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Review
. 2022 Feb 16;58(2):299.
doi: 10.3390/medicina58020299.

Atherosclerosis Development and Progression: The Role of Atherogenic Small, Dense LDL

Jelena Vekic  1 , Aleksandra Zeljkovic  1 , Arrigo F G Cicero  2 , Andrej Janez  3 , Anca Pantea Stoian  4 , Alper Sonmez  5 , Manfredi Rizzo  6
Affiliations
Review

Atherosclerosis Development and Progression: The Role of Atherogenic Small, Dense LDL

Jelena Vekic et al. Medicina (Kaunas). .

Abstract

Atherosclerosis is responsible for large cardiovascular mortality in many countries globally. It has been shown over the last decades that the reduction of atherosclerotic progression is a critical factor for preventing future cardiovascular events. Low-density lipoproteins (LDL) have been successfully targeted, and their reduction is one of the key preventing measures in patients with atherosclerotic disease. LDL particles are pivotal for the formation and progression of atherosclerotic plaques; yet, they are quite heterogeneous, and smaller, denser LDL species are the most atherogenic. These particles have greater arterial entry and retention, higher susceptibility to oxidation, as well as reduced affinity for the LDL receptor. Increased proportion of small, dense LDL particles is an integral part of the atherogenic lipoprotein phenotype, the most common form of dyslipidemia associated with insulin resistance. Recent data suggest that both genetic and epigenetic factors might induce expression of this specific lipid pattern. In addition, a typical finding of increased small, dense LDL particles was confirmed in different categories of patients with elevated cardiovascular risk. Small, dense LDL is an independent risk factor for cardiovascular diseases, which emphasizes the clinical importance of both the quality and the quantity of LDL. An effective management of atherosclerotic disease should take into account the presence of small, dense LDL in order to prevent cardiovascular complications.

Keywords: CVD; atherosclerosis; lipoproteins; prevention; residual risk; small dense LDL.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The formation of small dense LDL. Legend: VLDL: very low density lipoproteins; IDL: intermediate density lipoproteins; LDL: low density lipoproteins; HDL: high-density lipoproteins; TG: triglycerides; CE: cholesterol esters; LPL: lipoprotein lipase; HL: hepatic lipase; CETP: cholesterol-ester transfer protein.
Figure 2
Figure 2
Pathophysiologic mechanisms explaining the enhanced atherogenic potential of small dense LDL.
Figure 3
Figure 3
The clinical significance of small dense LDL.
See this image and copyright information in PMC

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