rial
The Triglyceride Issue RevisitedFindings From the Helsinki Heart Study Leena Tenkanen, PhD; Kati Pietilä; Vesa Manninen, MD; Matti Mänttäri, MD Arch Intern Med. 1994;154(23):2714-2720. doi:10.1001/archinte.1994.00420230107012.
Results: Triglycerides occupied a central role in the pattern of associations of the factors studied; in particular, the associations with HDL-C level, blood pressure, and blood glucose level were without threshold values. The prevalence of high triglyceride level plus low HDL-C level was strongly associated with blood pressure and blood glucose level, while the prevalence of low HDL-C level alone was not. Only the subgroup with both high triglyceride and low HDL-C levels showed a substantial CHD risk, while those with low HDL-C levels alone or high triglyceride levels alone showed a marginal risk.
Conclusions: Our results suggest that triglycerides play a central mediating role in the occurrence of several CHD risk factors, especially those related to the insulin resistance syndrome. Because of these interdependencies, the question of an independent effect of triglycerides is not relevant, and when assessing CHD risk, triglycerides should be considered jointly with HDL-C
21 Evidence type: prospective analysis
Relation of High TG–Low HDL Cholesterol and LDL Cholesterol to the Incidence of Ischemic Heart Disease: An 8-Year Follow-up in the Copenhagen Male Study. Jørgen Jeppesen, Hans Ole Hein, Poul Suadicani, Finn Gyntelberg. Arteriosclerosis, Thrombosis, and Vascular Biology. 1997; 17: 1114-1120
High triglyceride (TG) and low HDL cholesterol (HDL-C) is the characteristic dyslipidemia seen in insulin-resistant subjects. We examined the role of this dyslipidemia as a risk factor of ischemic heart disease (IHD) compared with that of high LDL cholesterol (LDL-C) in the Copenhagen Male Study. In total 2910 white men, aged 53 to 74 years, free of cardiovascular disease at baseline, were subdivided into four groups on the basis of fasting concentrations of serum TG, HDL-C, and LDL-C. “High TG–low HDL-C” was defined as belonging to both the highest third of TG and the lowest third of HDL-C; this group encompassed one fifth of the population. “High LDL-C” was defined as belonging to the highest fifth of LDL-C. A control group was defined as not belonging to either of these two groups. “Combined dyslipidemia” was defined as belonging to both dyslipidemic groups. Age-adjusted incidence of IHD during 8 years of follow-up was 11.4% in high TG–low HDL-C, 8.2% in high LDL-C, 6.6% in the control group, and 17.5% in combined dyslipidemia.
At both low and high levels of total cholesterol and LDL-C, the presence of high TG–low HDL-C approximately doubled the risk of IHD, and individuals with high TG–low HDL-C in the lowest fifth of LDL-C (≤3.6 mmol/L) had a similar risk of IHD to subjects without high TG–low HDL-C in the highest fifth of LDL-C (≥5.3 mmol/L). High TG–low HDL-C thus clearly identified a group at high risk of IHD, though they had LDL-C levels considered to be safe or borderline (<3.4 mmol/L).
22 Evidence type: observational
Fasting Triglycerides, High-Density Lipoprotein, and Risk of Myocardial Infarction. J. Michael Gaziano, MD, MPH; Charles H. Hennekens, MD, DrPH; Christopher J. O’Donnell, MD, MPH; Jan L. Breslow, MD; Julie E. Buring, ScD. Circulation. 1997; 96: 2520-2525 doi: 10.1161/01.CIR.96.8.2520
We examined the interrelationships of fasting triglycerides, other lipid parameters, and nonlipid risk factors with risk of myocardial infarction among 340 cases and an equal number of age-, sex-, and community-matched control subjects. Cases were men or women of <76 years of age with no prior history of coronary disease 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 triglycerides with risk of myocardial infarction (relative risk [RR] in the highest compared with the lowest quartile=6.8; 95% confidence interval [CI]=3.8 to 12.1; P for trend <.001). Results 