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Is hypertriglyceridaemia an independent risk factor for coronary heart disease? The epidemiological evidence
1Center for Preventative Cardiology, University of Maryland School of Medicine, Baltimore 21201-1595, USA.
Insights
Elevated triglyceride levels, or hypertriglyceridaemia, are linked to coronary heart disease (CHD). Current risk classifications may underestimate the danger, necessitating a reevaluation of triglyceride thresholds for assessing coronary artery disease (CAD) risk.
Area of Science:
- Cardiology
- Lipid Metabolism
- Public Health
Background:
- The role of elevated triglyceride levels (hypertriglyceridaemia) as an independent risk factor for coronary heart disease (CHD) remains controversial.
- Discrepancies in statistical analyses may stem from the inverse correlation between plasma triglycerides and high-density lipoprotein cholesterol.
- Meta-analyses of fasting triglyceride levels and angiographic studies provide evidence linking higher triglycerides to coronary artery disease (CAD) progression.
Purpose of the Study:
- To investigate the association between plasma triglyceride levels and coronary heart disease (CHD) risk.
- To evaluate the adequacy of current triglyceride thresholds in assessing coronary artery disease (CAD) risk.
- To determine if existing classifications need redefinition based on long-term outcomes.
Main Methods:
- Review of meta-analyses on fasting triglyceride levels and CHD.
- Analysis of angiographic studies examining triglyceride levels and coronary artery disease (CAD) progression.
- Long-term (18-year) follow-up study correlating plasma triglyceride levels with stenosis incidence and severity.
Main Results:
- A meta-analysis confirmed a link between elevated fasting triglyceride levels and CHD.
- Angiographic studies showed a relationship between plasma triglyceride levels and the progression of coronary artery disease (CAD).
- An 18-year follow-up revealed that triglyceride levels of 100 mg/dL, considered low risk, were associated with reduced survival from coronary events, and stenosis severity correlated with triglyceride levels.
Conclusions:
- The current classification of triglyceride levels for assessing coronary artery disease (CAD) risk may require redefinition.
- Setting appropriate triglyceride thresholds is critical for identifying patients at risk of CHD and initiating timely lipid-lowering treatment.
- Lower triglyceride levels than currently classified may be associated with increased risk of coronary events and reduced survival.
Abstract:
There has been considerable controversy over whether elevated levels of triglycerides, or hypertriglyceridaemia, is an independent risk factor in coronary heart disease (CHD). Discrepancies between findings of univariate and multivariate statistical analyses are likely to be due to the strong inverse correlation between plasma triglyceride levels and high density lipoprotein cholesterol. Convincing evidence of a link between elevated triglyceride levels and CHD has been reported in a meta-analysis of patients whose plasma triglyceride levels were measured in the fasting state. Further evidence has come from several angiographic studies that have examined the relationship between plasma triglyceride levels and the progression of coronary artery disease (CAD). It is critical that the threshold of placebo triglyceride, above which hypertriglyceridaemia is recognized, is set at an appropriate level. This will ensure that patients at potential risk of CHD receive appropriate lipid-lowering treatment. In an 18-year follow-up study, incidence and severity of stenosis correlated with plasma triglyceride level. At a triglyceride level of 100 mg. dl-1, which current guidelines would consider to be low risk, patients had a reduced chance of survival from coronary events. These findings suggest that the present classification of triglyceride levels in the assessment of CAD risk may need to be redefined.
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