The emergence of triglycerides as a significant independent risk factor in coronary artery disease

• Published in: European heart journal Vol. 19; pp. 8 - 14
• Main Authors: ASSMANN, G, SCHULTE, H, FUNKE, H, VON ECKARDSTEIN, A
• Format: Conference Proceeding Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.10.1998
• Subjects: Anticholesteremic Agents - therapeutic use; Atorvastatin Calcium; Biological and medical sciences; Cardiology. Vascular system; Cholesterol, HDL - blood; Coronary Disease - blood; Coronary Disease - drug therapy; Coronary Disease - epidemiology; Coronary Disease - prevention & control; Coronary heart disease; Heart; Heptanoic Acids - therapeutic use; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Incidence; Male; Medical sciences; Middle Aged; Prospective Studies; Pyrroles - therapeutic use; Risk Assessment; Risk Factors; Triglycerides - blood; Human; Cholesterol HDL; Hypertriglyceridemia; Risk factor; Cardiovascular disease; Metabolic diseases; Cholesterol LDL; Lipids; Hyperlipoproteinemia; Dyslipemia; Enzymopathy; Coronary heart disease
• ISSN: 0195-668X; 1522-9645

The Prospective Cardiovascular Münster (PROCAM) study involved 4849 middle-aged men who were followed up for 8 years to record the incidence of coronary heart disease (CHD) events according to the risk factors present at study entry. The study showed that fasting levels of triglycerides were an independent risk factor for CHD events, irrespective of serum levels of high density lipoprotein cholesterol (HDL-C) or low density lipoprotein cholesterol (LDL-C). Other independent predictors of CHD included serum levels of LDL-C and HDL-C, age, systolic blood pressure, cigarette smoking, diabetes mellitus, a family history of myocardial infarction and angina pectoris, but did not include total serum cholesterol levels. Individuals with an LDL-C/HDL-C ratio > 5 had a 19.2% chance of experiencing a CHD event in the next 8 years. Furthermore, if an LDL-C/HDL-C ratio > 5 was combined with hypertriglyceridaemia (> or = 2.3 mmol. l-1), the risk of CHD increased to 26.9%. The association between hypertriglyceridaemia and CHD events may be related to the presence of atherogenic, triglyceride-rich particles in plasma, such as LDL and very low density lipoproteins. High triglyceride levels may also predispose to thrombosis. Individuals with potentially atherogenic lipid profiles should be managed initially through the introduction of lifestyle changes. However, if these fail to achieve recommended target values, lipid-lowering therapy should be considered.