Evidence that triglycerides are an independent coronary heart disease riskfactor

In the past, the relation between hypertriglyceridemia and coronary heart d isease (CHD) has been uncertain. However, a recent multivariate analysis of 8-year follow-up data from the large-scale Prospective Cardiovascular Muns ter study found hypertriglyceridemia to be an independent risk factor for m ajor coronary events after controlling for low-density lipoprotein (LDL) an d high-density lipoprotein (HDL) cholesterol, Hypertriglyceridemia combined with elevated LDL cholesterol and high LDL:HDL cholesterol ratio (>5) incr eased the CHD event risk by approximately sixfold, Similarly, a large metaa nalysis of 17 prospective trials reported hypertriglyceridemia to be an ind ependent risk factor for cardiovascular disease. In this study, an 88 mg/dl (1.0 mmol/L) increase in plasma triglyceride levels significantly increase d the relative risk of cardiovascular disease by approximate to 30% in men and 75% in women; the corresponding rates were somewhat lower (14% and 37%) but still statistically significant after adjustment for HDL cholesterol l evel. These data and observations from patients in the Helsinki Heart Study and the Stockholm Ischemic Heart study, that the greatest coronary benefit during lipid-lowering drug therapy occurred among hypertriglyceridemic pat ients, argue strongly for an independent role for hypertriglyceridemia in C HD risk. In the recent Veterans Affairs Cooperative Studies Program High-De nsity Lipoprotein Cholesterol Intervention Trial, the use of gemfibrozil to raise HDL cholesterol levels and lower levels of triglycerides without low ering LDL cholesterol levels reduced coronary events in men with establishe d CHD, whereas preliminary results from the Bezafibrate Infarction Preventi on Trial indicate a reduction in coronary end points in patients with eleva ted baseline triglyceride levels. To achieve the greatest possible reductio n in CHD risk, antihyperlipidemic treatment strategies should also be aimed at reducing elevated triglycerides, (C)2000 by Excerpta Medica, Inc.