4.4 Review

Managing of Dyslipidaemia Characterized by Accumulation of Triglyceride-Rich Lipoproteins

Journal

CURRENT ATHEROSCLEROSIS REPORTS
Volume 24, Issue 1, Pages 1-12

Publisher

CURRENT MEDICINE GROUP
DOI: 10.1007/s11883-022-00979-y

Keywords

Atherosclerotic cardiovascular disease; Pancreatitis; Remnant cholesterol; Hypertriglyceridemia; TRL; Triglyceride-lowering drugs

Funding

  1. Netherlands CardioVascular Research Initiative: the Dutch Heart Foundation
  2. Dutch Federation of University Medical Centers
  3. Netherlands Organization for Health Research and Development
  4. Royal Netherlands Academy of Sciences
  5. Netherlands Heart Foundation [2015T068]

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This review provides the latest progress in researching the accumulation of triglyceride-rich lipoproteins (TRLs) and its association with pancreatitis and atherosclerotic cardiovascular disease (ASCVD). Recent findings suggest that targeting specific proteins involved in TRL metabolism effectively reduces triglyceride levels. However, further research is needed to evaluate the potential of these drugs in reducing the risk of atherosclerosis.
Purpose of Review The accumulation of triglyceride-rich lipoproteins (TRLs) in plasma in patients with familial chylomicronaemia syndrome (FCS) or severe hypertriglyceridemia is associated with an increased risk of potentially life-threatening pancreatitis. Elevated TRL levels have also been suggested to contribute to atherosclerotic cardiovascular disease (ASCVD). This review provides the latest progress that has been made in this field of research. Recent Findings Apolipoprotein C-III and angiopoietin-like protein 3 play key roles in the metabolism of TRLs. Targeting their production in the liver or their presence in the circulation effectively reduces triglycerides in patients with FCS or severe hypertriglyceridemia. Attempts to reduce triglyceride synthesis in the small intestine have been halted. Early studies with a fibroblast growth factor 21 agonist have shown to reduce plasma triglycerides and hepatic steatosis and improve glucose homeostasis. New drugs have recently been shown to effectively reduce plasma triglycerides which render hope for treating the risk of pancreatitis. Studies that have just been initiated will learn whether this unmet clinical will be met. It is too early to evaluate the potential of these drugs to reduce the risk of atherosclerosis through the reduction of triglycerides.

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