Novel Lipids Targets in the Era of Metabolic Syndrome: Toward a Better Prediction of Cardiovascular Risk

Authors: Paneni, Francesco; Palano, Francesca; Testa, Marco

Source: High Blood Pressure & Cardiovascular Prevention, Volume 16, Number 3, 1 September 2009 , pp. 93-100(8)

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Abstract:

During the last decades, the prevalence of obesity, diabetes mellitus and metabolic syndrome (MetS) has dramatically risen in developed countries. A further increase in MetS and diabetes can be anticipated because of projections of a greater prevalence of obesity in the future. Albeit the cardiovascular (CV) risk in patients with MetS has been considered high, a large proportion of these patients present with normal low-density lipoprotein-cholesterol (LDL-C) levels. Conversely, these patients often display high levels of apolipoprotein B-100 (apoB), triglycerides (TG) and non-high-density lipoprotein-cholesterol (non-HDL-C). Among routine lipoprotein assessment, the use of non-HDL-C has shown several advantages over LDL-C, particularly in the presence of hypertriglyceridaemia. Non-HDL-C is a combined measurement of LDL-C, lipoprotein (a), small dense LDL-C (sd-LDL-C), chilomicron remnants, and intermediate-density lipoproteins. Several studies have shown that non-HDL-C is a strong predictor of subclinical atherosclerosis and CV events as well as a reasonable surrogate of apoB measurement. Moreover, current evidence is supporting that non-HDL-C accurately predicts major CV events even in patients with normal TG values. However, current recommendations suggest non-HDL-C only when TG exceeds 200 mg/dL, recommending the use of LDL-C as the primary target of therapy in all the other conditions. These definitions contrast with the finding of normal LDL-C in obesity, diabetes and MetS, all considered high-risk conditions. Therefore, a redefinition of LDL-C as a predictor of CV events is needed also in the view of an increased prevalence of insulin resistance, abdominal obesity and diabetes.

Received for publication 26 January 2009; accepted for publication 26 May 2009.

Keywords: metabolic syndrome; non-HDL-cholesterol; apolipoprotein b; cardiovascular risk

Document Type: Research article

Affiliations: 1: Division of Cardiology, II Faculty of Medicine, University of Rome “Sapienza”, Sant'Andrea Hospital, Rome, Italy

Publication date: 2009-09-01

Novel Lipids Targets in the Era of Metabolic Syndrome: Toward a Better Prediction of Cardiovascular Risk

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