FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 328:1220-1225 April 29, 1993 Number 17 Next

	Full Text Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Whether the plasma triglyceride level is a risk factor for coronary heart disease has been controversial, and evaluation of the triglyceride level as a risk factor is fraught with methodologic difficulties.

Methods We studied the association between plasma triglyceride levels and the 12-year incidence of death from coronary heart disease in 10 North American populations participating in the Lipid Research Clinics Follow-up Study, while adjusting for the potential confounding effects of other risk factors for cardiovascular disease, including the level of high-density lipoprotein (HDL) cholesterol. All analyses were sex-specific, and separate analyses were performed in high and low strata of HDL cholesterol, low-density lipoprotein (LDL) cholesterol, fasting plasma glucose, and age.

Results The rates of coronary death in both men and women increased with the triglyceride level. In Cox proportional-hazards models adjusted for age, in which the natural log of the triglyceride levels was used to give a normal distribution, the relative risk per natural-log unit of triglyceride (e.g., a triglyceride level of 150 mg per deciliter vs. a level of 55 mg per deciliter) was 1.54 (95 percent confidence interval, 1.19 to 1.98; P<0.001) in men and 1.88 (95 percent confidence interval, 1.19 to 2.98; P = 0.007) in women. After an adjustment for potential covariates, however, these relative risks were not statistically significant. Analyses based on lipoprotein cholesterol levels revealed a positive association between the triglyceride level and coronary mortality in the lower stratum of both HDL and LDL cholesterol, but not in the higher stratum. Conversely, the HDL cholesterol level was unrelated to coronary mortality in the lower stratum of LDL cholesterol, but was strongly inversely associated with coronary death in the higher stratum of LDL cholesterol. The relative risk of coronary death associated with triglyceride level was higher at younger ages. The associations between the triglyceride level and coronary mortality in the lower HDL cholesterol, LDL cholesterol, and age strata were small and were further reduced by an adjustment for the fasting plasma glucose level.

Conclusions Overall, the plasma triglyceride level showed no independent association with coronary mortality. However, in subgroups of subjects with lower HDL and LDL cholesterol levels and in younger subjects, defined a priori, an association between the triglyceride level and coronary mortality was observed, although this association was small and was not statistically significant after an adjustment for the plasma glucose level.

Source Information

From the Departments of Community and Family Medicine and Medicine, University of California, La Jolla (M.H.C.); the Departments of Epidemiology (G.H.) and Biostatistics (G.H., R.C., C.M.S., S.B., H.K.O., C.E.D.), University of North Carolina, Chapel Hill; the Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma, Oklahoma City (L.D.C.); the Department of Biostatistics and Epidemiology, University of Tennessee, Memphis (S.K.); and the Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis (D.R.J.).

Address reprint requests to Dr. Basil M. Rifkind at the Lipid Metabolism-Atherogenesis Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892.

Full Text of this Article

Related Letters:

Treatment of and Screening for Hyperlipidemia
Ornish D., Brown S. E., Kottke B. A., Shea S., Barth J. D., Bryan G. K., Hokanson J. E., Austin M. A., Ginsberg H. N., Tall A. R., Deckelbaum R. J., Hunninghake D. B., Criqui M. H., Heiss G., Sox H. C.
Extract | Full Text  
N Engl J Med 1993; 329:1124-1128, Oct 7, 1993. Correspondence

This article has been cited by other articles:

