Triglycerides and the Risk of Coronary Heart Disease

Sarwar, Nadeem; Danesh, John; Eiríksdóttir, Guðný; Sigurðsson, Gunnar; Wareham, Nick; Bingham, Sheila; Boekholdt, S. Matthijs; Khaw, Kay‐Tee; Gudnason, Vilmundur

doi:10.1161/circulationaha.106.637793

Cited by 1,189 publications

(403 citation statements)

References 43 publications

Supporting

Mentioning

374

Contrasting

Unclassified

Order By: Relevance

“…There are no data on high‐density lipoprotein cholesterol or on use of statins at midlife because these drugs were licensed in the late 1980s toward the end of the Reykjavik study. The association between serum triglycerides and all MI, independent of serum cholesterol, is consistent with prior combined mortality and morbidity data 54, 55…”

Section: Discussionsupporting

confidence: 84%

Midlife Cardiovascular Risk Factors and Late‐Life Unrecognized and Recognized Myocardial Infarction Detect by Cardiac Magnetic Resonance: ICELAND‐MI, the AGES‐Reykjavik Study

McAreavey

Vidal

Aspelund

et al. 2016

JAHA

Self Cite

View full text Add to dashboard Cite

BackgroundAssociations of atherosclerosis risk factors with unrecognized myocardial infarction (UMI) are unclear. We investigated associations of midlife risk factors with UMI and recognized MI (RMI) detected 31 years later by cardiac magnetic resonance.Methods and ResultsThe Reykjavik Study (1967–1991) collected serial risk factors in subjects, mean (SD) age 48 (7) years. In ICELAND‐MI (2004–2007), 936 survivors (76 (5) years) were evaluated by cardiac magnetic resonance. Analysis included logistic regression and random effects modeling. Comparisons are relative to subjects without MI. At baseline midlife evaluation, a modified Framingham risk score was significantly higher in RMI and in UMI versus no MI (7.4 (6.3)%; 7.1 (6.2)% versus 5.4 (5.8)%, P<0.001). RMI and UMI were more frequent in men (65%, 64% versus 43%; P<0.0001). Baseline systolic and diastolic blood pressure were significantly higher in UMI (138 (17) mm Hg versus 133 (17) mm Hg; P<0.006; 87 (10) mm Hg versus 84 (10) mm Hg; P<0.02). Diastolic BP was significantly higher in RMI (88 (10) mm Hg versus 84 (10) mm Hg; P<0.02). Cholesterol and triglycerides were significantly higher in RMI (6.7 (1.1) mmol/L versus 6.2 (1.1) mmol/L; P=0.0005; and 1.4 (0.7) mmol/L versus 1.1 (0.7) mmol/L; P<0.003). Cholesterol trended higher in UMI (P=0.08). Serial midlife systolic BP was significantly higher in UMI versus no MI (β [SE] = 2.69 [1.28] mm Hg, P=0.04). Serial systolic and diastolic BP were significantly higher in RMI versus no MI (4.12 [1.60] mm Hg, P=0.01 and 2.05 [0.91] mm Hg, P=0.03) as were cholesterol (0.43 [0.11] mmol/L, P=0.0001) and triglycerides (0.3 [0.06] mmol/L, P<0.0001).ConclusionsMidlife vascular risk factors are associated with UMI and RMI detected by cardiac magnetic resonance 31 years later. Systolic blood pressure was the most significant modifiable risk factor associated with later UMI.

show abstract

Section: Discussionsupporting

confidence: 84%

Midlife Cardiovascular Risk Factors and Late‐Life Unrecognized and Recognized Myocardial Infarction Detect by Cardiac Magnetic Resonance: ICELAND‐MI, the AGES‐Reykjavik Study

McAreavey

Vidal

Aspelund

et al. 2016

JAHA

Self Cite

View full text Add to dashboard Cite

show abstract

“…Multiple prospective cohorts from around the world consistently suggest a link between RLPs, often reflected by serum TG measurements, and CHD 8, 9, 10, 11. Historically, some studies have suggested that this association is attenuated by the inclusion of other potentially causal factors such as HDL‐C, thus raising the question of whether RLPs may represent a surrogate for other causative factors in atherosclerotic disease 12, 13.…”

Section: Introductionmentioning

confidence: 99%

“…Further, TGs are predictive of residual risk in statin‐treated individuals 17. However, this extensive recent work relies on surrogate measures of RLP‐C and mainly stems from European populations and thus is not necessarily generalizable to the ethnically diverse US population 8, 14, 15, 16, 18…”

Section: Introductionmentioning

confidence: 99%

Remnant Lipoprotein Cholesterol and Incident Coronary Heart Disease: The Jackson Heart and Framingham Offspring Cohort Studies

