medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2013-9-50-55medsovet-1103Research ArticleАтеросклероз и ишемическая болезнь сердцаAtherosclerosis and ischemic heart diseaseХолестерин липопротеинов низкой плотности (ХС-ЛНП) и ремнантный холестерин неЛВП»: нужна ли рокировка для оценки сердечно-сосудистого риска?Low density lipoprotein cholesterol (H-LDL) and remnant non-HDL cholesterol: any reason to change the order when assessing cardiovascular risk?СусековА. В.SusekovA. V.noemail@neicon.ruФГБУ РКНПК Минздрава России, МоскваРоссияRussian Cardiology Research and Production Complex, Russia’s Ministry of Health, MoscowRussian Federation201330122013095055Copyright © Сусеков А.В., 20132013Сусеков А.В.Susekov A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/1103

В статье рассмотрена роль различных вариантов холестерина в качестве основных факторов сердечно-сосудистого риска, поскольку в последнее время наряду с традиционным липидным показателем холестерина липопротеинов низкой плотности (ЛНП) рекомендуется применение в повседневной клинической практике нового показателя – уровня холестерина неЛВП (липопротеинов высокой плотности). В работе поднимается вопрос о достаточности научных и клинических данных для смены липидных приоритетов в оценке сердечно-сосудистого риска: измерения и мониторинга холестерина неЛВП против традиционных липидных маркеров – уровней холестерина ЛНП и холестерина ЛВП плазмы крови.

The paper reviews the relevance of various types of cholesterol as factors of cardiovascular risks. According to recent recommendations, apart from the routinely evaluated low-density lipoprotein cholesterol (LDL-H), clinicians now look at non-HDL (high-density lipoprotein) cholesterol. The paper questions, whether there is enough clinical and scientific evidence to change priorities in the lipid assessment of cardiovascular risk: measurement and monitoring of non-HDL cholesterol vs. routine lipid markers - LDL cholesterol and plasma HDL cholesterol.

cholesterollow-density lipoproteinshigh density lipoproteinsnon-HDL cholesterollipid correcting therapycardiovascular risk factorsхолестеринлипопротеины низкой плотностихолестерин не ЛВПлипидкоррегирующая терапияфакторы сердечно-сосудистого рискаReferencesYusuf S., Hawken S., Ounpuu S. et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case- control study // Lancet. 2004. Sep. 11–17. №364(9438). Р. 937–952.Yusuf S., Hawken S., Ounpuu S. et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case- control study // Lancet. 2004. Sep. 11–17. №364(9438). Р. 937–952.Catapano A., Reiner Z, De Backer G. et al. EAS/EAS Guidelines for the management of dyslipidemias. The Task Force for the management of dyslipideamias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) // Atherosclerosis. 2011. №217. S1–S44.Catapano A., Reiner Z, De Backer G. et al. EAS/EAS Guidelines for the management of dyslipidemias. The Task Force for the management of dyslipideamias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) // Atherosclerosis. 2011. №217. S1–S44.European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR) // Eur. J. Prev. Cardiol. 2012. Aug. №19(4). Р. 585–667. Epub. 2012, Jul.European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR) // Eur. J. Prev. Cardiol. 2012. Aug. №19(4). Р. 585–667. Epub. 2012, Jul.Shepherd J., Cobbe S.M., Isles C.G., Lorimer A.R., Macfariane P.W., Mckillop J.H., Packard C.J. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia // N. Engl. J. Med. 1995. №333. Р. 1301–1307.Shepherd J., Cobbe S.M., Isles C.G., Lorimer A.R., Macfariane P.W., Mckillop J.H., Packard C.J. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia // N. Engl. J. Med. 1995. №333. Р. 1301–1307.Scandinavian Simvastatin Survival Study Group. Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S) // Lancet. 1994. №344. Р. 1383–1389.Scandinavian Simvastatin Survival Study Group. Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S) // Lancet. 1994. №344. Р. 1383–1389.Sacks F.N., Pfeffer M.A., Moye L.A. et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol level // N. Engl. J. Med. 1996. №335. Р. 1001–1009.Sacks F.N., Pfeffer M.A., Moye L.A. et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol level // N. Engl. J. Med. 1996. №335. Р. 1001–1009.Baigent C., Keech A., Kearney P.M. et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomized trials of statins // Lancet. 2005. №366(9433). Р. 1267–1278.Baigent C., Keech A., Kearney P.M. et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomized trials of statins // Lancet. 2005. №366(9433). Р. 1267–1278.Cholesterol Treatment Trialists’ (CTT) Collaboration. Baigent C., Blackwell L., Emberson J., Holland L.E., Reith C., Blaha N., Peto R., Barnes E.H., Keech A., Simes J., Collins R. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials // Lancet. 2010. №376(9753). Р. 1670–1681. doi: 10.1016/S0140-6736(10)61350-5. Epub. 2010, Nov. 8.Cholesterol Treatment Trialists’ (CTT) Collaboration. Baigent C., Blackwell L., Emberson J., Holland L.E., Reith C., Blaha N., Peto R., Barnes E.H., Keech A., Simes J., Collins R. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials // Lancet. 2010. №376(9753). Р. 1670–1681. doi: 10.1016/S0140-6736(10)61350-5. Epub. 2010, Nov. 8.Cholesterol Treatment Trialist Collaborators, The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials // Lancet. 2012 (11). №380(9841). Р. 581–590.Cholesterol Treatment Trialist Collaborators, The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials // Lancet. 2012 (11). №380(9841). Р. 581–590.The ACCORD Study Group. Long-term effects of intensive glucose lowering on cardiovascular outcomes // N. Engl. J. Med. 2011. №364. Р. 818–828.The ACCORD Study Group. Long-term effects of intensive glucose lowering on cardiovascular outcomes // N. Engl. J. Med. 2011. №364. Р. 818–828.Michos E.D., Sibley C.T., Baer J.T., Blaha M.J., Blumenthal R.S. Niacin and statin combination therapy for atherosclerosis regression and prevention of cardiovascular disease events: reconciling the AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome With Low HDL/High Triglycerides: Impact on Global Health Outcomes) trial with previous surrogate endpoint trials // J. Am. Coll. Cardiol. 2012. №59. Р. 2058–2064.Michos E.D., Sibley C.T., Baer J.T., Blaha M.J., Blumenthal R.S. Niacin and statin combination therapy for atherosclerosis regression and prevention of cardiovascular disease events: reconciling the AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome With Low HDL/High Triglycerides: Impact on Global Health Outcomes) trial with previous surrogate endpoint trials // J. Am. Coll. Cardiol. 2012. №59. Р. 2058–2064.HPS2-THRIVE Collaborative Group. HPS2-THRIVE randomized placebo- controlled trial in 25,673 high-risk patients of ER niacin/laropiprant: trial design, pre-specified muscle and liver outcomes, and reasons for stopping study treatment // Eur. Heart J. 2013. doi:10.1093/eurheartj/eht055.HPS2-THRIVE Collaborative Group. HPS2-THRIVE randomized placebo- controlled trial in 25,673 high-risk patients of ER niacin/laropiprant: trial design, pre-specified muscle and liver outcomes, and reasons for stopping study treatment // Eur. Heart J. 2013. doi:10.1093/eurheartj/eht055.Диагностика и коррекция нарушений липидного обмена с целью профилактики и лечения атеросклероза. Российские рекомендации, 5 пересмотр // Российский кардиологический журнал. 2012. №5 (97). Р. 2–32.