Low density lipoprotein natural history, prognosis and complications: Difference between revisions
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===Renovascular disease=== | ===Renovascular disease=== | ||
*Elevations of LDL is hypothesized to be the major initiator of renovascular injury associated with renal artery stenosis.<ref name="pmid22279335">{{cite journal| author=Annigeri RA| title=Medical therapy is best for atherosclerotic renal artery stenosis: Arguments for. | journal=Indian J Nephrol | year= 2012 | volume= 22 | issue= 1 | pages= 1-4 | pmid=22279335 | doi=10.4103/0971-4065.91177 | pmc=PMC3263056 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22279335 }} </ref> | |||
*Oxidation of high concentrations of LDL, along with an increasein local and systemic oxidative stress, promotes the generation of reactive oxygen species (ROS) that cause vasoconstriction and worsen renal ischemia.<ref name="pmid17210599">{{cite journal| author=Meier P, Rossert J, Plouin PF, Burnier M| title=Atherosclerotic renovascular disease: beyond the renal artery stenosis. | journal=Nephrol Dial Transplant | year= 2007 | volume= 22 | issue= 4 | pages= 1002-6 | pmid=17210599 | doi=10.1093/ndt/gfl784 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17210599 }} </ref> | |||
*Emerging evidence currently favors the pharmacologic management of dyslipidemia for the treatment of renal artery stenosis compared to angioplasty.<ref name="pmid22279335">{{cite journal| author=Annigeri RA| title=Medical therapy is best for atherosclerotic renal artery stenosis: Arguments for. | journal=Indian J Nephrol | year= 2012 | volume= 22 | issue= 1 | pages= 1-4 | pmid=22279335 | doi=10.4103/0971-4065.91177 | pmc=PMC3263056 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22279335 }} </ref> | |||
===Stroke=== | ===Stroke=== | ||
Revision as of 03:37, 29 September 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Rim Halaby, M.D. [2]
Overview
The natural history and prognosis of patients with elevated LDL are directly related to the complications associated with dyslipidemia. The decreased affinity of small dense LDL particles for LDL receptors has been postulated to be the cause of atherogenic properties of small dense LDL.[1] They are more prone to oxidation,[2] have higher affinity to vascular proteoglycans,[3] and are preferentially phagocytosed by macrophages via scanvenger proteins that promote atherosclerosis.[4] Accordingly, high LDL concentrations are not only associated with the initiation of atherogenesis, but also with the gradual worsening of atherosclerosis.[5] Patients with elevated plasma LDL who are left untreated often develop atherosclerosis and cardiovascular disease (CVD). More importantly, the risk of CVD further increases when dyslipidemia is associated with other cardiovascular risk factors, such as diabetes mellitus, hypertension, and low HDL, which are often concomitantly present among patients with dyslipidemia.[6][7]
Coronary artery disease
- Dyslipidemia caused by elevated LDL is a major risk factor for coronary artery disease (CAD) and often regarded as a prerequisite.[8]
- There is a direct association between cardiovascular death and duration of elevated plasma LDL levels.[9]
- An increase of LDL by 10 mg/dL is associated with a 12% increase in CVD risk in both genders.
- Accumulating evidence has proved the role of elevated LDL in the development of atherosclerosis and has demonstrated that lowering LDL attributes to significant reductions (30-37%) in CAD.[10]
Diabetes mellitus and insulin resistance
- Elevated concentrations of small dense LDL is often observed among patients before development of insulin resistance.[11]
- The majority of patients with elevated LDL have other components of the metabolic syndrome, such as hypertriglyceridemia, hypertension, and insulin resistance.[11]
Renovascular disease
- Elevations of LDL is hypothesized to be the major initiator of renovascular injury associated with renal artery stenosis.[12]
- Oxidation of high concentrations of LDL, along with an increasein local and systemic oxidative stress, promotes the generation of reactive oxygen species (ROS) that cause vasoconstriction and worsen renal ischemia.[13]
- Emerging evidence currently favors the pharmacologic management of dyslipidemia for the treatment of renal artery stenosis compared to angioplasty.[12]
Stroke
- LDL concentration is also associated with a significant increase in the incidence of stroke
- The Framingham study demonstrated that elevated LDL is associated with non-CAD-death among both genders.[7]
Peripheral arterial disease
- Elevated LDL is associated with the development of peripheral arterial disease (PAD)
References
- ↑ Lamarche B, Tchernof A, Moorjani S, Cantin B, Dagenais GR, Lupien PJ; et al. (1997). "Small, dense low-density lipoprotein particles as a predictor of the risk of ischemic heart disease in men. Prospective results from the Québec Cardiovascular Study". Circulation. 95 (1): 69–75. PMID 8994419.
- ↑ Tribble DL, Holl LG, Wood PD, Krauss RM (1992). "Variations in oxidative susceptibility among six low density lipoprotein subfractions of differing density and particle size". Atherosclerosis. 93 (3): 189–99. PMID 1590824.
- ↑ Chapman MJ, Guérin M, Bruckert E (1998). "Atherogenic, dense low-density lipoproteins. Pathophysiology and new therapeutic approaches". Eur Heart J. 19 Suppl A: A24–30. PMID 9519339.
- ↑ Vergès B (2005). "New insight into the pathophysiology of lipid abnormalities in type 2 diabetes". Diabetes Metab. 31 (5): 429–39. PMID 16357786.
- ↑ Grundy SM (1997). "Small LDL, atherogenic dyslipidemia, and the metabolic syndrome". Circulation. 95 (1): 1–4. PMID 8994405.
- ↑ Stamler J, Vaccaro O, Neaton JD, Wentworth D (1993). "Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial". Diabetes Care. 16 (2): 434–44. PMID 8432214.
- ↑ 7.0 7.1 Gordon T, Kannel WB, Castelli WP, Dawber TR (1981). "Lipoproteins, cardiovascular disease, and death. The Framingham study". Arch Intern Med. 141 (9): 1128–31. PMID 7259370.
- ↑ Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM; et al. (2011). "Heart disease and stroke statistics--2011 update: a report from the American Heart Association". Circulation. 123 (4): e18–e209. doi:10.1161/CIR.0b013e3182009701. PMID 21160056.
- ↑ Rader DJ, Cohen J, Hobbs HH (2003). "Monogenic hypercholesterolemia: new insights in pathogenesis and treatment". J Clin Invest. 111 (12): 1795–803. doi:10.1172/JCI18925. PMC 161432. PMID 12813012.
- ↑ Sharma SB, Garg S (2012). "Small dense LDL: risk factor for coronary artery disease (CAD) and its therapeutic modulation". Indian J Biochem Biophys. 49 (2): 77–85. PMID 22650003.
- ↑ 11.0 11.1 Solano MP, Goldberg RB (2006). "Management of dyslipidemia in diabetes". Cardiol Rev. 14 (3): 125–35. doi:10.1097/01.crd.0000188034.76283.5e. PMID 16628021.
- ↑ 12.0 12.1 Annigeri RA (2012). "Medical therapy is best for atherosclerotic renal artery stenosis: Arguments for". Indian J Nephrol. 22 (1): 1–4. doi:10.4103/0971-4065.91177. PMC 3263056. PMID 22279335.
- ↑ Meier P, Rossert J, Plouin PF, Burnier M (2007). "Atherosclerotic renovascular disease: beyond the renal artery stenosis". Nephrol Dial Transplant. 22 (4): 1002–6. doi:10.1093/ndt/gfl784. PMID 17210599.