Lipid risk factors and their role in the pathogenesis of atherosclerosis

: The author presents an account on the main lipid risk factors of ischaemic heart disease. She emphasizes the causal role of cholesterol and low density lipoproteins (LDL), incl. the VLDL subclass and oxidized LDL in the pathogenesis of atherosclerosis. The atherogenic action of elevated concentrations of triacylglycerols is discussed (the importance of heterogenity of lipoproteins rich in triacyglycerols, postprandial hypertriacylglycerolaemia, combination with low concentrations of high density lipoproteins (HDL) and prothrombogenic changes). The protective role of HDL is mediated not only by their participation in the reverse cholesterol transport but also other antiatherogenic changes (antioxidant, increased prostacycline secretion, effect on the vascular tonus). Low HDL cholesterol concentrations in subjects with ischaemic heart disease indicate not only loss of these protective properties but also a pathological metabolism of lipoproteins rich in triacylglycerols with which they are metabolically associated. The author emphasizes the antiatherogenic importance of the sub-population HDL2 and of lipoprotein particles Lp AI. Lipoprotein (a) is another independent risk factor of ischaemic heart disease. The genetic determination and ratio of factors of the external environment in the variability of concentrations of all these lipid risk factors in the population is discussed.