Remnant lipoproteins as therapeutic targets

Increasing evidence suggests that subsets of triglyceride-rich lipoproteins are particularly atherogenic. These include particles with some, but not necessarily all the properties classically attributed to remnants. Cholesteryl ester-enrichment seems to be a common feature of these particles, some of which can be taken up by macrophages by a novel receptor that recognizes species of apolipoprotein B but not apolipoprotein E. These characteristics seem to be common to postprandial and hypertriglyceridemic very low density lipoproteins as well as chylomicron remnants. Remnant-like triglyceride-rich lipoproteins that exhibit several potentially atherogenic properties can be quantified by a simple test that shows promise for identifying individuals at high risk for lesion formation and clinical events. Available hygienic and pharmaceutical measures that effectively lower the concentration of atherogenic triglyceride-rich lipoproteins deserve wider use.