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Does hypertriglyceridemia increase risk for CAD? Growing evidence suggests it plays a role

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Although the role of high serum triglyceride levels in coronary artery disease (CAD) has been debated, evidence now points to a link. Triglyceride-lowering treatments, including diet and exercise modifications and pharamacotherapy, can reduce the risk of CAD. Drs Coughlan and Sorrentino review the accumulated study findings, describe primary and acquired hypertriglyceridemia, and discuss the various approaches to treating these conditions.

The role of triglycerides in the development of coronary artery disease (CAD) has been controversial. Triglycerides are major lipids in chylomicrons and very-low-density lipoprotein (VLDL) particles. These particles are closely related to the metabolism of other lipoproteins, including high-density lipoprotein (HDL) particles. When controlling for these other lipoproteins, many studies do not identify triglycerides as an independent risk factor for the development of CAD. However, emerging evidence suggests that elevated serum triglyceride levels--especially in patients with additional lipoprotein abnormalities--predict an increased risk of cardiovascular disease.

Epidemiologic data

The first studies to evaluate triglycerides and coronary events were case-control studies that compared patients with myocardial infarction or angina with matched control subjects. Most of these studies showed an association between elevated triglyceride levels and CAD.1 (Reference) However, because these studies were retrospective, they are potentially biased. Triglyceride levels were measured after patients had a cardiac event, and these levels may have been modified by the event itself, lifestyle changes, or medications.

Prospective studies also have shown an association between triglycerides and CAD, with relative risk between 1.2 and 1.6.1 (Reference) When these studies were controlled for other lipoproteins- -especially HDL cholesterol--triglycerides often lost significance as an independent risk factor for CAD.

Several intriguing observations can be derived from these epidemiologic studies. The Lipid Research Clinics Follow-up Study found that triglycerides were not independently associated with coronary mortality in the full study group, but that they were associated in younger subjects...