Reassessing lipid metabolism and its potentialities in the prediction of cardiovascular risk

There are numerous particles, enzymes, and mechanisms in the lipid metabolism that are involved in the genesis of cardiovascular disease (CVD). Given its prevalence in populations and its impact on mortality, it is relevant to review the lipid metabolism as it may potentially provide subsidies to better prediction. This article reviews the importance of traditional cardiovascular risk factors and comments on the potential of novel lipid biomarkers involved in the physiopathology of CVD. The Framingham cohorts proved the role of traditional risk factors (physical inactivity, smoking, blood pressure, total cholesterol, LDL-C, HDL-C, plasma glucose) in the prediction of cardiovascular events. However, a significant number of individuals that suffer from a cardiovascular event has few or none of these factors. Such finding indicates the need for new biomarkers able to identify plaques that are more susceptible to rupture. Some of bloodstream biomarkers related to lipid metabolism are modified LDL particles, apolipoprotein AI (apo AI), apolipoprotein B, lipoprotein (a) [Lp (a)], cholesteryl ester transfer protein (CETP), subtypes of LDL and HDL particles, and lipoprotein-associated phospholipase A2 (Lp-PLA2). These factors participate in the atherosclerotic process, and are abnormal in individuals at high risk, or in those who suffered from a cardiovascular event. Lp (a) determination is already employed in clinical practice and should be included as a reference parameter for CVD monitoring. Furthermore, there are expectations for wider use of apo B, non-HDL cholesterol and total cholesterol / HDL-C determination to improve cardiovascular risk assessment.

脂质代谢中存在众多颗粒、酶类及调控机制，均与心血管疾病（Cardiovascular Disease, CVD）的发生发展密切相关。鉴于其在人群中的高患病率以及对死亡率的显著影响，对脂质代谢展开综述具有重要价值，因其或可为心血管疾病的精准预测提供理论支撑。本文综述了传统心血管危险因素的重要性，并探讨了参与心血管疾病病理生理过程的新型脂质生物标志物的应用潜力。
弗雷明汉队列（Framingham Cohort）已证实，传统危险因素（包括缺乏运动、吸烟、血压异常、总胆固醇、低密度脂蛋白胆固醇（Low-Density Lipoprotein Cholesterol, LDL-C）、高密度脂蛋白胆固醇（High-Density Lipoprotein Cholesterol, HDL-C）及血浆葡萄糖）在心血管事件预测中的作用。然而，相当一部分发生心血管事件的个体仅存在极少上述危险因素，甚至完全不具备。这一发现提示，亟需开发可识别易破裂动脉粥样硬化斑块的新型生物标志物。
与脂质代谢相关的血液生物标志物包括：修饰型低密度脂蛋白颗粒、载脂蛋白AI（apolipoprotein AI, apo AI）、载脂蛋白B、脂蛋白(a) [Lipoprotein(a), Lp(a)]、胆固醇酯转运蛋白（cholesteryl ester transfer protein, CETP）、低密度脂蛋白及高密度脂蛋白颗粒亚型，以及脂蛋白相关磷脂酶A2（lipoprotein-associated phospholipase A2, Lp-PLA2）。上述因子均参与动脉粥样硬化进程，且在心血管疾病高风险人群或已发生心血管事件的个体中存在异常表达。
脂蛋白(a)的检测已应用于临床实践，应将其作为心血管疾病监测的参考参数之一。此外，学界期待更广泛地应用载脂蛋白B、非高密度脂蛋白胆固醇及总胆固醇/高密度脂蛋白胆固醇检测，以优化心血管风险评估流程。