Диагностика и коррекция нарушений липидного обмена с целью профилактики и лечения атеросклероза. Российские рекомендации, 5 пересмотр // Российский кардиологический журнал. 2012. №5 (97). Р. 2–32.Chapman M.J., Ginsberg H.N., Amarenco P. et al. European Atherosclerosis Society Consensus Panel. Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management // Eur. Heart J. 2011. Jun. №32(11). Р. 1345–1361.Chapman M.J., Ginsberg H.N., Amarenco P. et al. European Atherosclerosis Society Consensus Panel. Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management // Eur. Heart J. 2011. Jun. №32(11). Р. 1345–1361.Sniderman A., Williams K., Contoins J. et al. A meta-analysis of low density lipoprotein cholesterol, non-density lipoprotein cholesterol and apolipoprotein B as a markers of cardiovascular risk // Circ. Cardiovasc. Qual. Outcomes. 2011. №4(3). Р. 337–345. doi: 10.1161/CIRCOUTCOMES.110.959247. Epub. 2011, Apr. 12.Sniderman A., Williams K., Contoins J. et al. A meta-analysis of low density lipoprotein cholesterol, non-density lipoprotein cholesterol and apolipoprotein B as a markers of cardiovascular risk // Circ. Cardiovasc. Qual. Outcomes. 2011. №4(3). Р. 337–345. doi: 10.1161/CIRCOUTCOMES.110.959247. Epub. 2011, Apr. 12.Varbo A., Benn M., Tybjarg-Hansen A. et al. Remnant Cholesterol as a Causal Risk Factor for Ischemic heart disease // J. Am .Coll. Card. 2013.Varbo A., Benn M., Tybjarg-Hansen A. et al. Remnant Cholesterol as a Causal Risk Factor for Ischemic heart disease // J. Am .Coll. Card. 2013.van der Steeg W.A., Holme I., Boekholdt S.M. et al. High-density lipoprotein cholesterol, high-density lipoprotein particle size, and apolipoprotein A-I: significance for cardiovascular risk: the IDEAL and EPIC-Norfolk studies // J. Am. Coll. Cardiology 2008. №51(6). Р. 634–642.van der Steeg W.A., Holme I., Boekholdt S.M. et al. High-density lipoprotein cholesterol, high-density lipoprotein particle size, and apolipoprotein A-I: significance for cardiovascular risk: the IDEAL and EPIC-Norfolk studies // J. Am. Coll. Cardiology 2008. №51(6). Р. 634–642.Briel M., Ferrera-Gonzales I., You J.J. et al. Association between change in high-density lipoprotein cholesterol and cardiovascular disease morbidity and mortality: systemic review and meta-regression analysis // BMJ. 2009. №338. b92. Doi:1136/bmj.b92.Briel M., Ferrera-Gonzales I., You J.J. et al. Association between change in high-density lipoprotein cholesterol and cardiovascular disease morbidity and mortality: systemic review and meta-regression analysis // BMJ. 2009. №338. b92. Doi:1136/bmj.b92.Davidson M. HDL-C and CETP inhibition: will this define the FUTURE? // Current Treatment Opinions in Cardiovascular Medicine. 2012. №14. Р. 384–390.Davidson M. HDL-C and CETP inhibition: will this define the FUTURE? // Current Treatment Opinions in Cardiovascular Medicine. 2012. №14. Р. 384–390.Trout J.C., Alborn W.E., Moisior M.K. et al. An apolipoprotein A-I mimetic dose-dependently increases the formation of prebeta1 HDL in human plasma // J. Lipid. Res. 2008. №49(3). Р. 581–587.Trout J.C., Alborn W.E., Moisior M.K. et al. An apolipoprotein A-I mimetic dose-dependently increases the formation of prebeta1 HDL in human plasma // J. Lipid. Res. 2008. №49(3). Р. 581–587.Sakata K., Miho N., Shirotani M. et al. Remnant-like particle cholesterol is a major risk factor for myocardial infarction in vasospastic angina with nearly normal coronary artery // Atherosclerosis. 1998. №136. Р. 225–231.Sakata K., Miho N., Shirotani M. et al. Remnant-like particle cholesterol is a major risk factor for myocardial infarction in vasospastic angina with nearly normal coronary artery // Atherosclerosis. 