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High triglycerides/low high-density lipoprotein cholesterol, ischemic electrocardiogram changes, and risk of ischemic
Jørgen Jeppesen1, Hans Ole Hein, Poul Suadicani
1Copenhagen Male Study, Epidemiological Research Unit, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark. hoh01@bbh.hosp.dk
Insights
High triglycerides/low HDL-C and ischemic ECG changes significantly increase ischemic heart disease (IHD) risk in men. Combining these factors indicates a particularly poor prognosis for IHD development and mortality.
Area of Science:
- Cardiology
- Preventive Medicine
- Biomarkers
Background:
- High triglycerides (TG) and low high-density lipoprotein cholesterol (HDL-C) are established risk factors for ischemic heart disease (IHD).
- Ischemic ST-T changes on resting electrocardiogram (ECG) also independently predict IHD risk.
- These factors are particularly relevant in men without pre-existing cardiovascular disease.
Purpose of the Study:
- To investigate the combined prognostic value of high TG/low HDL-C and ischemic ECG changes in men without clinical IHD.
- To determine if these two risk factors have a synergistic effect on IHD development and mortality.
Main Methods:
- A cohort study involving 2906 men aged 53-74 years without overt IHD at baseline.
- Follow-up for 8 years to ascertain incident IHD cases, including fatal events.
- Statistical analysis to assess the relative risk and interaction effects of high TG/low HDL-C and ischemic ECG changes.
Main Results:
- During 8 years, 229 men developed IHD, with 61 fatal cases.
- Men with both high TG/low HDL-C and ischemic ECG changes had a 3.5-fold increased risk of total IHD and an 11.2-fold increased risk of fatal IHD compared to those without these factors.
- Adjusted analysis revealed a significant interaction between high TG/low HDL-C and ischemic ECG changes, predicting IHD death with a relative risk of 2.6.
Conclusions:
- Ischemic ECG changes are a significantly stronger predictor of fatal IHD in men with high TG/low HDL-C.
- An adverse synergistic effect exists between high TG/low HDL-C and ischemic ECG changes in predicting fatal IHD among men without prior clinical cardiovascular disease.
Background:
High triglycerides (TG)/low high-density lipoprotein cholesterol (HDL-C)(TG > or =1.60 and HDL-C < or =1.18 mmol/L) and ischemic ST-T changes in the resting electrocardiogram (ECG) are both strong risk factors of ischemic heart disease (IHD) in men without clinical cardiovascular diseases. This study tested the hypothesis that men free of clinical IHD with high TG/low HDL-C and resting ischemic ECG changes would have a particularly poor prognosis with respect to IHD.
Methods:
We conducted a cohort study of 2906 men, aged 53 to 74 years, without overt IHD at baseline.
Results:
During 8 years, IHD developed in 229 men; 61 cases were fatal. Of the risk factors recorded, ischemic ECG changes and high TG/low HDL-C were the strongest risk factors of IHD. Compared with men without high TG/low HDL-C and without ischemic ECG changes, age-adjusted relative risk of total IHD (95% CI) was 3.5 (1.7-7.2) in men with both high TG/low HDL-C and ischemic ECG changes; the corresponding value for fatal IHD was 11.2 (4.9-25.8). Adjusted for conventional risk factors, the interaction term high TG/low HDL-C x ischemic ECG changes was a significant predictor of IHD death, with a relative risk of 2.6 (1.0-6.9).
Conclusions:
In men free of clinical IHD, ischemic ECG changes were significantly more predictive of fatal IHD in men with high TG/low HDL-C, indicating an adverse synergistic effect of these 2 risk factors.
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