• Despres, J.-P., Lemieux, I., Bergeron, J., Pibarot, P., Mathieu, P., Larose, E., Rodes-Cabau, J., Bertrand, O. F., Poirier, P. (2008). Abdominal Obesity and the Metabolic Syndrome: Contribution to Global Cardiometabolic Risk. Arterioscler. Thromb. Vasc. Bio. 28: 1039-1049 [Abstract] [Full Text]  
• Miller, M., Cannon, C. P., Murphy, S. A., Qin, J., Ray, K. K., Braunwald, E., for the PROVE IT-TIMI 22 Investigators, (2008). Impact of Triglyceride Levels Beyond Low-Density Lipoprotein Cholesterol After Acute Coronary Syndrome in the PROVE IT-TIMI 22 Trial.. J Am Coll Cardiol 51: 724-730 [Abstract] [Full Text]  
• Schindler, C. (2007). Review: The metabolic syndrome as an endocrine disease: is there an effective pharmacotherapeutic strategy optimally targeting the pathogenesis?. Therapeutic Advances in Cardiovascular Disease 1: 7-26 [Abstract]  
• Tirosh, A., Rudich, A., Shochat, T., Tekes-Manova, D., Israeli, E., Henkin, Y., Kochba, I., Shai, I. (2007). Changes in Triglyceride Levels and Risk for Coronary Heart Disease in Young Men. ANN INTERN MED 147: 377-385 [Abstract] [Full Text]  
• Criqui, M. H. (2007). Triglycerides and Coronary Heart Disease Revisited (Again). ANN INTERN MED 147: 425-427 [Full Text]  
• Yuan, G., Al-Shali, K. Z., Hegele, R. A. (2007). Hypertriglyceridemia: its etiology, effects and treatment. CMAJ 176: 1113-1120 [Abstract] [Full Text]  
• de Graaf, J., van der Vleuten, G. M., ter Avest, E., Dallinga-Thie, G. M., Stalenhoef, A. F. H. (2007). High Plasma Level of Remnant-Like Particles Cholesterol in Familial Combined Hyperlipidemia. J. Clin. Endocrinol. Metab. 92: 1269-1275 [Abstract] [Full Text]  
• Sarwar, N., Danesh, J., Eiriksdottir, G., Sigurdsson, G., Wareham, N., Bingham, S., Boekholdt, S. M., Khaw, K.-T., Gudnason, V. (2007). Triglycerides and the Risk of Coronary Heart Disease: 10 158 Incident Cases Among 262 525 Participants in 29 Western Prospective Studies. Circulation 115: 450-458 [Abstract] [Full Text]  
• Reeds, D. N., Yarasheski, K. E., Fontana, L., Cade, W. T., Laciny, E., DeMoss, A., Patterson, B. W., Powderly, W. G., Klein, S. (2006). Alterations in liver, muscle, and adipose tissue insulin sensitivity in men with HIV infection and dyslipidemia. Am. J. Physiol. Endocrinol. Metab. 290: E47-E53 [Abstract] [Full Text]  
• Criqui, M. H. (2005). Obesity, Risk Factors, and Predicting Cardiovascular Events. Circulation 111: 1869-1870 [Full Text]  
• Asia Pacific Cohort Studies Collaboration, (2004). Serum Triglycerides as a Risk Factor for Cardiovascular Diseases in the Asia-Pacific Region. Circulation 110: 2678-2686 [Abstract] [Full Text]  
• Monti, L. D., Landoni, C., Setola, E., Galluccio, E., Lucotti, P., Sandoli, E. P., Origgi, A., Lucignani, G., Piatti, P., Fazio, F. (2004). Myocardial insulin resistance associated with chronic hypertriglyceridemia and increased FFA levels in Type 2 diabetic patients. Am. J. Physiol. Heart Circ. Physiol. 287: H1225-H1231 [Abstract] [Full Text]  
• Twickler, T.B., Dallinga-Thie, G.M., Cohn, J.S., Chapman, M.J. (2004). Elevated Remnant-Like Particle Cholesterol Concentration: A Characteristic Feature of the Atherogenic Lipoprotein Phenotype. Circulation 109: 1918-1925 [Full Text]  
