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HDL Cholesterol and Triglycerides for Predicting CAD Risk

Practice guidelines and experts' recommendations regarding the risk of coronary artery disease (CAD) usually focus on the LDL fraction of total cholesterol. However, the combination of high triglyceride (TG) and low HDL levels also is associated with a high risk for CAD. These Danish researchers studied the interaction between HDL and TG in 2906 men (age range, 53 to 74) without clinical evidence of CAD at baseline. Only 2 percent of participants had diabetes.

Participants were divided into 3 groups: 1) high TG (142 mg/dL) plus low HDL (46 mg/dL); 2) low TG (97 mg/dL) plus high HDL (57 mg/dL); and 3) intermediate (fitting into neither group 1 nor group 2). During 8 years of follow-up, 229 men had a first CAD event; about 25 percent of those events were fatal. The crude cumulative incidence of CAD events was 5 percent in the low-TG plus high-HDL group, 7 percent in the intermediate group, and 12 percent in the high-TG plus low-HDL group. High TG plus low HDL conferred a significantly increased risk for CAD events after adjustment for other risk factors, including LDL level.

Comment: These researchers did not tease apart the independent contributions of LDL, HDL, and TG; in addition, the prevalence of type 2 diabetes was surprisingly low (3 percent) in the high-TG plus low-HDL group. Although primary prevention studies focused on the high-TG plus low-HDL combination (independent of LDL) have not been done, the findings here suggest that aggressive risk factor modification might be beneficial in this high-risk patient subset.

— TL Schwenk

Published in Journal Watch General Medicine March 6, 2001

Citation(s):

Jeppesen J et al. Low triglycerides-high high-density lipoprotein cholesterol and risk of ischemic heart disease. Arch Intern Med 2001 Feb 12 161 361-366.

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