In the ATVB in focus section of the latest issue of Arteriosclerosis, Thrombosis, and Vascular Biology, Adiels et al. reviewed the role of VLDL production in the pathophysiology of the metabolic syndrome and associated insulin resistance. As VLDL overproduction is the hallmark of hepatic fat deposition (the fatty liver), the mechanisms that lead from lipidation of apolipoprotein B in the liver to the actual secretion of VLDL particles is explained in detail. The metabolic factors that predict the overproduction of VLDL particles are also discussed. Among those, liver fat, intra-abdominal (visceral) adipose tissue accumulation, plasma adiponectin, insulin and glucose levels, as well as peripheral insulin resistance were suggested to be important causal factors leading to the overproduction of large and slowly metabolized VLDL particles. The overproduction of VLDL particles is also associated with the lipid triad, e.g., high plasma levels of triglycerides, low levels of HDL cholesterol, and an increased proportion of small, dense LDL particles. The authors concluded by reviewing the lipid management of dyslipidemia in insulin-resistant or diabetic patients. The relevance of statins, fibrates, and nicotinic acid in light of recent clinical trials was also discussed and clarified.
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