The Complex Role of Triglycerides in Cardiovascular Disease

 

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ABSTRACT

The objectives of the present work were to obtain a summary estimate of the magnitude of association between triglycerides and cardiovascular disease in the general population based on currently available data. Our goal was to determine whether this relationship is independent of other risk factors, particularly high density lipoprotein cholesterol (HDL-C), using semi-quantitative meta-analysis. We only included studies reporting the association between fasting triglyceride levels and incident cardiovascular disease endpoints. Twenty-one studies including 65,863 men and 11,089 women were selected for the analysis from population-based prospective studies using standard meta-analysis calculations, relative risks (RR) and 95% confidence intervals (CI). Multivariable adjusted RRs were determined only for the studies reporting adjustment for HDL-C (9 studies in men, 2 studies in women). These analyses indicate plasma triglycerides are an independent predictor of cardiovascular disease.

REFERENCES

• 1 Gotto Jr M A. Triglyceride: the forgotten risk factor.  Circulation . 1998;  97 1027-1028
  PubMedGoogle Scholar
• 2 Gofman J W, DeLalla O, Flazier F. The serum lipoprotein transport system in health, metabolic disorders, atherosclerosis, and coronary disease.  Plasma . 1954;  2 413-483
  PubMedGoogle Scholar
• 3 Austin M A, King M C, Vranizan K M. Atherogenic lipoprotein phenotype. A proposed genetic marker for coronary heart disease risk.  Circulation . 1990;  82 495-506
  CrossrefPubMedGoogle Scholar
• 4 Grundy S M. Hypertriglyceridemia, atherogenic dyslipidemia, and the metabolic syndrome.  Am J Cardiol . 1998;  81 18B-25B
  CrossrefPubMedGoogle Scholar
• 5 Albrink M, Mann E. Serum triglycerides in coronary artery disease.  Arch Intern Med . 1959;  103 4-8
  PubMedGoogle Scholar
• 6 Austin M A. Plasma triglyceride as a risk factor for coronary heart disease. The epidemiologic evidence and beyond.  Am J Epidemiol . 1989;  129 249-259
  PubMedGoogle Scholar
• 7 Coughlan B J, Sorrentino M J. Does hypertriglyceridemia increase risk for CAD?.  <~>Growing evidence suggests it plays a role. Postgrad Med . 2000;  108 77-84
  PubMedGoogle Scholar
• 8 Pelkonen R, Nikkila E A, Koskinen S. Association of serum lipids and obesity with cardiovascular mortality.  Br Med J . 1977;  2 1185-1187
  PubMedGoogle Scholar
• 9 Glynn R J, Rosner B, Silbert J E. Changes in cholesterol and triglyceride as predictors of ischemic heart disease in men.  Circulation . 1982;  66 724-731
  PubMedGoogle Scholar
• 10 Hulley S B, Rosenman R H, Bawol R D. Epidemiology as a guide to clinical decisions. The association between triglyceride and coronary heart disease.  N Engl J Med . 1980;  302 1383-1389
  CrossrefPubMedGoogle Scholar
• 11 Rosenman R H, Brand R J, Jenkins D. Coronary heart disease in Western Collaborative Group Study. Final follow-up experience of 8 1/2 years.  JAMA . 1975;  233 872-877
  CrossrefPubMedGoogle Scholar
• 12 Criqui M H, Heiss G, Cohn R. Plasma triglyceride level and mortality from coronary heart disease.  N Engl J Med. 193;  328 1220-1225
  PubMedGoogle Scholar
• 13 Menotti A, Scanga M, Morisi G. Serum triglycerides in the prediction of coronary artery disease (an Italian experience).  Am J Cardiol . 1994;  73 29-32
  CrossrefPubMedGoogle Scholar
• 14 Menotti A, Spagnolo A, Scanga M. Multivariate prediction of coronary deaths in a 10 year follow-up of an Italian occupational male cohort.  Acta Cardiol . 1992;  47 311-320
  PubMedGoogle Scholar
• 15 Gotto Jr M A. Triglyceride as a risk factor for coronary artery disease.  Am J Cardiol . 1988;  82 22Q-25Q
  PubMedGoogle Scholar
