Triglycerides: a risk factor for coronary heart disease

Area of Science:

• Cardiovascular Epidemiology
• Lipid Metabolism
• Atherosclerosis Research

Background:

• Historically, multivariate analyses suggested plasma triglyceride (TG) was not an independent risk factor for coronary heart disease (CHD).
• Recent subgroup and meta-analyses indicate a significant independent association between TG and CHD.
• Elevated TG reflects atherogenic triglyceride-rich lipoprotein (TRL) remnants, implicated in cardiovascular disease.

Purpose of the Study:

• To review the evolving understanding of the association between plasma triglycerides and coronary heart disease.
• To highlight the role of triglyceride-rich lipoprotein remnants in atherogenesis.
• To emphasize the clinical implications for managing hypertriglyceridaemia.

Main Methods:

• Review of epidemiological data, subgroup analyses, and meta-analyses.
• Examination of clinical evidence from specific genetic deficiencies (e.g., type III hyperlipoproteinaemia, hepatic lipase deficiency, apolipoprotein E deficiency).
• Consideration of genetic factors (e.g., ApoE epsilon 2 allele) and postprandial triglyceridaemia.

Main Results:

• Evidence supports an independent role for TG in predicting CHD, primarily through TRL remnants.
• Patients with increased TRL and specific genetic conditions exhibit higher CHD incidence.
• Postprandial triglyceridaemia and TRL are implicated in atherosclerotic disease progression, independent of LDL.

Conclusions:

• Plasma TG concentration, particularly via TRL remnants, is a significant predictor of CHD.
• Physicians must thoroughly evaluate hypertriglyceridaemic patients, assessing risk factors and lipoprotein profiles.
• Understanding TRL atherogenicity is crucial for managing cardiovascular risk in hypertriglyceridaemic individuals.