HDL quality in atherosclerosis: can ratios between apolipoproteins of HDL be used effectively to indicate risk of premature myocardial infarction?

Abstract

Recently the idea that HDL quality is very important for atheroprotection has been gaining ground and measurable changes in HDL apolipoprotein ratios may serve as effective prognostic markers for the early identification of asymptomatic individuals at high risk for a life-threatening acute myocardial infarction. Coronary heart disease (CHD) is the most common cause of death worldwide. According to WHO, an estimated 7.2 million people died from CHD in 2008, representing approximately 12% of deaths worldwide, while in the year 2030 it is estimated that 23.6 million people will die from cardiovascular disease [101]. CHD is caused by atherosclerosis, a focal disease of the arterial wall that affects largeand medium-sized arteries [1]. Although multiple risk factors have been associated with atherosclerosis, dyslipidemia has been identified as a leading cause of CHD. In particular, an imbalance between atheroprotective and atherogenic lipoproteins in plasma is one of the most important parameters associated with atherosclerosis [2,3]. Conventional imaging technologies usually allow detection of atherosclerotic lesions that occlude 50% or more of the lumen of the arteries. Such plaques are usually stable and less prone to rapture and rarely lead to embolism and myocardial infarction (MI). By contrast, unstable atherosclerotic plaques are usually smaller in size and have a weak fibrous cap that can rapture and release the lipid core of the lesion into the circulation, creating an infarct. Such small unstable lesions are life threatening and often hard to diagnose with classical imaging techniques [4]. This deficiency in the early diagnosis of atherosclerosis increases the