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Diagnosis and treatment of apolipoprotein B dyslipoproteinemias

Nature Reviews Endocrinology volume 6, pages 335–346 (2010)Cite this article

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Abstract

Conventionally, atherogenic dyslipidemias have been defined by elevated levels of triglyceride and/or LDL cholesterol. However, cholesterol and triglycerides are not metabolically and physically independent entities. Rather, they are constituents of the atherogenic apolipoprotein B (apoB) particles, which differ in their origin and their metabolic function. Moreover, the risk of vascular disease is not related to the plasma concentration of cholesterol or triglyceride per se, but to the number, composition and size of the apoB particles, within which the cholesterol and triglycerides are contained. After all, the entire apoB particle—rather than individual cholesterol or triglyceride molecules—enters and is trapped within the arterial wall, and this particle initiates and sustains the process that results in atherosclerosis. Accordingly, we suggest a change of name and focus from dyslipidemias to dyslipoproteinemias. Virtually all the atherogenic apoB dyslipoproteinemias can be specifically identified on the basis of plasma levels of cholesterol, triglyceride and apoB. Not only does this enable an accurate diagnosis in the individual, but the major familial dyslipoproteinemias can be identified as well. Here, we review the diagnostic algorithm for apoB dyslipoproteinemias and provide, for the first time, a treatment plan on the basis of a reduction of atherogenic lipoprotein particles rather than plasma lipids.

Key Points

  • The six major apolipoprotein B (apoB) dyslipoproteinemias can be specifically identified by their levels of total cholesterol, triglycerides and apoB

  • These dyslipoproteinemias can be discriminated owing to differences in the type of the apoB particle, the number of apoB particles and the composition of the apoB particles

  • The characteristic apoB phenotype of the major apoB dyslipoproteinemias is a product of their underlying pathophysiology

  • Atherogenic apoB particles—in particular, remnants and LDL particles—should be the primary target of therapy rather than plasma lipid levels

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Figure 1: Three models of apolipoprotein B (apoB) particles.
Figure 2: Chylomicron and chylomicron remnant particles.
Figure 3: VLDL and LDL particles.
Figure 4: Diagnostic algorithm of apolipoprotein B dyslipoproteinemias.

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  1. Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Center, Room H7.22, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, H3A 1A1, QC, Canada

    Allan Sniderman

  2. Centre Hospitalier Universitaire de Québec, Pavillon CHUL, Bureau @-102, 2705 Boulevard Laurier, Sainte-Foy, G1V 4G2, QC, Canada

    Patrick Couture

  3. Department of General Internal Medicine 463, Radboud University Nijmegen Medical Center, P. O. Box 9101, Nijmegen, The Netherlands

    Jacqueline de Graaf

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Sniderman, A., Couture, P. & de Graaf, J. Diagnosis and treatment of apolipoprotein B dyslipoproteinemias. Nat Rev Endocrinol 6, 335–346 (2010). https://doi.org/10.1038/nrendo.2010.50

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