Triglycerides as Determinants of Global Lipoprotein Derangement: Implications for Cardiovascular Prevention

Plasma triglyceride levels are a strong cardiovascular risk marker. However, triglyceride-lowering therapies have not demonstrated a reduction in cardiovascular events, suggesting that triglycerides may serve as surrogate markers for other atherogenic mechanisms. The aim is to investigate the role of triglycerides in derangements of the global lipoprotein profile, as assessed by ¹H-NMR spectroscopy. Serum lipoprotein profiles were analyzed in patients with metabolic alterations attending the Lipid Unit of a University hospital (n = 822). Lipoprotein particle number, size, and composition were evaluated and visualized through a graphic representation of a lipoprotein network analysis referred to lipid silhouette in patients sorted by triglyceride quartiles. Profound alterations in lipoprotein quantity and composition were associated with incremental triglyceride concentrations independently on the presence of diabetes or obesity, including a significantly increased number of VLDL and smaller LDL particles, and higher remnant cholesterol, representing up to 30% of all cholesterol in quartile 4. It was also a significant triglyceride enrichment of LDL and HDL particles. Triglycerides are not merely components of atherogenic dyslipidemia; they are a key driver of the overall changes and are strongly associated with a proatherogenic plasma lipoprotein profile. Visualization of these alterations provides supplementary insights to support cardiovascular prevention strategies.