Impact of triglycerides on lipid and lipoprotein biology in women

Abstract

Because atherosclerosis, a leading cause of morbidity and mortality in women, is thought of as a sterol (cholesterol and noncholesterol sterol)-mediated disease, plasma triglyceride (TG) levels (the concentration of all TG trafficked within all of the lipoproteins per dL of plasma), TG biology, and TG pathobiology historically have been ignored or frequently misunderstood in both risk assessment and treatment decisions. This review presents information on the importance of TG (chemical name, triacylglycerol) in atherogenesis and the relationship of TG to gender, adiposopathy (the pathophysiological transformation of functional adipose tissue into an organ with pathogenic endocrine and immune responses), insulin resistance, sterol-trafficking lipoproteins, and overall vascular health. In addition, this review seeks to explain the complexities of lipid homeostasis and how it is influenced by lipid-modulating medications, reproductive hormones, and selective estrogen receptor modulators (SERMs). Using peer-reviewed materials published in English from the extensive libraries of the authors, this narrative review references key epidemiologic, basic science lipid/lipoprotein publications as well as efficacy trials of lipid-modulating, hormonal, and SERM therapies. TG are associated with insulin resistance; the metabolic syndrome; increased atherogenic lipo-proteins; and rheologic, inflammatory, and coagulation abnormalities. TG can be influenced by lifestyle and multiple medications used by women, including hormonal therapies. Several studies, but not all, support sex differences in TG. Through effects on sterol-trafficking lipoproteins, TG have a significant influence on atherosclerotic cardiovascular disease risk in menopausal women. TG-rich lipoproteins are affected by lipid-modulating drugs, estrogen therapy, estrogen-progestogen therapy, and SERMs.