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Normal triglyceride levels and coronary artery disease events: the Baltimore Coronary Observational Long-Term Study
M Miller1, A Seidler, A Moalemi
1Division of Cardiology, University of Maryland School of Medicine, Baltimore 21201-1595, USA. mmiller@heart.ab.umd.edu
Insights
Triglyceride levels previously considered normal can predict new coronary artery disease (CAD) events. These findings suggest current guidelines for elevated triglycerides may need revision for better cardiovascular event prediction.
Area of Science:
- Cardiovascular Medicine
- Lipid Metabolism
- Preventive Cardiology
Background:
- Conflicting evidence exists regarding triglycerides (TGs) as a prognosticator for coronary artery disease (CAD).
- Previous studies have not assessed the long-term impact of "normal" triglyceride levels on predicting new coronary events.
Purpose of the Study:
- To evaluate long-term predictors of coronary events in individuals with arteriographically defined coronary artery disease (CAD).
- To investigate the prognostic value of triglyceride levels, including those previously considered normal, in predicting future cardiovascular events.
Main Methods:
- Retrospective cohort study of 740 patients undergoing coronary arteriography (1977-1978).
- Follow-up recontact of 350 patients with CAD (starting 1988) via medical questionnaires.
- Stratification of patients based on new coronary events (cardiac death, myocardial infarction, revascularization) over 18 years.
Main Results:
- Lower high-density lipoprotein cholesterol (HDL-C) and higher triglycerides (TGs) were observed in patients with events.
- Independent predictors of CAD events included diabetes mellitus, HDL-C <35 mg/dl, and TGs >100 mg/dl.
- Patients with baseline TGs ≥100 mg/dl had significantly reduced survival from CAD events (p=0.008).
Conclusions:
- Triglyceride levels previously considered "normal" are significant predictors of new coronary artery disease events.
- Established cutpoints for elevated triglycerides (e.g., >200 mg/dl) may require refinement for improved risk assessment.
- This study highlights the importance of reassessing triglyceride thresholds in cardiovascular risk prediction.
Objectives:
This study sought to evaluate long-term predictors of coronary events in men and women with arteriographically defined coronary artery disease (CAD).
Background:
There is conflicting evidence of the role of triglycerides (TGs) as a prognosticator of CAD, and no studies have examined the long-term outcome of "normal" levels in predicting new coronary events.
Methods:
This was a retrospective cohort study that evaluated 740 consecutive patients presenting for diagnostic coronary arteriography between 1977 and 1978. Beginning in 1988, patients with arteriographic CAD (n=350) were recontacted and asked to complete detailed medical questionnaires. Case and control patients were stratified by development of new coronary events, including death from ischemic heart disease, nonfatal myocardial infarction and revascularization.
Results:
There were 199 events during the 18-year follow-up period. The mean high density lipoprotein cholesterol (HDL-C) was significantly lower (35 vs. 39 mg/dl; p=0.002) and TGs higher (160 vs. 137 mg/dl; p=0.03) in case patients than in control patients; After adjusting for age, gender and beta-adrenergic blocking agent use, multiple logistic regression analysis revealed the following independent predictors of CAD events: diabetes mellitus (relative risk [RR] 2.1, 95% confidence interval [CI] 1.4% to 3.1%), HDL-C <35 mg/dl (RR 1.5, 95% CI 1.1% to 2.00) and TGs >100 mg/dl (RR 1.5, 95% CI 1.1% to 2.1%). A Kaplan-Meier analysis revealed significantly reduced survival from CAD events in patients with baseline TG levels > or = 100 mg/dl compared with TG levels <100 mg/dl (p=0.008).
Conclusions:
TG levels previously considered "normal" are predictive of new CAD events. The cutpoints established by the National Cholesterol Education Program for elevated TGs (>200 mg/dl) may need to be refined.