1998. №136. Р. 225–231.Masuoka H., Kamei S., Ozaki M. et al. Predictive value of remnant-like particle cholesterol with coronary artery disease in patients with normal cholesterol level. Intern. Med. 2000. №39. Р. 540–546.Masuoka H., Kamei S., Ozaki M. et al. Predictive value of remnant-like particle cholesterol with coronary artery disease in patients with normal cholesterol level. Intern. Med. 2000. №39. Р. 540–546.Karpe F., Boquist S., Tang R. et al. Remnant lipoproteins are related to intima-media thickness of carotid artery independently of LDL cholesterol and plasma triglycerides // J. Lipid. Res. 2001. №42. Р. 17–21.Karpe F., Boquist S., Tang R. et al. Remnant lipoproteins are related to intima-media thickness of carotid artery independently of LDL cholesterol and plasma triglycerides // J. Lipid. Res. 2001. №42. Р. 17–21.Devaraj S., Vega G., Lange R. et al. Remnant-like particle cholesterol levels in patients with dysbetalipoproteinemia or coronary heart disease // Am. J. Med. 1998. №104. Р. 445–450.Devaraj S., Vega G., Lange R. et al. Remnant-like particle cholesterol levels in patients with dysbetalipoproteinemia or coronary heart disease // Am. J. Med. 1998. №104. Р. 445–450.Kugiyama K., Doi H., Takazoe K. et al. Remnant lipoprotein levels in fasting serum predict coronary events in patients with coronary artery disease // Circulation. 1999. №99. Р. 2859–2860.Kugiyama K., Doi H., Takazoe K. et al. Remnant lipoprotein levels in fasting serum predict coronary events in patients with coronary artery disease // Circulation. 1999. №99. Р. 2859–2860.McNamara J.R., Shah P.K., Nakajima K. et al. Remnant-like particle (RLP) cholesterol is an independent cardiovascular disease risk factor in women: results from Framingham Heart Study // Atherosclerosis. 2001. №154. Р. 229–236.McNamara J.R., Shah P.K., Nakajima K. et al. Remnant-like particle (RLP) cholesterol is an independent cardiovascular disease risk factor in women: results from Framingham Heart Study // Atherosclerosis. 2001. №154. Р. 229–236.Fukushima H., Kugiyama K., Sugiyama S et al. Comparison of remnant-like particles in postmenopausal women with and without coronary heart disease and men with coronary disease // Am. J. Cardiol. 2001. №88. Р. 1370–1373.Fukushima H., Kugiyama K., Sugiyama S et al. Comparison of remnant-like particles in postmenopausal women with and without coronary heart disease and men with coronary disease // Am. J. Cardiol. 2001. №88. Р. 1370–1373.Nakamura T, Takano H, Umeratani K et al. Remnant lipoproteinemia is a risk factor for endothelial vasomotor dysfunction and coronary artery disease in metabolic syndrome. Atherosclerosis 2005; 181: 321-7.Nakamura T, Takano H, Umeratani K et al. Remnant lipoproteinemia is a risk factor for endothelial vasomotor dysfunction and coronary artery disease in metabolic syndrome. Atherosclerosis 2005; 181: 321-7.Robinson J, Wang S, Smith B et al. Meta-analysis of the relationship between non-high-density lipoprotein cholesterol reduction and coronary heart disease risk. J Am Coll Cardiol 2009; 53(4):316-22. doi: 10.1016/j.jacc.2008.10.024.Robinson J, Wang S, Smith B et al. Meta-analysis of the relationship between non-high-density lipoprotein cholesterol reduction and coronary heart disease risk. J Am Coll Cardiol 2009; 53(4):316-22. doi: 10.1016/j.jacc.2008.10.024.Baigent C, Keech A, Kearney PM et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomized trials of statins. Lancet 2005;366(9433):1267-78.Baigent C, Keech A, Kearney PM et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomized trials of statins. Lancet 2005;366(9433):1267-78.Orakzai SH, Nasir K, Blaha M, et al. Non-HDL cholesterol is strongly associated with coronary artery calcification in asymptomatic individuals. Atherosclerosis 2009; 202(1):289-95. doi: 10.1016/j.atherosclerosis.2008.03.014. Epub 2008 Mar 25.Orakzai SH, Nasir K, Blaha M, et al. Non-HDL cholesterol is strongly