FASTING TRIGLYCERIDES, HIGH-DENSITY-LIPOPROTEIN, AND RISK OF MYOCARDIAL-INFARCTION

Background Recent data suggest that triglyceride-rich lipoproteins may play a role in atherogenesis. However, whether triglycerides, as a ma rker for these lipoproteins, represent an independent risk factor for coronary heart disease remains unclear, despite extensive research. Se veral methodological issues have limited the interpretability of the e xisting data. Methods and Results We examined the interrelationships o f fasting triglycerides, other lipid parameters, and nonlipid risk fac tors with risk of myocardial infarction among 340 cases and an equal n umber of age-, sex-, and community-matched control subjects. Cases wer e men or women of <76 years of age with no prior history of coronary d isease who were discharged from one of six Boston area hospitals with the diagnosis of a confirmed myocardial infarction. In crude analyses, we observed a significant association of elevated fasting triglycerid es with risk of myocardial infarction (relative risk [RR] in the highe st compared with the lowest quartile=6.8; 95% confidence interval [CI] =3.8 to 12.1; P for trend <.001). Results were not materially altered after control for nonlipid coronary risk factors. As expected, the rel ationship was attenuated after adjustment for HDL but remained statist ically significant (RR in the highest quartile=2.7; 95% confidence int erval [CI]=1.4 to 5.5; P for trend=.016). Furthermore, the ratio of tr iglycerides to HDL was a strong predictor of myocardial infarction (RR in the highest compared with the lowest quartile=16.0; 95% CI=7.7 to 33.1; P for trend <.001). Conclusions Our data indicate that fasting t riglycerides, as a marker for triglyceride-rich lipoproteins, may prov ide valuable information about the atherogenic potential of the lipopr otein profile, particularly when considered in context of HDL levels.