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Elevated LDL Triglycerides and Atherosclerotic Risk

Mie Balling1, Shoaib Afzal1, George Davey Smith2

  • 1Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark; The Copenhagen General Population Study, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

Journal of the American College of Cardiology
|January 11, 2023
PubMed

Insights

Elevated low-density lipoprotein (LDL) triglycerides significantly increase the risk of atherosclerotic cardiovascular disease (ASCVD) and its components. This finding was consistent across two cohort studies and meta-analyses, confirming a robust association.

Area of Science:

  • Cardiovascular Medicine and Epidemiology
  • Lipid Metabolism and Atherosclerosis Research

Background:

  • The association between elevated low-density lipoprotein (LDL) triglycerides and the risk of atherosclerotic cardiovascular disease (ASCVD) remains incompletely understood.
  • Clarifying this relationship is crucial for refining cardiovascular risk assessment and prevention strategies.

Purpose of the Study:

  • To investigate the hypothesis that elevated LDL triglycerides are significantly associated with an increased risk of ASCVD.
  • To determine the association of elevated LDL triglycerides with individual components of ASCVD, including ischemic heart disease, myocardial infarction, ischemic stroke, and peripheral artery disease.

Main Methods:

  • Utilized data from the Copenhagen General Population Study, measuring LDL triglycerides via direct automated assay (n=38,081) and NMR spectroscopy (n=30,208).
  • Conducted meta-analyses combining findings from the current study with previously published research.
  • Employed Cox proportional hazards models to assess hazard ratios (HRs) for ASCVD events per unit increase in LDL triglycerides.

Main Results:

  • A significant positive association was observed between higher direct LDL triglycerides and increased risk for ASCVD (HR=1.26), ischemic heart disease (HR=1.27), myocardial infarction (HR=1.28), ischemic stroke (HR=1.22), and peripheral artery disease (HR=1.38).
  • Similar associations were found with NMR LDL triglycerides, indicating robust risk prediction across different measurement methods.
  • Meta-analyses confirmed these findings, with the highest quartile of LDL triglycerides showing a 1.50-fold increased risk for ASCVD compared to the lowest quartile.

Conclusions:

  • Elevated LDL triglycerides are robustly associated with a significantly increased risk of developing ASCVD and its individual components.
  • These findings underscore the importance of monitoring and managing LDL triglycerides as a critical factor in cardiovascular disease prevention.
Abstract

Keywords:
atherosclerosiscardiovascular diseaselipidsremnantstriglyceride-rich lipoproteinsvery low-density lipoprotein

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