Is Hypertriglyceridemia a Risk Factor for Atherosclerotic Cardiovascular Disease? A Simple Question with a Complicated Answer
Authors: Henry N. Ginsberg
Journal: Annals of Internal Medicine (1997)

Editorials1 June 1997Is Hypertriglyceridemia a Risk Factor for Atherosclerotic Cardiovascular Disease? A Simple Question with a Complicated AnswerHenry N. Ginsberg, MDHenry N. Ginsberg, MDCollege of Physicians and Surgeons of Columbia University, New York, NY 10032Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-126-11-199706010-00012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The role of hypertriglyceridemia in the pathogenesis of atherosclerotic cardiovascular disease has been controversial for many years [1, 2]. It remains so despite extensive investigation by basic scientists, clinicians, and epidemiologists. The lack of resolution of this issue derives mainly from the complexity inherent in the lipoprotein transport system [3]. Although it is not possible to either unravel all of this complexity or resolve the controversy here, I attempt to provide a balanced review of the relevant literature, concluding with a suggested approach to the evaluation and treatment of the many patients who have elevated plasma triglyceride levels. I focus ...References1. Hully SB, Rosenman RH, Bawol RD, Brand RJ. Epidemiology as a guide to clinical decisions. The association between triglyceride and coronary heart disease. N Engl J Med. 1980; 302:1383-9. Google Scholar2. Austin MA. Plasma triglyceride and coronary heart disease. Arterioscler Thromb. 1991; 11:2-14. Google Scholar3. Ginsberg HN. Lipoprotein metabolism and its relationship to atherosclerosis. Med Clin North Am. 1994; 78:1-20. Google Scholar4. Hamsten A. Hypertriglyceridemia, triglyceride-rich lipoproteins and coronary heart disease. Baillieres Clin Endocrinol Metabol. 1990; 4:895-922. Google Scholar5. Daugherty A, Lange LG, Sobel BE, Schonfeld G. Aortic accumulation and plasma clearance of β-VLDL and HDL: effects of diet-induced hypercholesterolemia in rabbits. J Lipid Res. 1985; 26:955-63. Google Scholar6. Rapp JH, Lespine A, Hamilton RL, Colyvas N, Chaumeton AH, Tweedle-Hardman J, et al. Triglyceride-rich lipoproteins isolated by selected-affinity anti-apolipoprotein B immunosorption from human atherosclerotic plaque. Arterioscler Thromb. 1994; 14:1767-74. Google Scholar7. Breslow JL. Mouse models of atherosclerosis. Science. 1996; 272:685-8. Google Scholar8. Miller NE. High-density lipoprotein: a major risk factor for coronary athero-sclerosis. Baillieres Clin Endocrinol Metabol. 1987; 1:603-22. Google Scholar9. Plump AS, Scott CJ, Breslow JL. Human apolipoprotein A-I gene expression increases high density lipoprotein and suppresses atherosclerosis in the apolipoprotein E-deficient mouse. Proc Natl Acad Sci U S A. 1994; 91:9607-11. Google Scholar10. Liu AC, Lawn RM, Verstuyft JG, Rubin EM. Human apolipoprotein A-1 prevents atherosclerosis associated with apolipoprotein[a] in transgenic mice. J Lipid Res. 1994; 35:2263-7. Google Scholar11. Tall AR. Plasma high density lipoproteins. Metabolism and relationship to atherogenesis. J Clin Invest. 1990; 86:379-84. Google Scholar12. Ginsberg HN, Jones J, Blaner WS, Thomas A, Karmally W, Fields L, et al. Association of postprandial triglyceride and retinyl palmitate responses with newly diagnosed exercise-induced myocardial ischemia in middle-aged men and women. Arterioscler Thromb Vasc Biol. 1995; 15:1829-38. Google Scholar13. Sharrett AR, Chambless LE, Heiss G, Paton CC, Patsch W. Association of postprandial triglyceride and retinyl palmitate responses with asymptomatic carotid artery atherosclerosis in middle-aged men and women. The Atherosclerosis Risk in Communities (ARIC) Study. Arterioscler Thromb Vasc Biol. 1995; 15:2122-9. Google Scholar14. National Cholesterol Education Program. Second report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). Circulation. 1994; 89:1333-445. Google Scholar15. Frick MH, Elo H, Haapa K, Heinonen OP, Henisalmi P, Helo P, et al. Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-age men with dyslipidemia. Safety of treatment, changes in risk factors, and incidence of coronary heart disease. N Engl J Med. 1987; 317:1237-45. Google Scholar16. Carlson LA, Rosenhamer G. Reduction in mortality in the Stockholm Ischaemic Heart Disease Secondary Prevention Study by combined treatment with clofibrate and nicotinic acid. Acta Med Scand. 1988; 223:405-18. Google Scholar17. Manninen V, Tenkanen L, Koskinen P, Huttunen JK, Manttari M, Heinonen O, et al. 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. Google Scholar18. Assmann G, Schulte H. Relation of high-density lipoprotein cholesterol and triglycerides to incidence of atherosclerotic coronary artery disease (the PRO-CAM experience). Prospective Cardiovascular Munster Study. Am J Cardiol. 