• de Araujo, I. E., Rolls, E. T. (2004). Representation in the Human Brain of Food Texture and Oral Fat. J. Neurosci. 24: 3086-3093 [Abstract] [Full Text]  
• Johansson, S., Wilhelmsen, L., Lappas, G., Rosengren, A. (2003). High lipid levels and coronary disease in women in Goteborg--outcome and secular trends: a prospective 19 year follow-up in the BEDAstudy. Eur Heart J 24: 704-716 [Abstract] [Full Text]  
• Hyson, D. A., Schneeman, B. O., Davis, P. A. (2002). Almonds and Almond Oil Have Similar Effects on Plasma Lipids and LDL Oxidation in Healthy Men and Women. J. Nutr. 132: 703-707 [Abstract] [Full Text]  
• Gaenzer, H., Sturm, W., Neumayr, G., Kirchmair, R., Ebenbichler, C., Ritsch, A., Foger, B., Weiss, G., Patsch, J. R (2001). Pronounced postprandial lipemia impairs endothelium-dependent dilation of the brachial artery in men. Cardiovasc Res 52: 509-516 [Abstract] [Full Text]  
• Yarnell, J.W.G., Patterson, C. C., Sweetnam, P. M., Thomas, H. F., Bainton, D., Elwood, P. C., Bolton, C. H., Miller, N. E. (2001). Do Total and High Density Lipoprotein Cholesterol and Triglycerides Act Independently in the Prediction of Ischemic Heart Disease?: Ten-Year Follow-Up of Caerphilly and Speedwell Cohorts. Arterioscler. Thromb. Vasc. Bio. 21: 1340-1345 [Abstract] [Full Text]  
• Cui, Y., Blumenthal, R. S., Flaws, J. A., Whiteman, M. K., Langenberg, P., Bachorik, P. S., Bush, T. L. (2001). Non-High-Density Lipoprotein Cholesterol Level as a Predictor of Cardiovascular Disease Mortality. Arch Intern Med 161: 1413-1419 [Abstract] [Full Text]  
• Mattes, R. D. (2001). Oral Exposure to Butter, but Not Fat Replacers Elevates Postprandial Triacylglycerol Concentration in Humans. J. Nutr. 131: 1491-1496 [Abstract] [Full Text]  
• Iso, H., Naito, Y., Sato, S., Kitamura, A., Okamura, T., Sankai, T., Shimamoto, T., Iida, M., Komachi, Y. (2001). Serum Triglycerides and Risk of Coronary Heart Disease among Japanese Men and Women. Am J Epidemiol 153: 490-499 [Abstract] [Full Text]  
• Miyanishi, K., Yamamoto, T., Irisa, T., Yamashita, A., Jingushi, S., Noguchi, Y., Iwamoto, Y. (2001). A high low-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio as a potential risk factor for corticosteroid-induced osteonecrosis in rabbits. Rheumatology (Oxford) 40: 196-201 [Abstract] [Full Text]  
• Twickler, T. B., Wilmink, H. W., Schreuder, P. C. N. J., Cabezas, M. C., van Dam, P. S., Koppeschaar, H. P. F., Erkelens, D. W., Dallinga-Thie, G. M. (2000). Growth Hormone (GH) Treatment Decreases Postprandial Remnant-Like Particle Cholesterol Concentration and Improves Endothelial Function in Adult-Onset GH Deficiency. J. Clin. Endocrinol. Metab. 85: 4683-4689 [Abstract] [Full Text]  
• Twickler, Th. B., Dallinga-Thie, G. M., de Valk, H. W., Schreuder, P. C. N. J., Jansen, H., Cabezas, M. C., Erkelens, D. W. (2000). High Dose of Simvastatin Normalizes Postprandial Remnant-Like Particle Response in Patients With Heterozygous Familial Hypercholesterolemia. Arterioscler. Thromb. Vasc. Bio. 20: 2422-2427 [Abstract] [Full Text]  
