Triglycerides and cardiovascular disease.

Area of Science:

• Cardiology
• Metabolic Disorders
• Pharmacology

Background:

• Triglycerides (TGs) are routinely measured but their cardiovascular disease (CVD) risk association is debated, often overshadowed by high-density lipoprotein cholesterol (HDL-C).
• Non-high-density lipoprotein cholesterol (non-HDL-C) better captures risk from TG-containing lipoproteins than low-density lipoprotein cholesterol (LDL-C).

Purpose of the Study:

• To review the controversial relationship between triglycerides (TGs) and cardiovascular disease (CVD) risk.
• To evaluate the evidence for TG-lowering therapies in CVD prevention.

Main Methods:

• Review of epidemiological studies, Mendelian randomization studies, and meta-analyses of intervention trials (statins, fibrates, omega-3 fatty acids).
• Analysis of historical subgroup data and recent clinical trial results.

Main Results:

• Epidemiological and genetic studies consistently link TG-rich lipoproteins and TG metabolism gene variants to CVD risk.
• Meta-analyses suggest TG reduction with statins and other drugs benefits CVD outcomes.
• High-dose eicosapentaenoic acid (a specific omega-3 fatty acid) showed CVD outcome benefits in recent trials.

Conclusions:

• Evidence supports a role for TG-lowering strategies in CVD risk management.
• Further research with novel agents like pemafibrate and vupanorsen is needed to define optimal therapeutic pathways.