Joshi

Khokhar

Massaro

et al. 2016

JAHA

133

View full text Add to dashboard Cite

BackgroundRemnant lipoproteins (RLPs), the triglyceride‐enriched precursors to low‐density lipoprotein, are an emerging risk factor for coronary heart disease (CHD). We sought to determine the association of RLP cholesterol (RLP‐C) levels with incident CHD in 2 diverse, prospective, longitudinal observational US cohorts.Methods and ResultsWe analyzed cholesterol levels from serum lipoprotein samples separated via density gradient ultracentrifugation in 4114 US black participants (mean age 53.8 years, 64% women) from the Jackson Heart Study and a random sample of 818 predominantly white participants (mean age 57.3 years, 52% women) from the Framingham Offspring Cohort Study. Multivariable‐adjusted hazard ratios (HRs) for RLP‐C (the sum of very low‐density lipoprotein3 cholesterol and intermediate‐density lipoprotein cholesterol) were derived to estimate associations with incident CHD events consisting of myocardial infarction, CHD death, and revascularizations for each cohort separately and as a combined population. There were 146 CHD events in the combined population. After adjustments for age, sex, body mass index, smoking, blood pressure, diabetes, and lipid‐lowering therapy for the combined population, RLP‐C (HR 1.23 per 1‐SD increase, 95% CI 1.06–1.42, P<0.01) and intermediate‐density lipoprotein cholesterol (HR 1.26 per 1‐SD increase, 95% CI 1.08–1.47, P<0.01) predicted CHD during an 8‐year follow‐up. Associations were attenuated by high‐density lipoprotein cholesterol and ultimately lost significance with inclusion of real low‐density lipoprotein cholesterol, which excludes Lp(a) and IDL cholesterol fractions. Similar associations were seen in multivariable analyses within each cohort.Conclusion RLP‐C levels are predictive of incident CHD in this diverse group of primary prevention subjects. Interventions aimed at reducing RLP‐C to prevent CHD warrant further intensive investigation.Clinical Trial Registration URL: http://www.ClinicalTrials.gov. Unique identifier: NCT00415415.

show abstract

“…There is also increasing interest in treating other lipoprotein abnormalities in type 2 diabetes by reducing triacylglycerol [10,11] and/or raising HDL-cholesterol (HDL-C) [12,13]. Fibrate therapy can improve both of these, but there are concerns about combining them with statins because of adverse events [14] and the failure of the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial to demonstrate CVD-risk reduction with fenofibrate [15].…”

Section: Introductionmentioning

confidence: 99%

Atorvastatin in Factorial with Omega-3 EE90 Risk Reduction in Diabetes (AFORRD): a randomised controlled trial

et al. 2008

View full text Add to dashboard Cite

Aims/hypothesis The aim of the study was to examine the impact of statin or omega-3-acid ethyl esters 90 (omega-3 EE90; omega-3-acid ethyl esters 90 refers to a mixture of ethyl esters of n-3 fatty acids) on estimated cardiovascular disease (CVD) risk in community-based people with type 2 diabetes but without known CVD and not taking lipid-lowering therapy. Methods A central computer randomised 800 patients in 59 UK general practices to atorvastatin (n=401, 20 mg/day) or placebo (n=399) and omega-3 EE90 (n=397, 2 g/day) or placebo (n=403) in a concealed factorial manner. Participants with LDL-cholesterol <2.6 mmol/l, triacylglycerol <1.5 mmol/l and estimated 10-year CVD risk <20% were compared at 4 months.Results Mean (SD) age was 63.5 (11.7) years, HbA 1c 6.9 (1.1) % and known diabetes duration (median [interquartile range]) was 4 (2-8) years. Fifty-seven per cent were men, 90% white and 74% had an estimated 10-year CVD risk ≥20%. Of 732 patients with 4-month data, more allocated atorvastatin (n=371) compared with placebo (n=361) achieved LDLcholesterol <2.6 mmol/l (91% vs 24%, p<0.001) and had estimated 10-year CVD risks <20% (38% vs 26%, p<0.001). No differences were seen between those allocated omega-3 EE90 (n=371) compared with placebo (n=361) for participants achieving triacylglycerol <1.5 mmol/l (65% vs 60%, p=0.18) or estimated 10-year CVD risks <20% (34% vs 30%, p=0.18). There were no side effects of note. Conclusions/interpretation Many community-based diabetic patients without known CVD remain at high CVD risk despite statin treatment and require additional risk-reduction strategies. The impact of omega-3 EE90 on CVD risk will remain uncertain until clinical endpoint trial results are available.

show abstract

Triglycerides and the Risk of Coronary Heart Disease

Cited by 1,189 publications

References 43 publications

Midlife Cardiovascular Risk Factors and Late‐Life Unrecognized and Recognized Myocardial Infarction Detect by Cardiac Magnetic Resonance: ICELAND‐MI, the AGES‐Reykjavik Study

Midlife Cardiovascular Risk Factors and Late‐Life Unrecognized and Recognized Myocardial Infarction Detect by Cardiac Magnetic Resonance: ICELAND‐MI, the AGES‐Reykjavik Study

Remnant Lipoprotein Cholesterol and Incident Coronary Heart Disease: The Jackson Heart and Framingham Offspring Cohort Studies

Atorvastatin in Factorial with Omega-3 EE90 Risk Reduction in Diabetes (AFORRD): a randomised controlled trial

Contact Info

Product

Resources

About