Evaluation of Event Risks of Cerebro- and Cardiovascular Diseases by Focusing on the Profile of Atherogenic Lipoproteins Developing Atherosclerotic Plaque, not the Value of Lipids

<p> Lipid levels such as LDL cholesterol, triglyceride (TG), HDL cholesterol levels are measured for evaluating the event risk of arteriosclerotic cardiovascular diseases, their cutoff values ​​are based on many epidemiological data. Evaluation in LDL and HDL cholesterol levels are useful for assessing arteriosclerotic cardiovascular events because they had direct correlations with the number of LDL and HDL particles, but fasting TG levels vary widely and different lipoprotein profiles have significantly different risk status even though they had similar TG values. Accumulation of TG-containing remnant lipoprotein exists in the background of arteriosclerotic cardiovascular disease risk of hypertriglyceridemia. The remnant cholesterol level (RLP-C or RemL-C) is usually measured for evaluating remnant lipoproteins, we independently developed a measurement system for apo (lipoprotein) B-48 concentration that reflects the accumulation of chylomicron remnant derived from the small intestine. The fasting apo B-48 level concentration was lower in healthy subjects (reference interval; 0.74-5.65 µg/mL, upper limit of reference value; 5.7 µg/mL) than other apolipoproteins and it was high in patients with the accumulation of remnant lipoproteins, such as those with type III hyperlipidemia, metabolic syndrome and chronic kidney disease. Furthermore, fasting apo B-48 concentration was positively correlated with carotid intima-intima thickness in patients with high but normal fasting TG concentrations (100-150 mg/dL) and with the prevalence of the coronary stenosis in consecutive cases of coronary artery catheterization, the de novo coronary stenosis after stent implantation and the cerebral infarction of large arteries. Thus, the measurement of fasting apo B-48 concentration could be established as an independent evaluation method for atherosclerotic risk factors reflecting the chylomicron remnant accumulation. The measurement of TG level is still important for health examination, but detection of lipoprotein abnormality is important for estimating atherosclerotic disease risk, and lipoprotein profile analysis such as apo B-48 concentration measurement should be utilized.</p>