Postprandial Hypertriglyceridemia and Cardiovascular Disease: Current and Future Therapies
Postprandial Hypertriglyceridemia and Cardiovascular Disease: Current and Future Therapies
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DOI：
10.1007/s11883-013-0309-9
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发表时间：
2013-03-01
影响因子：
5.8
通讯作者：
Watts, G. F.
中科院分区：
文献类型：
--
作者：
Chan, D. C.;Pang, J.;Watts, G. F.
餐后过度高甘油三酯血症是心血管疾病的危险因素。这种代谢异常主要是由于富含甘油三酯的脂蛋白（TRL）的过量产生和/或分解代谢减少造成的，并且是致病性遗传变异和其他共存的医疗状况（特别是肥胖和胰岛素抵抗）的结果。餐后状态下 TRL 的积累会促进小而密的低密度脂蛋白的形成，以及氧化应激、炎症和内皮功能障碍，所有这些都会增加心血管疾病的风险。改变生活方式（减肥和锻炼）和传统降脂疗法（他汀类药物、贝特类药物、烟酸、依折麦布和 n-3 脂肪酸补充剂）对心血管的益处可能涉及对 TRL 代谢的有利影响。新药，如双过氧化物酶体增殖物激活受体α/δ激动剂、二酰甘油、二酰甘油酰基转移酶1和微粒体甘油三酯转移蛋白抑制剂、载脂蛋白B-100和载脂蛋白C-III反义寡核苷酸以及基于肠促胰素的疗法，可能会增强餐后脂血症的治疗，但其疗效需要临床最终检验点试验。需要进一步的工作来制定一个简单的临床方案来调查餐后血脂，以及国际公认的此类血脂异常的管理指南。
Exaggerated postprandial hypertriglyceridemia is a risk factor for cardiovascular disease. This metabolic abnormality is principally due to overproduction and/or decreased catabolism of triglyceride-rich lipoproteins (TRLs) and is a consequence of pathogenic genetic variations and other coexistent medical conditions, particularly obesity and insulin resistance. Accumulation of TRL in the postprandial state promotes the formation of small, dense low-density lipoproteins, as well as oxidative stress, inflammation, and endothelial dysfunction, all of which compound the risk of cardiovascular disease. The cardiovascular benefits of lifestyle modification (weight loss and exercise) and conventional lipid-lowering therapies (statins, fibrates, niacin, ezetimibe, and n-3 fatty acid supplementation) could involve their favorable effects on TRL metabolism. New agents, such as dual peroxisome-proliferator-activated receptor alpha/delta agonists, diacylglycerol, inhibitors of diacylglycerol acyltransferase 1 and microsomal triglyceride transfer protein, antisense oligonucleotides for apolipoprotein B-100 and apolipoprotein C-III, and incretin-based therapies, may enhance the treatment of postprandial lipemia, but their efficacy needs to be tested in clinical end point trials. Further work is required to develop a simple clinical protocol for investigating postprandial lipemia, as well as internationally agreed management guidelines for this type of dyslipidemia.