Nutrition, Lipids, and Cardiovascular Disease: Clinical Benefits Without Biochemical Effects and Biochemical Effects Without Clinical Benefits

摘要

Atherosclerosis, the primary cause of cardiovascular disease (CVD), is a common-source epidemic attributable to dietary intake of saturated fat and cholesterol. Genetic susceptibility to diet is related to levels of atherogenic lipoproteins such as apolipoprotein B and the development of the atherosclerosis and plaque characteristics. Inflammation and endothelial dysfunction play important roles in propagating the development of atherosclerosis but are not the primary cause. A new epidemic of obesity and insulin resistance has modified the relationship between measured lipoproteins and atherosclerosis. There is little evidence that obesity alone is an independent risk factor for atherosclerosis. Raising high-density lipoprotein cholesterol (HDLC) may not reduce the incidence of coronary heart disease. Characteristics of metabolism in the HDL particle and the methods of raising the HDL may be of much greater importance. Atherosclerosis progresses over a person's lifetime. Most older individuals have significant atherosclerosis. We should focus on the long-term risks of atherosclerosis to CVD and on the primary prevention of atherosclerosis rather than only on end-stage CVD.