Atherogenic lipoproteins carry cholesterol in the blood and can cause cardiovascular disease by accumulating in blood vessels and forming embolisms. LDL is the “bad” type of cholesterol that accumulates in arterial plaques, while HDL carries LDL out of the bloodstream. Atherogenesis is caused by the oxidation of atherogenic lipoproteins, leading to inflammation and atherosclerosis. High blood triglyceride levels can also increase the risk of cardiovascular disease. The small dense LDL phenotype is a heritable trait that increases the risk of disease.
Atherogenic lipoproteins are molecules that carry cholesterol in the blood. They are distinguished from other lipids by their tendency to accumulate in blood vessels and block circulation, causing cardiovascular disease. Most commonly, these lipids come from the intake of cholesterol-rich foods. They also form embolisms that lead to blockage of vessels, heart attacks and strokes. Some individuals may have a genetic predisposition for higher than average levels of atherogenic lipoproteins in the blood.
Lipoproteins are molecules that carry lipids in the bloodstream. Low-density lipoproteins (LDL) are atherogenic and are colloquially called the “bad” type of cholesterol. LDL carries the majority of cholesterol in the blood serum and is the major lipid that accumulates in arterial plaques. High-density lipoprotein (HDL), in contrast, carries LDL cholesterol out of the bloodstream and into the liver, where it’s metabolized and can’t block blood vessels.
Atherogenesis is the formation of hardened plaques, made up of lipids, within the arteries. It is caused when atherogenic lipoproteins such as LDL are oxidized by free radical molecules. When these particles stick to the arterial wall, inflammation occurs as the immune system tries to repair the damage. Over time, this leads to atherosclerosis, as more arteries narrow and become blocked, resulting in cardiovascular disease, a leading cause of death in the industrialized world.
In some cases, small pieces of plaque can leak out of a blocked vessel and circulate in the bloodstream. These fragments, called emboli, include atherogenic lipoproteins. Some cause strokes or heart attacks if lodged in a major blood vessel. In addition to LDL, an embolus can contain other lipids and cells formed by the inflammatory response within the blood vessel. In some cases, plaques that don’t completely block one artery can eventually move to a critical location in another and cause serious damage or death.
Some lipid-storing tissues are potentially atherogenic. For example, much of the fat within the body is stored in adipose tissue in the form of triglycerides. These molecules are generally kept out of the bloodstream and are not strictly speaking atherogenic. But some lipoproteins with triglycerides also contain LDL cholesterol, and therefore contribute to the formation of arterial plaque. For this reason, high blood triglyceride levels can be interpreted as an increased risk of cardiovascular disease.
In the late 20th century, scientific studies indicated that people with coronary heart disease may have a different type of atherogenic lipoprotein circulating in their blood. Further studies suggested that an heritable phenotype caused these patients to have small, dense LDL particles that increased their risk of disease. Called the small dense LDL phenotype, this is usually found in individuals who also have endothelial disease in the lining of blood vessels and have low HDL levels.
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