1992; 70:733-7. Google Scholar19. Despres JP, Lamarche B, Mauriege P, Cantin B, Dagenais GR, Moorjani S, et al. Hyperinsulinemia as an independent risk factor for ischemic heart disease. N Engl J Med. 1996; 334:952-7. Google Scholar20. Wilt TJ, Rubins HB, Collins D, O'Connor TZ, Rutan GH, Robins SJ. Correlates and consequences of diffuse atherosclerosis in men with coronary heart disease. Veterans Affairs High-Density Lipoprotein Intervention Trial Study Group. Arch Intern Med. 1996; 156:1181-8. Google Scholar Author, Article, and Disclosure InformationAffiliations: College of Physicians and Surgeons of Columbia University, New York, NY 10032Grant Support: By grants HL21006, HL55638, and RR00645 from the National Institutes of Health.Corresponding Author: Henry N. Ginsberg, MD, Division of Preventive Medicine and Nutrition, College of Physicians and Surgeons of Columbia University, 630 West 168th Street, New York, NY 10032. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byThe effects of green coffee extract supplementation on glycemic indices and lipid profile in adults: a systematic review and dose-response meta-analysis of clinical trialsImpact of proprotein convertase subtilisin/kexin type 9 inhibition with evolocumab on the postprandial responses of triglyceride-rich lipoproteins in type II diabetic subjectsModulation of the lipidomic profile due to a lipid challenge and fitness level: a postprandial studySoya products and serum lipids: a meta-analysis of randomised controlled trialsMenopausal hormone treatment cardiovascular disease: another look at an unresolved conundrumOmega-3 polyunsaturated fatty acids and proanthocyanidins improve postprandial metabolic flexibility in ratEffect of Statin Therapy on the Progression of Common Carotid Artery Intima-Media Thickness: An Updated Systematic Review and Meta-Analysis of Randomized Controlled TrialsPostprandial metabolism of meal triglyceride in humansSoy Protein Effects on Serum Lipoproteins: A Quality Assessment and Meta-Analysis of Randomized, Controlled StudiesDietary InterventionsA Reduced-Carbohydrate Diet Improves Outcomes in Patients With Metabolic SyndromeChylomicron remnants regulate early growth response factor-1 in vascular smooth muscle cellsThe use of very-low-calorie diets (VLCDs) and meal replacements for weight controlA randomized study comparing the effects of a low-carbohydrate diet and a conventional diet on lipoprotein subfractions and C-reactive protein levels in patients with severe obesityAppropriateness of cholesterol and triglycerides reporting checked by External Quality Assessment programsA Low-Carbohydrate as Compared with a Low-Fat Diet in Severe ObesityWhole grains protect against atherosclerotic cardiovascular diseaseObesity and Disease Management: Effects of Weight Loss on Comorbid ConditionsHigh blood pressure and associated cardiovascular risk factors in FrancePrevalence of coronary artery disease and its relationship to lipids in a selected population in South IndiaThe American Heart Association Dietary Guidelines for 2000: A Summary ReportHypertriglyceridemia: new insights and new approaches to pharmacologic therapyManipulating the vascular biology of coronary atherosclerosis in diabetes: New opportunitiesRisk Factors for Coronary Disease: the Time for a Paradigm Shift?Risk Factors for Stiffness of the Wall of the Thoracic Aorta in Patients With Mild Atherosis.Dietary fiber prevents carbohydrate-induced hypertriglyceridemiaCurrent concepts and controversies in the pathogenesis, prevention, and treatment of the macrovascular complications of diabetesPrevention of coronary heart disease Part I. Primary preventionA Frequent Mutation in the Lipoprotein Lipase Gene (D9N) Deteriorates the Biochemical and Clinical Phenotype of Familial HypercholesterolemiaActivation of the Contact System of Coagulation Does Not Contribute to the Hemostatic Imbalance in HypertriglyceridemiaDrug Treatment of Lipid DisordersGemfibrozil for the Secondary Prevention of Coronary Heart Disease in Men with Low Levels of High-Density Lipoprotein CholesterolElevated Serum Triglyceride Levels and Long-Term Mortality in Patients With Coronary Heart DiseasePostprandial dyslipidaemia in a nutshell: food for thought 1 June 1997Volume 126, Issue 11Page: 912-914KeywordsAtherosclerotic cardiovascular diseaseBlood plasmaCholesterolEpidemiologyHigh density lipoproteinLipoproteinsLow density lipoproteinMedical risk factorsNiacinVery low density lipoprotein Issue Published: 1 June 1997 Copyright & PermissionsCopyright © 1997 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...