Predictors of atherosclerosis.

It is herein discussed what should be measured as predictors of atherosclerosis, to increase the predictive power of coronary risk evaluation in clinical practice. Plasma apolipoprotein (apo)B and apoAI have been reported to be stronger predictors of coronary artery disease (CAD) than plasma low-density lipoprotein (LDL)-cholesterol (C) and high-density lipoprotein (HDL)-C. The estimation of plasma levels of remnants of TG-rich lipoproteins is also important for coronary risk evaluation. An increase in plasma small, dense LDL is a risk factor for CAD. It is not practical to measure plasma small, dense LDL as a routine clinical examination. We should estimate the plasma levels of small, dense LDL by plasma triglyceride (TG), apoB, and HDL-C levels. Oxidized LDL (ox-LDL) plays an important role in atherosclerosis. Further large-scale, prospective studies are necessary to determine whether the measurement of plasma ox-LDL and autoantibodies against ox-LDL is an essential predictor of atherosclerosis. High plasma levels of Lp(a) are a risk factor for atherosclerotic vascular diseases in subjects with high plasma LDL-C levels and multiple coronary risk factors. Metabolic syndrome (MS) has been recognized recently as a predictor of CAD. As a result, it should be elucidated whether MS must be involved in the coronary risk evaluation score because all components of MS are involved in the score. A high plasma level of high-sensitivity C-reactive protein (hs-CRP) is an important predictor of atherosclerotic diseases. Whether it is essential to measure the plasma levels of atherosclerosis surrogate markers in clinical practice remains to be elucidated. It is concluded that plasma levels of apoB, apoAI, remnant-like particle (RLP)-C, lipoprotein (a) [Lp(a)], and hs-CRP in addition to those of lipids should be measured as predictors of atherosclerosis in clinical practice. We need to establish a new atherosclerosis risk evaluation scoring system involving the above factors, based on large-scale, prospective studies, to prevent atherosclerotic vascular diseases. In Japan, plasma levels of Lp(a), RLP-C, and hs-CRP are routinely measured in clinical practice. As a result, it would be rather easy to establish a new atherosclerosis risk evaluation scoring system in Japan.