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Triglycerides and coronary heart disease: implications of recent clinical trials
1Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, Minneapolis, Minnesota 55417, USA. BLOOM013@tc.umn.edu
Abstract:
This paper reviews the clinical trial data that offer insight into the question of whether, and in what groups of people, triglycerides might be an appropriate therapeutic target for the primary or secondary prevention of atherosclerotic cardiovascular disease. Two angiographic trials (the Lopid Coronary Angiography Trial and the Bezafibrate Coronary Atherosclerosis Intervention Trial) and three clinical endpoint trials (the Helsinki Heart Study, the Bezafibrate Infarction Prevention Study, and the VA HDL Intervention Trial) are reviewed. Hypertriglyceridemia per se is probably not an appropriate therapeutic target for the prevention of atherosclerotic cardiovascular disease because it is a poor marker of atherogenic risk and because there have been no clinical trials that have directly addressed the question of whether lowering the triglyceride level reduces the number of clinical events. The studies reviewed here, however, suggest that patients with established coronary heart disease and a high triglyceride level, in association with either a low high-density lipoprotein-cholesterol level or perhaps other features of the metabolic syndrome, such as obesity, diabetes, or hypertension, may benefit from fibrate therapy. For patients without established coronary heart disease, it is reasonable to consider hypertriglyceridemia as a risk marker prompting the aggressive treatment of other risk factors such as hypertension, diabetes, high low-density lipoprotein-cholesterol, and obesity.
Insights
High triglyceride levels alone may not warrant treatment for preventing atherosclerotic cardiovascular disease. However, fibrate therapy may benefit patients with existing heart disease and metabolic syndrome risk factors.
Area of Science:
- Cardiology
- Metabolic Syndrome Research
- Clinical Trial Analysis
Background:
- Atherosclerotic cardiovascular disease (ASCVD) prevention strategies are crucial.
- The role of hypertriglyceridemia as a therapeutic target remains debated.
- Existing clinical trials offer insights into triglyceride management.
Purpose of the Study:
- To review clinical trial data on triglycerides as a therapeutic target for ASCVD prevention.
- To determine if lowering triglycerides reduces clinical events.
- To identify patient subgroups who may benefit from triglyceride-lowering therapies.
Main Methods:
- Review of two angiographic trials: Lopid Coronary Angiography Trial and Bezafibrate Coronary Atherosclerosis Intervention Trial.
- Review of three clinical endpoint trials: Helsinki Heart Study, Bezafibrate Infarction Prevention Study, and VA HDL Intervention Trial.
- Analysis of data concerning hypertriglyceridemia, high-density lipoprotein-cholesterol, and metabolic syndrome components.
Main Results:
- Hypertriglyceridemia alone is likely not an appropriate target for ASCVD prevention due to poor risk stratification.
- No clinical trials directly demonstrate that lowering triglycerides reduces clinical events.
- Patients with established coronary heart disease and high triglycerides, especially with low HDL-cholesterol or metabolic syndrome features, may benefit from fibrate therapy.
Conclusions:
- Hypertriglyceridemia is a risk marker, not a primary therapeutic target, for ASCVD prevention.
- Fibrate therapy may be beneficial for specific patient groups with established cardiovascular disease and metabolic risk factors.
- For individuals without established ASCVD, focus on aggressive management of other risk factors like hypertension, diabetes, obesity, and high LDL-cholesterol is recommended.