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Plasma triglyceride as a risk factor for coronary heart disease. The epidemiologic evidence and beyond
1Lawrence Berkeley Laboratory, Berkeley, CA.
Insights
Elevated plasma triglyceride levels are linked to coronary heart disease risk. Statistical analysis shows this risk is complex and not independent, requiring further biological investigation into triglyceride
Area of Science:
- Cardiovascular Epidemiology
- Lipid Metabolism
- Atherosclerosis Research
Background:
- Elevated plasma triglyceride is a univariate risk factor for coronary heart disease (CHD).
- This association is not independent of other lipid and lipoprotein measures in multivariate analyses.
- The complexity arises from statistical variations and biological heterogeneity in hypertriglyceridemia.
Purpose of the Study:
- To explore the complex role of triglyceride in atherosclerosis despite its inconsistent multivariate significance.
- To understand the disparity between univariate and multivariate findings regarding triglyceride as a CHD risk factor.
- To reconcile epidemiological observations with underlying biological mechanisms.
Main Methods:
- Review of epidemiological studies on triglyceride and coronary heart disease.
- Statistical analysis examining univariate and multivariate risk prediction models.
- Consideration of lipid and lipoprotein subclasses (HDL, LDL) in relation to triglyceride metabolism.
Main Results:
- Triglyceride is a significant univariate risk factor for CHD.
- In multivariate models, triglyceride's significance is often diminished due to measurement variability and inverse correlation with HDL cholesterol.
- Subclasses of HDL and LDL may offer more precise risk prediction related to triglyceride metabolism.
Conclusions:
- The epidemiological data suggest triglyceride is involved in atherosclerosis, but its precise causal role requires further biological validation.
- The complexity of triglyceride's role highlights intricate metabolic processes influencing cardiovascular disease.
- Further research into lipid subclasses and metabolic pathways is crucial for a definitive understanding of triglyceride as a CHD risk factor.
Abstract:
Elevated plasma triglyceride has been found to be a univariate risk factor for coronary heart disease in many epidemiologic studies, but this increased risk is not independent of other lipid and lipoprotein measures. Rather than dismiss triglyceride as a risk factor, we can see this disparity between univariate and multivariate results as a clue to better understanding of the potential role of triglyceride in atherosclerosis. From a statistical point of view, triglyceride often is not a significant predictor of coronary heart disease in multivariate statistical models because of the large variation in triglyceride measurements and the strong inverse relation between HDL cholesterol and triglyceride. Heterogeneity in both the biologic mechanisms producing hypertriglyceridemia and the manifestations of cardiovascular disease complicates the study of triglyceride as a risk factor. recently, subclasses of both HDL and LDL have been shown to be related to triglyceride metabolism and may provide more precise variables for predicting risk. However, none of this evidence precludes the involvement of triglyceride in the development of atherosclerosis. The final answer as to whether triglyceride is a causal risk factor for coronary heart disease must come from the biologic sciences, and the complexity of the epidemiologic results likely reflects the intricate metabolic processes involved.