Relationship between lipoproteins, thrombosis and atrial fibrillation

Wern Yew Ding, Majd B. Protty, Ian G. Davies, Gregory Y.H. Lip*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

32 Citations (Scopus)
45 Downloads (Pure)

Abstract

The prothrombotic state in atrial fibrillation (AF) occurs as a result of multifaceted interactions, known as Virchow's triad of hypercoagulability, structural abnormalities, and blood stasis. More recently, there is emerging evidence that lipoproteins are implicated in this process, beyond their traditional role in atherosclerosis. In this review, we provide an overview of the various lipoproteins and explore the association between lipoproteins and AF, the effects of lipoproteins on haemostasis, and the potential contribution of lipoproteins to thrombogenesis in AF. There are several types of lipoproteins based on size, lipid composition, and apolipoprotein category, namely: chylomicrons, very low-density lipoprotein, low-density lipoprotein (LDL), intermediate-density lipoprotein, and high-density lipoprotein. Each of these lipoproteins may contain numerous lipid species and proteins with a variety of different functions. Furthermore, the lipoprotein particles may be oxidized causing an alteration in their structure and content. Of note, there is a paradoxical inverse relationship between total cholesterol and LDL cholesterol (LDL-C) levels, and incident AF. The mechanism by which this occurs may be related to the stabilizing effect of cholesterol on myocardial membranes, along with its role in inflammation. Overall, specific lipoproteins may interact with haemostatic pathways to promote excess platelet activation and thrombin generation, as well as inhibiting fibrinolysis. In this regard, LDL-C has been shown to be an independent risk factor for thromboembolic events in AF. The complex relationship between lipoproteins, thrombosis and AF warrants further research with an aim to improve our knowledge base and contribute to our overall understanding of lipoprotein-mediated thrombosis.

Original languageEnglish
JournalCardiovascular Research
Volume118
Issue number3
Pages (from-to)716-731
Number of pages16
ISSN0008-6363
DOIs
Publication statusPublished - Feb 2022

Bibliographical note

© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.

Keywords

  • Atrial fibrillation
  • Haemostasis
  • High-density lipoprotein
  • Incidence
  • Lipids
  • Lipoprotein(a)
  • Lipoproteins
  • Low-density lipoprotein
  • Oxidized lipoprotein
  • Stroke
  • Thromboembolism
  • Thrombosis
  • Very low-density lipoprotein

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