Treating patients with hypertriglyceridaemia saves lives: Triglyceride revisited

The statin trials in secondary and primary prevention have shown that lower ing LDL cholesterol produces a reduction in coronary event rates of around 35%. The wrest common dyslipidaemia in hll survivors is mixed hyperlipidaem ia rather than hypercholesterolaemia. New evidence from VA-HIT and BIPS sug gests that relatively low levels of triglyceride may be associated with a s ignificant increase in coronary risk. In patients with established coronary disease, treatment with a fibrate that lowers triglyceride and raises HDL cholesterol, but which has little effect on LDL cholesterol, slows the rate of progression of coronary lesions. In hypertriglyceridaemic patients who have survived an MI or who have angina pectoris, fibrate treatment reduced the incidence of fatal and non-fatal MI by 40% (p = 0.03) (BIPS). lit patie nts with coronary artery disease, who have low levels of HDL, fibrate treat ment reduced the incidence of fatal and non-fatal MI by 22 % (p = 0.006) (V A-HIT). These patients represent around 25 % of the post-MI population Work in progress will shortly define the effect of fibrate treatment on coronar y event rate in patients with peripheral vascular disease and Type 2 diabet es.