Triglycerides revisited: is hypertriglyceridaemia a necessary therapeutic target in cardiovascular disease?

Area of Science:

• Cardiology
• Metabolic Disorders
• Pharmacology

Background:

• Residual atherosclerotic cardiovascular disease (ASCVD) risk remains a significant clinical challenge despite effective low-density lipoprotein cholesterol (LDL-C) lowering therapies.
• Elevated plasma triglyceride (TG) levels are increasingly recognized as an independent risk factor or marker for ASCVD.
• Understanding hypertriglyceridaemia's pathophysiology is crucial for addressing residual ASCVD risk.

Approach:

• This review synthesizes current knowledge on hypertriglyceridaemia, including its pathophysiology and the mechanisms of action for relevant therapeutic agents.
• It critically evaluates conflicting results from recent clinical trials investigating TG-lowering strategies.
• The review examines current primary and secondary prevention options for patients with elevated TG levels.

Key Points:

• Fibrates may offer benefits in primary prevention by reducing TG and increasing high-density lipoprotein cholesterol (HDL-C), potentially outweighing adverse effects on LDL-C.
• In secondary cardiovascular disease (CVD) prevention, purified eicosapentaenoic acid (EPA), without docosahexaenoic acid (DHA), combined with statins, demonstrates therapeutic potential.
• Novel therapeutic approaches targeting hypertriglyceridaemia are needed to further mitigate residual ASCVD risk.

Conclusions:

• Hypertriglyceridaemia represents a critical target for reducing residual ASCVD risk.
• Specific pharmacological interventions, such as fibrates and purified EPA, show promise in distinct clinical settings.
• Further research into novel strategies for managing high TG levels is warranted for improved cardiovascular outcomes.