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Triglycerides and triglyceride-rich lipoproteins in the development and progression of atherosclerosis

Generoso, Giulianoa; Janovsky, Carolina C.P.S.a; Bittencourt, Marcio S.a,b

Current Opinion in Endocrinology, Diabetes and Obesity: April 2019 - Volume 26 - Issue 2 - p 109–116
doi: 10.1097/MED.0000000000000468
LIPIDS: Edited by Dan Streja

Purpose of review In this review, we intend to show the heterogenicity of the triglyceride group, including the triglyceride-rich lipoproteins and its subparticles, apolipoproteins, and its role in atherogenesis through epidemiological and genetic studies, observing the association of these various components and subclasses with subclinical atherosclerosis and cardiovascular events. Also, we reevaluated the moment of blood collection for the triglyceride measurement and its repercussion in atherosclerosis. Finally, we present the current scenario and new insights about the pharmacologic treatment of hypertriglyceridemia.

Recent findings Recent studies have been observed, a correlation between cardiovascular disease and triglyceride components (as apolipoproteins A-V, C-I, C-III) as well as proteins involved in the metabolism pathway, such as the angiopoietin-like proteins. Also, the triglyceride-rich lipoproteins, also known as remnants, were recently associated with atherogenesis. Another important topic addressed is about nonfasting triglyceride level, which has been postulated as a better predictor of cardiovascular events than fasting collection.

Summary Regarding hypertriglyceridemia treatment, the drug therapy was updated, as the omega-3 polyunsaturated fatty acids were tested in primary prevention as eicosapentaenoic acid and docosahexaenoic acid combination resulted in no benefit, whereas the administration of icosapent ethyl in secondary prevention and high-risk patients showed a robust decrease of the cardiovascular outcomes.

aCenter for Clinical and Epidemiological Research, University Hospital, University of Sao Paulo

bHospital Israelita Albert Einstein & School of Medicine, Faculdade Israelita de Ciência da Saúde Albert Einstein, São Paulo, Brazil

Correspondence to Marcio S. Bittencourt, MD, MPH, PhD, Center for Clinical and Epidemiological Research, University Hospital, University of Sao Paulo, Av. Lineu Prestes, 2565 – Butantã, São Paulo, São Paulo CEP: 05412-003, Brazil. E-mail:

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