‐density lipoprotein cholesterol (LDL‐C) raising effects of certain SFA, in certain foods. There is over 100 years of evidence to link raised serum cholesterol with CVD and to support the current consensus that serum LDL is causally related to CVD morbidity and mortality. Nevertheless, the role of LDL as a biomarker of CVD risk, as measured by its cholesterol content (LDL‐C), is often confused with its contribution to cardio‐metabolic risk by its conversion into small and dense LDL particles with increased potential to cause CVD. The clinical utility of serum LDL is outstanding as a biomarker for CVD, albeit through an increase in its cholesterol mass (LDL‐C), its small particle size or over‐abundance of these particles. What is of overriding importance is to identify and modify these characteristics in LDL at the earliest stage of their development and to reduce the associated CVD risk through appropriate and sustained changes in diet and lifestyle.