Atherogenic dyslipidemia, characterized primarily by elevated triglycerides and low HDL-C, is a phenotype associated with increased cardiovascular risk. Atherogenic dyslipidemia is associated with poor cardiovascular outcomes, yet markers of this condition are often ignored in clinical practice. Atherogenic dyslipidemia (AD) refers to elevated levels of triglycerides (TG) and small-dense low-density lipoprotein and low levels of high-density lipoprotein cholesterol (HDL-C).Abstract · PATHOPHYSIOLOGY OF · EVIDENCE TO GO · MANAGEMENT OF.
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Insulin is a regulator of adipocyte functions and adipocytes show atherogenic dyslipidemia response to insulin, which promotes the differentiation of preadipocytes to adipocytes and regulates lipogenesis and lipolysis [ 22 ].
atherogenic dyslipidemia In the insulin resistance status fatty acid FA esterification and an increased lipolysis occurring in adipocytes are defective.
This condition is possibly due to the reduced insulin-mediated suppression of hormone-sensitive lipase HSL leading to an increased process of unesterified FA mobilization from the visceral fat depot [ 2223 ]. In addition, there is a decreased clearance of TG-rich lipoproteins in the circulation due to decreased lipoprotein lipase activity [ 22 ].
Thus, the FA flux to the liver is accelerated and affects adversely the hepatic insulin sensitivity, leading to increased production of TG and VLDL secretion.
Interestingly, Karpe atherogenic dyslipidemia al. By reviewing atherogenic dyslipidemia most important studies in this field, the authors concluded that as adipose tissue mass expands, NEFA release per kilogram adipose tissue is downregulated, not increased, leading to the normalization of plasma NEFA levels in obese subjects.
More studies are needed to clarify the relationships between obesity and FA kinetics. By stratifying a multiethnic cohort atherogenic dyslipidemia obese adolescents into tertiles based on the proportion of visceral and subcutaneous fat, Taksali et al.
Moreover, studies in children [ 2627 ] have atherogenic dyslipidemia that the phenotype of subjects with atherogenic dyslipidemia prevalence of small LDL particles was characterized by a greater degree of abdominal obesity.
In the study by Burns et al.
- Atherogenic Dyslipidemia
Dyslipidemia and NAFLD In spite of the demonstrated relationship between visceral fat, insulin resistance, and dyslipidemia, the ectopic fat deposition in atherogenic dyslipidemia liver is emerging as one of the most important markers of metabolic abnormalities in children [ 28 ].
Pediatric nonalcoholic fatty liver disease NAFLD is becoming the most frequent chronic liver disease in obese children and adolescents. A growing body of evidence from epidemiologic studies in both adults and children has established NAFLD as an independent predictor for development of MetS, diabetes, and cardiovascular disease [ atherogenic dyslipidemia30 ].
Similarly to adults, children with NAFLD have a higher prevalence of atherosclerosis when compared to control subjects, as shown by increased carotid intima media thickness cIMT compared with matched controls [ 3132 ]. In the study by Schwimmer et al. Significantly, among 49 obese adolescents with normal glucose tolerance, the presence of fatty liver, as assessed by fast magnetic resonance imaging, was associated with an increased concentration of large VLDL, sdLDL and decreased number of atherogenic dyslipidemia HDL particles [ 26 ].
Interestingly, hepatic steatosis was found to predict the concentration of the large VLDL particles, independently of insulin sensitivity and visceral adiposity [ 26 ]. The same study group has recently compared the different influence of visceral fat and fatty liver in the development of atherogenic dyslipidemia in a multiethnic group of obese adolescents [ 27 ].
Liver fat accumulation has been shown to be an important predictor in large VLDL particle concentrations, while visceral fat was a significant predictor for large HDL and total small LDL concentrations [ 27 ].
It has to be noted that the role of insulin resistance in the development of dyslipidemia could change when related to the ethnic group.
In fact, in the latest study [ 27 ] African Atherogenic dyslipidemia children, despite being hyperinsulinemic compared with Whites and Hispanics, have shown a more favourable lipid profile than the other groups. Although the factors responsible for these interracial differences are still unknown, along with genetic factors [ 27 ], fat distribution strongly contributes to the different lipoprotein atherogenic dyslipidemia observed among ethnicities [ 1628 ].
Several studies [ 1628 ] have attributed the lower concentrations of TG to the lower accumulation of visceral adipose tissue, typically seen in African Americans.
Furthermore, liver fat accumulation, independent of visceral fat and insulin resistance, has been showed to be atherogenic dyslipidemia important predictor in large VLDL particle concentrations among the three ethnic groups [ 27 ].
In accordance with the latest, Nobili et al. Thus, although insulin atherogenic dyslipidemia plays an important role in the development of atherogenic dyslipidemia in obese children, the abdominal fat deposition is emerging as an important link between insulin resistance and lipid alterations in obese children and adolescents.