Triglyceride-rich lipoproteins and atherosclerosis
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1Medical Department II, Klinikum Grosshadern, University of Munich, Federal Republic of Germany.
Insights
Elevated plasma triglyceride levels are a significant risk factor for coronary heart disease. Lowering these levels can substantially reduce coronary heart disease mortality, particularly in specific patient groups.
Area of Science:
- Cardiovascular Medicine
- Lipid Metabolism
- Atherosclerosis Research
Background:
- Plasma triglyceride levels are increasingly recognized as a risk factor for coronary heart disease (CHD).
- Epidemiological studies consistently link elevated triglycerides with higher CHD incidence.
- The atherogenic potential of triglyceride-rich lipoproteins is supported by in vitro and in vivo data.
Purpose of the Study:
- To consolidate evidence supporting plasma triglycerides as a risk factor for coronary heart disease.
- To examine the impact of lowering triglyceride levels on CHD mortality.
- To investigate the role of triglyceride-rich lipoprotein remnants in atherogenesis.
Main Methods:
- Review of epidemiological data from major cohort studies (e.g., Framingham, Paris, Stockholm).
- Analysis of studies correlating triglyceride levels with CHD incidence and mortality.
- Examination of angiographic findings and in vitro/in vivo studies on lipoprotein particle atherogenicity.
Main Results:
- Elevated plasma triglyceride levels are associated with increased coronary heart disease incidence.
- Significant reductions in CHD mortality (36-60%) observed with effective triglyceride lowering.
- Stronger association between triglycerides and CHD noted in patients with lower total cholesterol or HDL-cholesterol.
- Evidence suggests triglyceride-rich lipoprotein remnants are cytotoxic and atherogenic.
Conclusions:
- Plasma triglyceride levels are a confirmed risk factor for coronary heart disease.
- Therapeutic strategies aimed at lowering triglycerides can significantly reduce CHD mortality.
- Understanding the atherogenic mechanisms of triglyceride-rich lipoproteins is crucial for cardiovascular risk management.
Abstract:
Although still the subject of debate, most investigators accept that plasma triglyceride levels are a risk factor for coronary heart disease. Data from epidemiological studies such as the Framingham Heart Study, the Paris Prospective Heart Study and the Stockholm Heart Study have shown that patients with elevated plasma triglyceride levels have a higher incidence of coronary heart disease. In one study, coronary heart disease mortality fell by 36% after continued lowering of plasma triglyceride levels. In patients whose triglyceride levels fell greater than 30%, mortality decreased by 60%. The effect of triglycerides as a risk factor appears to be obscured in studies that use multiple cardiac end-points. Several studies demonstrated a stronger association between plasma triglyceride levels and coronary heart disease in patients with total cholesterol levels less than 5.7 mmol/L, or high density lipoprotein (HDL)-cholesterol levels less than 1 mmol/L. Angiographic data have confirmed these findings and show clearly that elevated triglyceride levels are frequently observed in men with coronary heart disease. Other studies have demonstrated that remnants of triglyceride-rich lipoprotein particles are cytotoxic and atherogenic in vitro and in vivo. Also, patients with familial dys beta-lipoproteinaemia, a condition characterised by high levels of triglyceride-rich very low density lipoprotein (VLDL) particles, have a high risk of atherosclerosis. Thus, there seems to be evidence supporting the atherogenic properties of cholesterylester-rich particles, or remnants thereof.