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残余胆固醇与心血管疾病风险研究进展
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Abstract:
近年来，针对低密度脂蛋白胆固醇水平(LDL-C)的药物治疗是动脉粥样硬化性心血管疾病预防和治疗的主要手段，但即使通过下调LDL-C水平仍然存在不良心血管事件发生风险。有研究表明残余胆固醇(remnant cholesterol, RC)可能是主要残余心血管风险的重要影响因素。本综述旨在将近年来对残余胆固醇的定义、计量方法、致动脉粥样硬化机制及证据、治疗方法等进展进行阐述。
In recent years, drug therapy targeting low density lipoprotein cholesterol (LDL-C) level is the main means for the prevention and treatment of atherosclerotic cardiovascular disease. However, there is still a risk of adverse cardiovascular events even by reducing LDL-C level. Studies have shown that remnant cholesterol (RC) may be an important factor affecting the major residual cardiovascular risk. This review aims to elaborate on the definition, measurement methods, atherogenic mechanism and evidence, and treatment methods of residual cholesterol in recent years.
| [1] | Mensah, G.A., Fuster, V., Murray, C.J.L., Roth, G.A., Mensah, G.A., Abate, Y.H., et al. (2023) Global Burden of Cardiovascular Diseases and Risks, 1990-2022. Journal of the American College of Cardiology, 82, 2350-2473. https://doi.org/10.1016/j.jacc.2023.11.007 |
| [2] | Mensah, G.A., Fuster, V. and Roth, G.A. (2023) A Heart-Healthy and Stroke-Free World. Journal of the American College of Cardiology, 82, 2343-2349. https://doi.org/10.1016/j.jacc.2023.11.003 |
| [3] | Sampson, U.K., Fazio, S. and Linton, M.F. (2011) Residual Cardiovascular Risk Despite Optimal LDL Cholesterol Reduction with Statins: The Evidence, Etiology, and Therapeutic Challenges. Current Atherosclerosis Reports, 14, 1-10. https://doi.org/10.1007/s11883-011-0219-7 |
| [4] | Averna, M., Stroes, E., Ogura, M., Postadzhiyan, A., Cercek, M., Calabrò, P., et al. (2017) How to Assess and Manage Cardiovascular Risk Associated with Lipid Alterations beyond LDL. Atherosclerosis Supplements, 26, 16-24. https://doi.org/10.1016/s1567-5688(17)30021-1 |
| [5] | Wang, L., Zhang, Q., Wu, Z. and Huang, X. (2024) A Significant Presence in Atherosclerotic Cardiovascular Disease: Remnant Cholesterol: A Review. Medicine, 103, e38754. https://doi.org/10.1097/md.0000000000038754 |
| [6] | Baratta, F., Cocomello, N., Coronati, M., Ferro, D., Pastori, D., Angelico, F., et al. (2023) Cholesterol Remnants, Triglyceride-Rich Lipoproteins and Cardiovascular Risk. International Journal of Molecular Sciences, 24, Article 4268. https://doi.org/10.3390/ijms24054268 |
| [7] | Martin, S.S., Blaha, M.J., Elshazly, M.B., Toth, P.P., Kwiterovich, P.O., Blumenthal, R.S., et al. (2013) Comparison of a Novel Method vs the Friedewald Equation for Estimating Low-Density Lipoprotein Cholesterol Levels from the Standard Lipid Profile. JAMA, 310, 2061-2068. https://doi.org/10.1001/jama.2013.280532 |
| [8] | Lütjohann, D., Klör, H. and Stellaard, F. (2023) Measurement of Serum Low Density Lipoprotein Cholesterol and Triglyceride-Rich Remnant Cholesterol as Independent Predictors of Atherosclerotic Cardiovascular Disease: Possibilities and Limitations. Nutrients, 15, Article 2202. https://doi.org/10.3390/nu15092202 |
| [9] | Chen, J., Kuang, J., Tang, X., Mao, L., Guo, X., Luo, Q., et al. (2020) Comparison of Calculated Remnant Lipoprotein Cholesterol Levels with Levels Directly Measured by Nuclear Magnetic Resonance. Lipids in Health and Disease, 19, Article No. 132. https://doi.org/10.1186/s12944-020-01311-w |
| [10] | Varbo, A. and Nordestgaard, B.G. (2021) Directly Measured vs. Calculated Remnant Cholesterol Identifies Additional Overlooked Individuals in the General Population at Higher Risk of Myocardial Infarction. European Heart Journal, 42, 4833-4843. https://doi.org/10.1093/eurheartj/ehab293 |
| [11] | Ginsberg, H.N., Packard, C.J., Chapman, M.J., Borén, J., Aguilar-Salinas, C.A., Averna, M., et al. (2021) Triglyceride-rich Lipoproteins and Their Remnants: Metabolic Insights, Role in Atherosclerotic Cardiovascular Disease, and Emerging Therapeutic Strategies—A Consensus Statement from the European Atherosclerosis Society. European Heart Journal, 42, 4791-4806. https://doi.org/10.1093/eurheartj/ehab551 |
