Clinical Heart and Vascular Center

Exploring the Association of Triglycerides with Cardiovascular Disease

By Anand Rohatgi, M.D., M.S.C.S., FACC, FAHA, Associate Professor of Internal Medicine

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Although LDL-C lowering is the cornerstone of atherosclerotic risk reduction, other lipids are important to cardiovascular (CV) disease. Indeed, triglycerides have received increased attention as a major atherogenic lipid. In a stimulating poster session at AHA, the association of triglycerides with CV disease was explored.  

Among close to 200,000 residents in Ontario with ASCVD, increased triglycerides were associated with recurrent adverse clinical outcomes. 20% of those with ASCVD had elevated TG levels despite controlled LDL-C, meeting criteria for the REDUCE-IT trial, which showed that icosapent ethyl 4 g/day reduced CV events in those with ASCVD or DM with TG >135mg/dL. In another analysis from the Rochester Epidemiology Project, severe isolated hypertriglyceridemia (TG >500 mg/dL) was identified in 3,800 patients, of whom 542 had primary hypertriglyceridemia, yielding an overall prevalence of 2%. This population is at increased risk of pancreatitis as well as ASCVD. A rarer condition called familial chylomicronemia syndrome (FCS) is when a patient has TG >750 and recurrent pancreatitis. Prior estimates were 1:1 million, but a study from Johns Hopkins presented at the AHA suggested it is much higher at 13:1 million. Further, these investigators demonstrated that patients with FCS, while having high risk of pancreatitis, actually had a lower risk of ASCVD than those with secondary hypertriglyceridemia.

“In an interesting analysis assessing which lipids predict decline in renal function in healthy participants enrolled in the MESA cohort, elevated triglycerides – but not total cholesterol, LDL-C, or HDL-C – predicted >30% decline in estimated glomerular filtration rate (eGFR).”

Anand Rohatgi, M.D., M.S.C.S., FACC, FAHA
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In an interesting analysis assessing which lipids predict decline in renal function in healthy participants enrolled in the MESA cohort, elevated triglycerides – but not total cholesterol, LDL-C, or HDL-C – predicted >30% decline in estimated glomerular filtration rate (eGFR). Lastly, perhaps the most interesting study came from Japan, identifying a rare condition called triglyceride deposit cardiomyovasculopathy (TGCV) in patients undergoing angiography. The condition is diagnosed with BMIPP (3-methyl pentadecanoic acid, a radioactive fatty acid analogue) scintigraphy and appears to result in massive accumulation of TG in smooth muscle cells leading to diffuse narrowing of coronary arteries in those with diabetes. The Japanese study found an increased incidence of vascular failure in diabetic patients with TGCV after receiving drug-eluting stents. 

Follow Dr. Rohatgi on Twitter @dranandrohatgi. Visit his lab

Read more articles from our Physician Update AHA Edition.