• 16 Castelli W P. Epidemiology of triglycerides: a view from Framingham.  Am J Cardiol . 1992;  70 3H-9H
  CrossrefPubMedGoogle Scholar
• 17 Assmann G, Schulte H. Role of triglycerides in coronary artery disease: lessons from the Prospective Cardiovascular Munster Study.  Am J Cardiol . 1992;  70 10H-13H
  CrossrefPubMedGoogle Scholar
• 18 Burchfiel C M, Laws A, Benfante R. Combined effects of HDL cholesterol, triglyceride, and total cholesterol concentrations on 18-year risk of atherosclerotic disease.  Circulation . 1995;  92 1430-1436
  PubMedGoogle Scholar
• 19 Jeppesen J, Hein H O, Suadicani P. 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.  Arterioscler Thromb Vasc Biol . 1997;  17 1114-1120
  CrossrefPubMedGoogle Scholar
• 20 Hokanson J E, Austin M A. Plasma triglyceride level is a risk factor for cardiovascular disease independent of high-density lipoprotein cholesterol level: a meta-analysis of population-based prospective studies.  J Cardiovasc Risk . 1996;  3 213-219
  CrossrefPubMedGoogle Scholar
• 21 Jeppesen J, Hein H O, Suadicani P. Triglyceride concentration and ischemic heart disease: an eight-year follow-up in the Copenhagen Male Study.  Circulation . 1998;  97 1029-1036
  PubMedGoogle Scholar
• 22 Stavenow L, Kjellstrom T. Influence of serum triglyceride levels on the risk for myocardial infarction in 12,510 middle aged males: interaction with serum cholesterol.  Atherosclerosis . 1999;  147 243-247
  CrossrefPubMedGoogle Scholar
• 23 Lamarche B, Cantin B, Mauriege P. Variability in the risk of ischemic heart disease associated with moderate hypertriglyceridemia. The Quebec Cardiovascular Study (Suppl S).  Circulation . 1999;  100 3900
  PubMedGoogle Scholar
• 24 Lamarche B. 2001. Personal Communication
  Google Scholar
• 25 Rhoads G G, Feinleib M. Serum triglyceride and risk of coronary heart disease, stroke, and total mortality in Japanese-American men.  Arteriosclerosis . 1983;  3 316-322
  PubMedGoogle Scholar
• 26 Heyden S, Heiss G, Hames C G. Fasting triglycerides as predictors of total and CHD mortality in Evans County, Georgia.  J Chronic Dis . 1980;  33 275-282
  CrossrefPubMedGoogle Scholar
• 27 Yarnell J W, Patterson C C, Sweetnam P M. Do total and high density lipoprotein cholesterol and triglycerides act independently in the prediction of ischemic heart disease?: ten-year follow-up of caerphilly and speedwell cohorts.  Arterioscler Thromb Vasc Biol . 2001;  21 1340-1345
  CrossrefPubMedGoogle Scholar
• 28 Assmann G, Schulte H, Eckardstein A. Hypertriglyceridemia and elevated lipoprotein (a) are risk factors for major coronary events in middle-aged men.  Am J Cardiol . 1996;  77 1179-1184
  CrossrefPubMedGoogle Scholar
• 29 Criqui M H. 1996. Personal Communication
  Google Scholar
• 30 Brown D F, Kinch S H, Doyle J T. Serum triglycerides in health and in ischemic heart disease.  N Engl J Med . 1965;  273 947-952
  PubMedGoogle Scholar
• 31 Wilson P, Castelli W P. Triglycerides, HDL-cholesterol and coronary artery disease: a Framingham update on the interactions.  Can J Cardiol . 1994;  10(Suppl B) 5B-9B
  PubMedGoogle Scholar
• 32 Bottiger L E, Carlson L A. Risk factors for death for males and females. A study of the death pattern in the Stockholm prospective study.  Acta Med Scand . 1982;  211 437-442
  PubMedGoogle Scholar
• 33 Wilhelmsen L, Wedel H, Tibblin G. Multivariate analysis of risk factors for coronary heart disease.  Circulation . 1973;  48 950-958
  PubMedGoogle Scholar
• 34 Aberg H, Lithell H, Selinus I. Serum triglycerides are a risk factor for myocardial infarction but not for angina pectoris. Results from a 10-year follow-up of Uppsala primary preventive study.  Atherosclerosis . 1985;  54 89-97
  PubMedGoogle Scholar