associated with coronary artery calcification in asymptomatic individuals. Atherosclerosis 2009; 202(1):289-95. doi: 10.1016/j.atherosclerosis.2008.03.014. Epub 2008 Mar 25.Erbel R, Lehmann N, Chuzidze S et al. Gender-specific association of coronary artery calcium and lipoprotein parameters: The Heinz Nixdorf Recall Study.Atherosclerosis 2013; S0021-9 150(13)00255-4. doi: 10.1016/j.atherosclerosis.2013.04.015. [Epub ahead of print]Erbel R, Lehmann N, Chuzidze S et al. Gender-specific association of coronary artery calcium and lipoprotein parameters: The Heinz Nixdorf Recall Study.Atherosclerosis 2013; S0021-9 150(13)00255-4. doi: 10.1016/j.atherosclerosis.2013.04.015. [Epub ahead of print]Niveen M E Abu-Rmeileh, Azza Shoaibi, Martin O”Flaherty et al. Analysing falls in coronary heart disease mortality in the West Bank between 1998 and 2009. B.M.J. 2012; 24:2(4): doi:pii: e001061. 10.1136/bmjopen-2012-001061. Print 2012Niveen M E Abu-Rmeileh, Azza Shoaibi, Martin O”Flaherty et al. Analysing falls in coronary heart disease mortality in the West Bank between 1998 and 2009. B.M.J. 2012; 24:2(4): doi:pii: e001061. 10.1136/bmjopen-2012-001061. Print 2012Оганов Р Г, Кухарчук В В, Арутюнов Г П с соавт. Сохраняющиеся нарушения показателей липидного спектра у пациентов с дислипидемией, получающих статины в реальной клинической практике. Кардиоваскулярная терапия и профилактика 2012; 11(4):1-10 .Оганов Р Г, Кухарчук В В, Арутюнов Г П с соавт. Сохраняющиеся нарушения показателей липидного спектра у пациентов с дислипидемией, получающих статины в реальной клинической практике. Кардиоваскулярная терапия и профилактика 2012; 11(4):1-10 .Jones PH et al. Comparison of efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR trial). Am J Cardiol 2003; 92: 152–160.Jones PH et al. Comparison of efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR trial). Am J Cardiol 2003; 92: 152–160.Schuster H, Barter P, Stender S et al. Effects of switching statins on achievement of lipid goals: Measuring Effective Reductions in Cholesterol Using Rosuvastatin Therapy (MERCURY I) study.Am Heart J 2004; 147: 705−712Schuster H, Barter P, Stender S et al. Effects of switching statins on achievement of lipid goals: Measuring Effective Reductions in Cholesterol Using Rosuvastatin Therapy (MERCURY I) study.Am Heart J 2004; 147: 705−712Palmer M.K, Nichols S J, Lundman P et al. Achievement of LDL-C goals depends on baseline LDL-C and choice and dose of statin: An analysis from the VOYAGER database Eur J Prev Cardiol 2013 May EPub ahead a print.Palmer M.K, Nichols S J, Lundman P et al. Achievement of LDL-C goals depends on baseline LDL-C and choice and dose of statin: An analysis from the VOYAGER database Eur J Prev Cardiol 2013 May EPub ahead a print.Karlson BW, Barter PJ, Palmer M.K. et al. Comparison of the effects of different statins and doses on lipid levels in patients with diabetes: results from VOYAGER. Nutr Metab Cardiovasc Disease 2012, 22(9): 697-703.Karlson BW, Barter PJ, Palmer M.K. et al. Comparison of the effects of different statins and doses on lipid levels in patients with diabetes: results from VOYAGER. Nutr Metab Cardiovasc Disease 2012, 22(9): 697-703.Boekholdt SM, Arsenault BJ, Hovingh GK, et al. Levels and Changes of HDL Cholesterol and Apolipoprotein A-I in Relation to Risk of Cardiovascular Events among Statin-Treated Patients: A Meta-Analysis Circulation. 2013. doi:10.1161/CIRCULATIONAHA.113.002670Boekholdt SM, Arsenault BJ, Hovingh GK, et al. Levels and Changes of HDL Cholesterol and Apolipoprotein A-I in Relation to Risk of Cardiovascular Events among Statin-Treated Patients: A Meta-Analysis Circulation. 2013. doi:10.1161/CIRCULATIONAHA.113.002670

The authors declare that there are no conflicts of interest present.