Triglycerides and cardiovascular risk
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Triglycerides and Cardiovascular Disease Risk
Elevated Triglycerides as a Cardiovascular Risk Factor
Multiple studies have shown that high triglyceride levels are linked to an increased risk of cardiovascular disease (CVD), including coronary heart disease (CHD), myocardial infarction, stroke, and all-cause mortality Harchaoui2009Miller2011Nordestgaard2014+3 MORE. This association remains significant even after adjusting for other lipid markers such as high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) Harchaoui2009Nordestgaard2014Balling2023. Both fasting and nonfasting triglyceride measurements are important, with nonfasting levels potentially offering better prediction of CVD risk Harchaoui2009Nordestgaard2014.
Triglyceride-Rich Lipoproteins and Remnant Cholesterol
Recent research highlights the role of triglyceride-rich lipoproteins (TRLs) and remnant cholesterol in the development of atherosclerotic cardiovascular disease (ASCVD) Nordestgaard2014Nordestgaard2016Sandesara2018. Genetic and epidemiological evidence supports that these lipoproteins are not just markers but causal contributors to ASCVD and related inflammation Nordestgaard2016Sandesara2018. Elevated LDL triglycerides, a component of TRLs, are also robustly associated with increased risk of ASCVD and its individual components, such as ischemic heart disease and stroke .
Triglycerides in Special Populations: Diabetes and Statin-Treated Patients
In people with type 2 diabetes mellitus (T2DM), higher triglyceride levels are associated with a greater risk of cardiovascular events, even among those treated with statins Toth2018Kristensen2023Ye2019. The risk increases progressively with higher triglyceride levels, and this relationship is particularly strong in women . However, while elevated triglycerides are linked to increased CVD risk in T2DM, they may not serve as an entirely independent risk marker after adjusting for other lipid parameters .
Triglyceride-Related Indices and Insulin Resistance
Indices such as the triglyceride-glucose (TyG) index and the triglyceride to HDL-C ratio are simple markers of insulin resistance and have been shown to predict CVD risk . The association between these indices and CVD is largely mediated by the presence of dyslipidemia, type 2 diabetes, and hypertension .
Clinical and Public Health Implications
Despite the focus on LDL-C lowering, residual cardiovascular risk remains, and hypertriglyceridemia is recognized as a significant contributor to this risk Miller2011Sandesara2018. The prevalence of high triglycerides has increased alongside obesity and diabetes rates . Lifestyle modification is the primary approach for managing high triglycerides, but new triglyceride-lowering drugs are being developed and tested in large clinical trials Nordestgaard2014Sandesara2018.
Conclusion
Elevated triglyceride levels, especially those associated with triglyceride-rich lipoproteins and remnant cholesterol, are strong and independent predictors of cardiovascular disease and mortality. This risk persists across different populations, including those with diabetes and those already on statin therapy. Monitoring and managing triglyceride levels, alongside other lipid parameters, is important for reducing overall cardiovascular risk.
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