The Plurimetabolic Syndrome: qualitative lipoprotein abnormalities and atherosclerosis

Hypercholesterolemia with increased LDL-C levels is associated with higher risk of coronary artery disease (CAD). However, over 50% of patients with CAD do not present with increased plasma LDL-C, but their lipoprotein profile is rather characterized by qualitative lipoprotein abnormalities such as LDL particles that are small, dense and more atherogenic, mild hypertriglyceridemia and low HDL-C, particularly HDL2-C. This lipoprotein profile is often found in patients with insulin resistance and increased intra-abdominal adipose tissue, hallmarks of the plurimetabolic syndrome. Smaller, denser LDL particles are more susceptible to oxidative modifications. Oxidized LDL are potent inflammatory agents when they reach the sub-endothelial space. In addition, low levels of HDL2-C may be a marker of an impaired reverse cholesterol transport. Indeed, this lipid profile is associated with a three- to six-fold increased risk of both cardiovascular and cerebrovascular disease. It is interesting to...