Evaluation and Treatment of Atherogenic Dyslipidemia

Abstract

Epidemiological data have shown a strong relationship between elevated plasma cholesterol levels and cardiovascular disease. Over the past 70 years the field of clinical lipidology has emerged. The specialties of endocrinology and cardiology, which long held the ownership of lipidology, have now given way to new generations of physicians who approach lipid management from wide-ranging perspectives. The birth of bariatric endocrinology brings a different perspective to lipidology. With the knowledge that adipose tissue is central to the regulation of metabolism, interventions to address dyslipidemia as a function of adipose tissue dysfunction, or adiposopathy, will take on increasing relevance. The traditional approach of treating vascular disease, once present, has been supplanted by a systematic approach in medicine to identify and treat vascular risk factors. We now add adiposopathy as the genesis of many of these risk factors. And thus, aggressive weight management stands to prevent and treat atherogenic dyslipidemia. This chapter will review the role of adipose tissue in lipid metabolism and the changes that come about with adiposopathy. Building on the knowledge that we have, it is imperative to identify patients at risk and treat their lipids to goal. It is now equally important to address the underlying adiposopathy.