Triglycerides and cardiovascular disease. A focus on clinical trials

Observational studies, both case control and prospective, have routinely identified elevated triglycerides as a univariate predictor of cardiovascular disease, especially coronary heart disease, and in several studies this association persists in multivariate analysis. However, experimental information from clinical trials is required for clinical guidelines. Many clinical trials in dyslipidaemia have employed interventions with only minor effects on triglycerides. Five trials have used pharmaceutical agents with significant triglyceride effects and have correlated the clinical or angiographic benefit observed with the change in various lipid or lipoprotein components. In three of these five trials, the benefit for various coronary disease endpoints was more closely associated with triglyceride reductions than with changes in other lipids and lipoproteins. A sixth trial showed reduced coronary disease progression with treatment despite no change in LDL cholesterol. Reduction in triglycerides may result in direct benefit for coronary disease. Clinical trials employing pharmacological agents with significant effects on triglycerides should correlate clinical and/or angiographic benefit with observed lipid and lipoprotein changes, as well as any changes in non-lipid risk factors such as fibrinogen.