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Current perspectives on the management of hypertriglyceridemia
1University of Maryland Medical System, Baltimore, MD, USA. mmiller@heart.umaryland.edu
Insights
Triglycerides are linked to coronary heart disease, but lowering them offers little proven benefit. Focus on lowering LDL cholesterol and raising HDL cholesterol for cardiovascular event prevention.
Area of Science:
- Cardiovascular Medicine
- Lipid Metabolism
- Preventive Cardiology
Background:
- Triglycerides are an independent risk factor for coronary heart disease.
- Atherothrombosis may involve triglyceride-rich lipoproteins and altered LDL/HDL particles.
- While lowering LDL cholesterol reduces cardiovascular events, the role of triglyceride lowering is unclear.
Purpose of the Study:
- To review evidence on triglyceride lowering strategies for cardiovascular disease prevention.
- To assess the independent benefit of triglyceride reduction on coronary event rates.
Main Methods:
- Review of major arteriographic and clinical end point trials.
- Evaluation of dietary, hygienic, and pharmacologic interventions for triglyceride management.
Main Results:
- Dietary changes and aerobic activity can reduce triglycerides by 20-24%.
- Omega-3 fatty acids, nicotinic acid, fibrates, and statins effectively lower triglyceride levels.
- No independent benefit of triglyceride lowering on coronary event rates has been demonstrated.
Conclusions:
- Limited evidence suggests triglyceride reduction improves cardiovascular event rates.
- Lowering LDL cholesterol and raising HDL cholesterol are proven therapies for coronary heart disease prevention.
- Management of dyslipidemia prioritizes LDL and HDL cholesterol, with triglyceride reduction as an adjunctive strategy.
Background:
Observational studies have demonstrated that triglycerides are an independent risk factor for coronary heart disease. Atherothrombosis may be mediated by uptake and incorporation of triglyceride-rich lipoproteins by macrophages and through an association with small, dense LDL and HDL particles. There are considerable data that lowering LDL cholesterol reduces cardiovascular events. However, the importance of triglyceride lowering remains elusive.
Methods:
A summary of major arteriographic and clinical end point trials is reviewed. Studies evaluating various strategies, including dietary and hygienic measures as well as pharmacologic therapies, are discussed.
Results:
Dietary reduction of saturated fat, coupled with aerobic activity, reduces triglyceride levels approximately 20% to 24%. Omega-3 fatty acids may also reduce triglyceride levels appreciably. Effective pharmacologic therapies that lower triglyceride levels include nicotinic acid (20% to 40%), fibrates (20% to 55%), and statins (10% to 30%). Nevertheless, an independent benefit of triglyceride lowering on coronary event rate has not been demonstrated.
Conclusions:
There are little data that triglyceride reduction improves cardiovascular event rate. In contrast, lowering LDL cholesterol and, more recently, raising HDL cholesterol are proven therapies in coronary heart disease prevention. As such, these modalities remain the top priority in the management of dyslipidemia with triglyceride reduction as an adjunctive consideration.