Triglyceride Concentration and Ischemic Heart Disease
ABSTRACT & COMMENTARY
Synopsis: An elevated fasting triglyceride level is a strong risk factor for ischemic heart disease independent of the other risk factors.
Source: Jeppesen J, et al. Circulation 1998;97:1029-1036.
Jeppesen and colleagues studied a group of 2906 white men aged 53-74. The authors followed the subjects for eight years, noting their ischemic heart events over that period. By stratifying the baseline triglyceride levels into the lowest, middle, and highest thirds and then comparing them to the 229 known fatal and non-fatal ischemic heart disease events, they were able to come up with a crude incidence rate. This was 4.6% on the lowest third, 7.7% for the middle third, and 11.5% for the highest third of triglyceride levels.
In their paper, they discussed the limitations of the previous studies that have not shown a risk to triglycerides in males. At the conclusion of the astounding amount of statistical analysis, including multiple regression analysis, antilogarithm steps, and other highly statistical techniques, Jeppesen et al showed something powerful. The high level of fasting triglycerides we used to think of as a problem only in women is also a strong risk factor for ischemic heart disease in men, especially the middle-aged and elderly.
The most curious finding in their study involved HDL-C, which was previously thought to be protective. A small subgroup of these hypertriglyceridemic men who had high HDL-C levels was still found to be at risk.
COMMENT BY LEN SCARPINATO, DO
Ever since we have heard about cholesterol and its subfractions risk, we have all been told that triglycerides were not a risk factor in men-only an independent risk factor in women. I have taken it as a given that this was the rule of the land, but, apparently, this is no longer the case.
Jeppesen and colleagues have completed a study that clearly indicates to me that triglycerides are an independent risk factor for men. This has incredible ramifications for primary care clinicians. The patient who comes in and has an otherwise normal cholesterol level with a high triglyceride may just be drinking. According to Jeppesen et al's data, a patient having those triglycerides elevated is indeed a candidate for triglyceride-lowering therapy.
The number of isolated hypertriglyceride patients can only be estimated. In my experience, this is a fairly significant number of males. They have previously been ignored and not told to do anything except to moderate alcohol intake.
I believe that I will be more careful and discriminating with hypertriglyceridemia in males. I will attempt to bring these down with both dietary and medication techniques to reduce their risk for ischemic heart disease.
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