Whither Triglycerides in the Cholesterol Campaign

Abstract

Considerable controversy remains about whether triglycerides are an important risk factor for coronary heart disease (CHD). Virtually every data set looking at the univariate relationship of triglycerides to subsequent CHD has shown what we found in Framingham in the 5127, men and women free of cardiovascular disease at entry, followed for 30 years, using in this case measures of the very low density lipoproteins, the principal carrier of triglycerides, determined in an analytical ultracentrifuge as the Sf 20 – 400 lipoproteins by Dr. John Gofman (8) (Figure 1). This figure shows that the men and women with the highest triglycerides run the highest rates of CHD and the men and women with the lowest triglycerides run the lowest rates of CHD. On multivariate analysis this is an independent risk factor in women; it was not an independent risk factor in men after adjusting for HDL cholesterol. Not only are the triglycerides an independent risk factor in women but on likelihood ratio analysis they are a more powerful predictor of CHD in women than are the LDL cholesterols (9). Through the years in the Framingham Heart Study, triglycerides were measured in many ways: non-fasting, spun in the preparative ultracentifuge for one hour to remove chylomicrons, non-fasting, fasting for 12 to 14 hours.