Lipoprotein metabolism and atherogenesis: implications for therapy.

The causes of atherosclerosis are numerous, but disturbances in lipid and lipoprotein (LP) metabolism undoubtedly play a key role. Although there exist multiple forms of genetic and secondary hyperlipoproteinemias linked with premature vascular diseases there are only a few LP that need to be considered: low-density LP, beta-very-low-density LP, chylomicron remnants and LP(a). In addition, low HDL levels have been found to represent an independent risk factor. Prolonged residence times of these LP lead to chemical modification and interaction with platelets, smooth muscle cells, endothelial cells and macrophages. Atherogenesis is thus a concerted action. Knowledge of the metabolic pathways of most of these LP is necessary in order to be able to specifically influence hyperlipoproteinemia with dietary measures or, ultimately, with lipid-lowering drugs.