Is hypertriglyceridaemia an independent risk factor for coronary heart disease? The epidemiological evidence.

There has been considerable controversy over whether elevated levels of triglycerides, or hypertriglyceridaemia, is an independent risk factor in coronary heart disease (CHD). Discrepancies between findings of univariate and multivariate statistical analyses are likely to be due to the strong inverse correlation between plasma triglyceride levels and high density lipoprotein cholesterol. Convincing evidence of a link between elevated triglyceride levels and CHD has been reported in a meta-analysis of patients whose plasma triglyceride levels were measured in the fasting state. Further evidence has come from several angiographic studies that have examined the relationship between plasma triglyceride levels and the progression of coronary artery disease (CAD). It is critical that the threshold of placebo triglyceride, above which hypertriglyceridaemia is recognized, is set at an appropriate level. This will ensure that patients at potential risk of CHD receive appropriate lipid-lowering treatment. In an 18-year follow-up study, incidence and severity of stenosis correlated with plasma triglyceride level. At a triglyceride level of 100 mg. dl-1, which current guidelines would consider to be low risk, patients had a reduced chance of survival from coronary events. These findings suggest that the present classification of triglyceride levels in the assessment of CAD risk may need to be redefined.