How Do Elevated Triglycerides and Low HDL-Cholesterol Affect Inflammation and Atherothrombosis?

Abstract

This review article summarizes recent research into the mechanisms as to how elevated levels of triglyceride (TG) and low levels of high- density- lipoprotein cholesterol (HDL-C) contribute to inflammation and atherosclerosis. Evidence supports the role of TG-rich lipoproteins in signaling mechanisms via apolipoproteins C-III and free fatty acids leading to activation of NFKβ, VCAM-1 and other inflammatory mediators which lead to fatty streak formation and advanced atherosclerosis. Moreover, the cholesterol content in TG-rich lipoproteins has been shown to predict CAD risk better than LDL-C. In addition to reverse cholesterol transport, HDL has many other cardioprotective effects which include regulating immune function. The “functionality” of HDL appears more important than the level of HDL-C. Insulin resistance and central obesity underlie the pathophysiology of elevated TG and low HDL-C in metabolic syndrome and type 2 diabetes. Lifestyle recommendations including exercise and weight loss remain first line therapy in ameliorating insulin resistance and the adverse signaling processes from elevated levels of TG-rich lipoproteins and low HDL-C.

Serum fatty acid profiling within distinct lipid fractions provides a more robust indicator of insulin resistance in humans than total triglyceride and fatty acid profiles

“…The discovery of PDGF--ββ is intriguing due to its suspected contribution to the development of atherogenesis [279]. This aligns with the fact that MHO and MUO subjects in our cohort were strongly distinguished by their lipid profiles (i.e., Total--c and LDL--c), which are routinely used to assess an individual's risk for atherogenesis [280]. It is therefore not surprising that PDGF--ββ levels could distinguish the MHO from MUO group.…”

Pivotal role of NOD2 in inflammatory processes affecting atherosclerosis and periodontal bone loss

“…It is a multifactorial disease characterized by the accumulation of cells from both the innate and acquired immune system within the intima of the arterial wall (13). Triglyceride-rich lipoproteins and free fatty acids are important factors involved in fatty streak formation and advanced atherosclerosis (14). Microorganisms have also been implicated as aggravating factors in atherosclerosis (15).…”

Waist Circumference-to-Height Ratio Detected in a Convenient Sample of Young Slovak People with Increased Cardio-Metabolic Risk

“…Therefore, non-HDL includes the cholesterol in all atherogenic apoB-containing lipoproteins: TG-enriched lipoproteins, chylomicrons, chylomicrons remnants, VLDL and VLDL remnants, IDL, LDL, and lipoprotein. As LDL and TG confer greater risk for CHD than LDL alone, elevated levels of non-HDL predict cardiovascular disease and cardiovascular mortality even better than those of LDL (26). As shown in Tables 2 and 3, up to 23% of men and 19.4% of women were found to have high levels of non-HDL.…”