Circulation. 1998;97:1027-1028
(Circulation. 1998;97:1027-1028.)
© 1998 American Heart Association, Inc.
Triglyceride
The Forgotten Risk Factor
Antonio M. Gotto, Jr, MD, DPhil
From Cornell University Medical College, New York, NY.
Correspondence to Antonio M. Gotto, MD, DPhil, Cornell University Medical College, Olin Hall, Room 205, 445 E 69th St, New York, NY 10021. E-mail jjou@mail.med.cornell.edu
Key Words: : Editorials • lipids • lipoproteins • risk factors
The
relation of serum TG concentrations and risk for CHD has been an issue
of great interest and controversy. Unlike analyses with LDL-C
and HDL-C, for which very strong and consistent relations with
CHD risk have been demonstrated in observational and interventional
studies, those with TG are ambiguous. Thus, TG represents a
clinical conundrum: should it be measured, what does it mean, and
should it be treated if elevated? In the past, the lack of an
independent effect led one authority to advise against measuring TG or
taking the serum TG concentration into account when assessing CHD
risk.1 Also, TG measurement was fraught with
problems, such as the confounding effect of free glycerol. In recent
years, both analytic methods and biostatistical analysis have
improved, and this forgotten risk factor has arisen again.
A number of factors have contributed to the conflicting views
concerning TG concentration and CHD risk, including a weakening of the
effect in multivariate analyses that control
for HDL-C compared with univariate analyses. The
inverse metabolic relation between HDL and the TG-rich
lipoproteins may contribute to this weakening.
An important confounder of TG and CHD risk is the
heterogeneity of the TG-rich lipoproteins. TG-rich
particles derived from dietary lipid intake are not thought to be
associated with increased risk for CHD, although extreme elevations of
TG (TG >11.29 mmol/L) carry the risk of pancreatitis. Chylomicron
remnant particles, on the other hand, are thought to be atherogenic.
Through the action of lipoprotein lipase, VLDLs, the TG-rich
lipoproteins secreted by . . . [Full Text of this Article]
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