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Lipoprotein classification, metabolism, and role in atherosclerosis

Robert S Rosenson, MD
Section Editor
Mason W Freeman, MD
Deputy Editors
Howard Libman, MD, FACP
Gordon M Saperia, MD, FACC


Lipids, such as cholesterol and triglycerides, are insoluble in plasma. Circulating lipid is carried in lipoproteins that transport the lipid to various tissues for energy utilization, lipid deposition, steroid hormone production, and bile acid formation. The lipoprotein consists of esterified and unesterified cholesterol, triglycerides, phospholipids, and protein. Based on the physicochemical characteristics of lipoproteins, these particles have been classified by their lipoprotein subclass size and concentrations [1].

The classification of lipoproteins, the function of the different apolipoproteins that they contain, the pathways of lipid metabolism, and how lipoprotein disorders can promote the development of atherosclerosis will be reviewed here.


One definition of dyslipidemia is total cholesterol, low density lipoprotein cholesterol (LDL-C), triglyceride, or lipoprotein(a) levels above the 90th percentile or high density lipoprotein cholesterol or apo A-1 levels below the 10th percentile for the general population (table 1).

The prevalence of dyslipidemia varies with the population being studied. The prevalence is highest in patients with premature coronary heart disease (CHD), which can be defined as occurring before 55 to 60 years of age in men and before 65 years in women. In this setting, the prevalence of dyslipidemia is as high as 75 to 85 percent compared to approximately 40 to 48 percent in age-matched controls without CHD (figure 1) [2,3].

The disturbance in lipoprotein metabolism is often familial. In one study, for example, 54 percent of all patients with premature CHD (and 70 percent of those with a lipid abnormality) had a familial disorder [2]. In the great majority of patients, inheritance is polygenic and the expression of dyslipidemia is strongly influenced by factors such as obesity (particularly central obesity) and the saturated fat and cholesterol content of the diet. In nations with low rates of obesity and where saturated fat intake is low, both the incidence of CHD and the prevalence of dyslipidemia are low compared to North America and Europe. This polygenic type of dyslipidemia is the major source of atherosclerotic cardiovascular disease.

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Literature review current through: Nov 2017. | This topic last updated: May 05, 2017.
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