The trig lyceride-high-density lipoprotein axis: An important target of therapy?
The trig lyceride-high-density lipoprotein axis: An important target of therapy?
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DOI：
10.1016/j.ahj.2004.03.037
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发表时间：
2004-08-01
影响因子：
4.8
通讯作者：
Rader, DJ
中科院分区：
文献类型：
--
作者：
Szapary, PO;Rader, DJ
冠心病是美国发病率和死亡率的最大单一原因。低密度脂蛋白胆固醇（LDL-C）水平升高与冠心病（CHD）之间的联系已被明确确立。然而，越来越多的人认为甘油三酯（TG）与CHID独立相关，而高密度脂蛋白胆固醇（HDL-C）与CHID风险呈负相关。高TG和低HDL经常同时发生，通常伴随着正常的LDL-C水平，可以被描述为TG-HDL轴的异常。这种脂质异常是代谢综合征患者的基本特征，代谢综合征与2型糖尿病和冠心病的发展密切相关。高TG和低HDL-C患者应积极治疗，改变治疗性生活方式。对于高危患者，还应考虑专门针对TG-HDL轴的脂质修饰治疗。目前此类患者的药物治疗选择包括他汀类药物、贝特类药物、烟酸、鱼油及其组合。目前正在研究几种治疗TG-HDL轴的新药理学方法。针对TG-HDL轴的药物治疗减少动脉粥样硬化和心血管事件的假设需要更多的临床试验数据来验证。
Coronary heart disease is the single largest cause of morbidity and mortality in the United States. The link between elevated low-density lipoprotein cholesterol (LDL-C) levels and coronary heart disease (CHD) has been clearly established. However, triglycerides (TG) are increasingly believed to be independently associated with CHID, while high-density lipoprotein cholesterol (HDL-C) is inversely associated with CHID risk. High TG and low HDL often occur together, often with normal levels of LDL-C, and can be described as abnormalities of the TG-HDL axis. This lipid abnormality is a fundamental characteristic of patients with the metabolic syndrome, a condition strongly associated with the development of both type 2 diabetes and CHD. Patients with high TG and low HDL-C should be aggressively treated with therapeutic lifestyle changes. For high-risk patients, lipid-modifying therapy that specifically addresses the TG-HDL axis should also be considered. Current pharmacologic treatment options for such patients include statins, fibrates, niacin, fish oils, and combinations thereof. Several new pharmacologic approaches to treating the TG-HDL axis are currently being investigated. More clinical trial data is needed to test the hypothesis that pharmacologic therapy targeting the TG-HDL axis reduces atherosclerosis and cardiovascular events.