Do the heterogeneous properties of VLDL particles (reactivity with cell-surface receptors, apolipoprotein content, or distribution) determine their atherogenicity?
Nutritional approaches to the treatment of hypertriglyceridemia have not been studied sufficiently. The promising initial finding of lowering effects for VLDL and LDL levels by fish-oil-containing diets needs additional research to understand better the mechanisms, the clinical potential, and the long-term safety of such diets. New quantitative noninvasive and invasive techniques for measuring arterial flow and atherosclerotic lesion size (and luminal impingement) should be employed to determine more directly the effects of hygienic and pharmacologic interventions. Coronary artery bypass grafts offer a promising opportunity to examine the effect of the lowering of triglyceride levels on graft occlusion. While there are several drugs available that affect triglyceride metabolism, there is a continuing need for drugs with greater potency, minimal or no adverse effects on LDL and HDL levels, and fewer side effects.
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