Abstract
The prothrombotic state in atrial fibrillation (AF) occurs as a result of multifaceted interactions, known as Virchow’s triad of hypercoagulability, structural abnormalities, and blood stasis. More recently, there is emerging evidence that lipoproteins are implicated in this process, beyond their traditional role in atherosclerosis. In this review, we provide an overview of the various lipoproteins and explore the association between lipoproteins and AF, the effects of lipoproteins on haemostasis, and the potential contribution of lipoproteins to thrombogenesis in AF. There are several types of lipoproteins based on size, lipid composition, and apolipoprotein category, namely: chylomicrons, very low-density lipoprotein, low-density lipoprotein (LDL), intermediate-density lipoprotein, and high-density lipoprotein. Each of these lipoproteins may contain numerous lipid species and proteins with a variety of different functions. Furthermore, the lipoprotein particles may be oxidized causing an alteration in their structure and content. Of note, there is a paradoxical inverse relationship between total cholesterol and LDL cholesterol (LDL-C) levels, and incident AF. The mechanism by which this occurs may be related to the stabilizing effect of cholesterol on myocardial membranes, along with its role in inflammation. Overall, specific lipoproteins may interact with haemostatic pathways to promote excess platelet activation and thrombin generation, as well as inhibiting fibrinolysis. In this regard, LDL-C has been shown to be an independent risk factor for thromboembolic events in AF. The complex relationship between lipoproteins, thrombosis and AF warrants further research with an aim to improve our knowledge base and contribute to our overall understanding of lipoprotein-mediated thrombosis.
Highlights
This is the author’s version of a work that was submitted to / accepted for p u blic a tio n
We provide an overview of the various lipoproteins and explore the association between lipoproteins and atrial fibrillation (AF), the effects of lipoproteins on haemostasis, and the potential contribution of lipoproteins to thrombogenesis in AF
We provide an overview of the various lipoproteins and explore their relationship with AF, haemostasis, and the potential contribution to thrombogenesis
Summary
There is a paradoxical relationship between TC and LDL-C, and incident AF. The mechanism by which this occurs is poorly defined but may be related to changes in the regulation of ion channels and inflammatory processes. Excess lipoproteins promote thrombin generation, inhibit fibrinolysis and enhance platelet activation. In this regard, LDLC has been shown to be an independent risk factor for thromboembolic events in AF. The complex relationship between lipoproteins, thrombosis and AF warrants further research. An improved knowledge base in this area may unlock important mechanistic pathways that contribute to our overall understanding of haemostasis and guide our clinical approach in the treatment of prothrombotic conditions.
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