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Featured Clinical Reviews

January 29, 2019

The Evolving Story of Triglycerides and Coronary Heart Disease Risk

Author Affiliations
  • 1Duke Clinical Research Institute, Durham, North Carolina
JAMA. 2019;321(4):347-349. doi:10.1001/jama.2018.20044

While elevated low-density lipoprotein cholesterol (LDL-C) is an established risk factor for coronary heart disease (CHD), the association between elevated triglyceride (TG) levels and CHD has been less well-defined. Many analyses have shown that adults with elevated TG levels have higher CHD risk, yet it is unclear whether TGs alone cause CHD or whether they are a surrogate for other concomitant metabolic derangements (obesity, diabetes, or other lipoprotein elements) that confer actual risk.1,2 Some genetic variants associated with isolated lifetime increases in TGs are associated with increased CHD risk, but the degree to which this is due to TGs or other lipid-related changes, such as elevations in apolipoprotein B (ApoB) or very-low-density lipoprotein (VLDL) particles remains unknown.3 Furthermore, clinical trials of TG lowering with fibrates have shown mixed results.4,5

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