Pathogenesis of Atherogenic Dyslipidemia

Scott M. Grundy, MD, PhD.

In This Article

Abstract and Introduction

A major component of the insulin resistance syndrome is dyslipidemia. Alterations in serum lipid levels can be worsened by insulin resistance and represent a leading risk factor for the development of atherosclerotic cardiovascular disease. Cardiovascular risk factors, eg, smoking, hypertension, hyperglycemia, and other dyslipidemias, promote premature atherosclerosis when accompanied by some elevation of low-density lipoprotein (LDL). The clustering of many of these risk factors in individual patients is referred to as the metabolic syndrome, which is characterized by abnormally high levels of triglyceride-rich very low-density lipoprotein, low levels of high-density lipoprotein, and increased small LDL particles (the lipid triad), as well as hypertension, glucose intolerance, and a procoagulant state.

Patients with the insulin resistance syndrome have dyslipidemia, specifically atherogenic dyslipidemia, which leads to increased morbidity and mortality from cardiovascular diseases, such as myocardial infarction and stroke. Atherogenic dyslipidemia is characterized by the lipid triad of high serum triglycerides, increased small low-density lipoproteins (LDL), and decreased high-density lipoproteins (HDL). The purpose of this article is to examine the role of these and other lipoproteins in atherogenesis and to examine the metabolic processes that underlie their abnormalities.


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