| [12] | Borén, J., Chapman, M.J., Krauss, R.M., Packard, C.J., Bentzon, J.F., Binder, C.J., et al. (2020) Low-Density Lipoproteins Cause Atherosclerotic Cardiovascular Disease: Pathophysiological, Genetic, and Therapeutic Insights: A Consensus Statement from the European Atherosclerosis Society Consensus Panel. European Heart Journal, 41, 2313-2330. https://doi.org/10.1093/eurheartj/ehz962 |
| [13] | Castañer, O., Pintó, X., Subirana, I., Amor, A.J., Ros, E., Hernáez, Á., et al. (2020) Remnant Cholesterol, Not LDL Cholesterol, Is Associated with Incident Cardiovascular Disease. Journal of the American College of Cardiology, 76, 2712-2724. https://doi.org/10.1016/j.jacc.2020.10.008 |
| [14] | Quispe, R., Martin, S.S., Michos, E.D., Lamba, I., Blumenthal, R.S., Saeed, A., et al. (2021) Remnant Cholesterol Predicts Cardiovascular Disease Beyond LDL and APOB: A Primary Prevention Study. European Heart Journal, 42, 4324-4332. https://doi.org/10.1093/eurheartj/ehab432 |
| [15] | Lee, S.J., Kim, S.E., Go, T.H., Kang, D.R., Jeon, H.S., Kim, Y.I., Cho, D.H., Park, Y.J., Lee, J.H., Lee, J.W., Youn, Y.J., Kim, S.H., Kim, J.Y. and Ahn, S.G. (2023) Remnant Cholesterol, Low-Density Lipoprotein Cholesterol, and Incident Cardiovascular Disease among Koreans: A National Population-Based Study. European Journal of Preventive Cardiology, 30, 1142-1150. |
| [16] | Wadström, B.N., Wulff, A.B., Pedersen, K.M., Jensen, G.B. and Nordestgaard, B.G. (2021) Elevated Remnant Cholesterol Increases the Risk of Peripheral Artery Disease, Myocardial Infarction, and Ischaemic Stroke: A Cohort-Based Study. European Heart Journal, 43, 3258-3269. https://doi.org/10.1093/eurheartj/ehab705 |
| [17] | Feng, Q., Li, H., Zhang, R., Sun, L., Zhang, S., Chen, Y., et al. (2024) Elevated Remnant Cholesterol Is a Risk Factor for Acute Ischemic Stroke. Journal of Stroke and Cerebrovascular Diseases, 33, Article ID: 107773. https://doi.org/10.1016/j.jstrokecerebrovasdis.2024.107773 |
| [18] | Zhang, P., Zhang, Z., Li, D., Han, R., Li, H., Ma, J., et al. (2023) Association of Remnant Cholesterol with Intracranial Atherosclerosis in Community-Based Population: The ARIC Study. Journal of Stroke and Cerebrovascular Diseases, 32, Article ID: 107293. https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.107293 |
| [19] | Huh, J.H., Han, K., Cho, Y.K., Roh, E., Kang, J.G., Lee, S.J., et al. (2022) Remnant Cholesterol and the Risk of Cardiovascular Disease in Type 2 Diabetes: A Nationwide Longitudinal Cohort Study. Cardiovascular Diabetology, 21, Article No. 228. https://doi.org/10.1186/s12933-022-01667-6 |
| [20] | Fu, L., Tai, S., Sun, J., Zhang, N., Zhou, Y., Xing, Z., et al. (2022) Remnant Cholesterol and Its Visit-to-Visit Variability Predict Cardiovascular Outcomes in Patients with Type 2 Diabetes: Findings from the ACCORD Cohort. Diabetes Care, 45, 2136-2143. https://doi.org/10.2337/dc21-2511 |
| [21] | Doi, T., Langsted, A. and Nordestgaard, B.G. (2023) Lipoproteins, Cholesterol, and Atherosclerotic Cardiovascular Disease in East Asians and Europeans. Journal of Atherosclerosis and Thrombosis, 30, 1525-1546. https://doi.org/10.5551/jat.rv22013 |
| [22] | Mach, F., Baigent, C., Catapano, A.L., Koskinas, K.C., Casula, M., Badimon, L., et al. (2020) 2019 ESC/EAS Guidelines for the Management of Dyslipidaemias: Lipid Modification to Reduce Cardiovascular Risk. European Heart Journal, 41, 111-188. |
| [23] | Mohamed, F., Mansfield, B.S. and Raal, F.J. (2022) ANGPTL3 as a Drug Target in Hyperlipidemia and Atherosclerosis. Current Atherosclerosis Reports, 24, 959-967. https://doi.org/10.1007/s11883-022-01071-1 |
| [24] | Ballantyne, C.M., Vasas, S., Azizad, M., Clifton, P., Rosenson, R.S., Chang, T., et al. (2024) Plozasiran, an RNA Interference Agent Targeting APOC3, for Mixed Hyperlipidemia. New England Journal of Medicine, 391, 899-912. https://doi.org/10.1056/nejmoa2404143 |
| [25] | Rosenson, R.S., Gaudet, D., Hegele, R.A., Ballantyne, C.M., Nicholls, S.J., Lucas, K.J., et al. (2024) Zodasiran, an Rnai Therapeutic Targeting ANGPTL3, for Mixed Hyperlipidemia. New England Journal of Medicine, 391, 913-925. https://doi.org/10.1056/nejmoa2404147 |
| [26] | Guo, D., Gao, J., Wang, X., Chen, Z., Gao, Q., Chen, Y., et al. (2024) Remnant Cholesterol and Risk of Incident Hypertension: A Population-Based Prospective Cohort Study. Hypertension Research, 47, 1157-1166. https://doi.org/10.1038/s41440-023-01558-7 |