• 35 Salonen J T, Puska P. Relation of serum cholesterol and triglycerides to the risk of acute myocardial infarction, cerebral stroke and death in eastern Finnish male population.  Int J Epidemiol . 1983;  12 26-31
  PubMedGoogle Scholar
• 36 Sigurdsson G, Baldursdottir A, Sigvaldason H. Predictive value of apolipoproteins in a prospective survey of coronary artery disease in men.  Am J Cardiol . 1992;  69 1251-1254
  CrossrefPubMedGoogle Scholar
• 37 Cambien F, Jacqueson A, Richard J L. Is the level of serum triglyceride a significant predictor of coronary death in ``normocholesterolemic'' subjects?.  <~>The Paris Prospective Study. Am J Epidemiol . 1986;  124 624-632
  PubMedGoogle Scholar
• 38 Bengtsson C, Bjorkelund C, Lapidus L. Associations of serum lipid concentrations and obesity with mortality in women: 20 year follow up of participants in prospective population study in Gothenburg, Sweden.  BMJ . 1993;  307 1385-1388
  PubMedGoogle Scholar
• 39 Greenland S. Quantitative methods in the review of epidemiologic literature.  Epidemiol Rev . 1987;  9 1-30
  PubMedGoogle Scholar
• 40 Despres J P, Lamarche B, Mauriege P. Hyperinsulinemia as an independent risk factor for ischemic heart disease.  N Engl J Med . 1996;  334 952-957
  CrossrefPubMedGoogle Scholar
• 41 Jeppesen J, Hein H O, Suadicani P. Low triglycerides-high high-density lipoprotein cholesterol and risk of ischemic heart disease.  Arch Intern Med . 2001;  161 361-366
  CrossrefPubMedGoogle Scholar
• 42 Steinberg D, Witztum J L. Lipoproteins and atherogenesis. Current concepts.  JAMA . 1990;  264 3047-3052
  CrossrefPubMedGoogle Scholar
• 43 Mack W J, Krauss R M, Hodis H N. Lipoprotein subclasses in the Monitored Atherosclerosis Regression Study (MARS). Treatment effects and relation to coronary angiographic progression.  Arterioscler Thromb Vasc Biol . 1996;  16 697-704
  PubMedGoogle Scholar
• 44 Hokanson J E, Austin M A. Treatment of and screening for hyperlipidemia.  N Engl J Med . 1993;  329 1126
  PubMedGoogle Scholar
• 45 Miller M. The epidemiology of triglyceride as a coronary artery disease risk factor.  Clin Cardiol . 1999;  22 II1-II6
  PubMedGoogle Scholar
• 46 Canner P L, Berge K G, Wenger N K. Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin.  J Am Coll Cardiol . 1986;  8 1245-1255
  CrossrefPubMedGoogle Scholar
• 47 Levy R I, Brensike J F, Epstein S E. The influence of changes in lipid values induced by cholestyramine and diet on progression of coronary artery disease: results of NHLBI Type II Coronary Intervention Study.  Circulation . 1984;  69 325-337
  CrossrefPubMedGoogle Scholar
• 48 Manninen V, Elo M O, Frick M H. Lipid alterations and decline in the incidence of coronary heart disease in the Helsinki Heart Study.  JAMA . 1988;  260 641-651
  CrossrefPubMedGoogle Scholar
• 49 Pedersen T R, Olsson A G, Faergeman O. Lipoprotein changes and reduction in the incidence of major coronary heart disease events in the Scandinavian Simvastatin Survival Study (4S).  Circulation . 1998;  97 1453-1460
  CrossrefPubMedGoogle Scholar
• 50 Sacks F M, Moye L A, Davis B R. Relationship between plasma LDL concentrations during treatment with pravastatin and recurrent coronary events in the Cholesterol and Recurrent Events trial.  Circulation . 1998;  97 1446-1452
  CrossrefPubMedGoogle Scholar
• 51 Manninen V, Tenkanen L, Koskinen P. Joint effects of serum triglyceride and LDL cholesterol and HDL cholesterol concentrations on coronary heart disease risk in the Helsinki Heart Study. Implications for treatment.  Circulation . 1992;  85 37-45
  CrossrefPubMedGoogle Scholar
• 52 Rubins H B, Robins S J, Collins D. Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group.  N Engl J Med . 1999;  341 410-418
  CrossrefPubMedGoogle Scholar
• 53 Executive Summary of the Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001 285: 2486-2497
  Google Scholar