• Stark, K. D, Park, E. J, Maines, V. A, Holub, B. J (2000). Effect of a fish-oil concentrate on serum lipids in postmenopausal women receiving and not receiving hormone replacement therapy in a placebo-controlled, double-blind trial. Am. J. Clin. Nutr. 72: 389-394 [Abstract] [Full Text]  
• Avins, A. L., Neuhaus, J. M. (2000). Do Triglycerides Provide Meaningful Information About Heart Disease Risk?. Arch Intern Med 160: 1937-1944 [Abstract] [Full Text]  
• Austin, M. A., McKnight, B., Edwards, K. L., Bradley, C. M., McNeely, M. J., Psaty, B. M., Brunzell, J. D., Motulsky, A. G. (2000). Cardiovascular Disease Mortality in Familial Forms of Hypertriglyceridemia: A 20-Year Prospective Study. Circulation 101: 2777-2782 [Abstract] [Full Text]  
• Oberman, A. (2000). Hypertriglyceridemia and Coronary Heart Disease. J. Clin. Endocrinol. Metab. 85: 2098-2105 [Full Text]  
• Roche, H. M, Gibney, M. J (2000). Effect of long-chain n-3 polyunsaturated fatty acids on fasting and postprandial triacylglycerol metabolism1. Am. J. Clin. Nutr. 71: 232S-237S [Abstract] [Full Text]  
• Edwards, K. L., Mahaney, M. C., Motulsky, A. G., Austin, M. A. (1999). Pleiotropic Genetic Effects on LDL Size, Plasma Triglyceride, and HDL Cholesterol in Families. Arterioscler. Thromb. Vasc. Bio. 19: 2456-2464 [Abstract] [Full Text]  
• Haim, M., Benderly, M., Brunner, D., Behar, S., Graff, E., Reicher-Reiss, H., Goldbourt, U. (1999). Elevated Serum Triglyceride Levels and Long-Term Mortality in Patients With Coronary Heart Disease : The Bezafibrate Infarction Prevention (BIP) Registry. Circulation 100: 475-482 [Abstract] [Full Text]  
• Yu, H. H., Ginsburg, G. S., O'Toole, M. L., Otvos, J. D., Douglas, P. S., Rifai, N. (1999). Acute Changes in Serum Lipids and Lipoprotein Subclasses in Triathletes as Assessed by Proton Nuclear Magnetic Resonance Spectroscopy. Arterioscler. Thromb. Vasc. Bio. 19: 1945-1949 [Abstract] [Full Text]  
• Lewis, T. V., Dart, A. M., Chin-Dusting, J. P. F. (1999). Endothelium-dependent relaxation by acetylcholine is impaired in hypertriglyceridemic humans with normal levels of plasma LDL cholesterol. J Am Coll Cardiol 33: 805-812 [Abstract] [Full Text]  
• Esterbauer, H., Hell, E., Krempler, F., Patsch, W. (1999). Allele-specific Differences in Apolipoprotein C-III mRNA Expression in Human Liver. Clin. Chem. 45: 331-339 [Abstract] [Full Text]  
• Duvernoy, C. S., Meyer, C., Seifert-Klauss, V., Dayanikli, F., Matsunari, I., Rattenhuber, J., Hoss, C., Graeff, H., Schwaiger, M. (1999). Gender differences in myocardial blood flow dynamics: Lipid profile and hemodynamic effects. J Am Coll Cardiol 33: 463-470 [Abstract] [Full Text]  
• Leary, E. T., Wang, T., Baker, D. J., Cilla, D. D., Zhong, J., Warnick, G. R., Nakajima, K., Havel, R. J. (1998). Evaluation of an immunoseparation method for quantitative measurement of remnant-like particle-cholesterol in serum and plasma. Clin. Chem. 44: 2490-2498 [Abstract] [Full Text]  
• McNamara, J. R., Shah, P. K., Nakajima, K., Cupples, L. A., Wilson, P. W. F., Ordovas, J. M., Schaefer, E. J. (1998). Remnant lipoprotein cholesterol and triglyceride reference ranges from the Framingham Heart Study. Clin. Chem. 44: 1224-1232 [Abstract] [Full Text]  
• Jeppesen, J o., Hein, H. O., Suadicani, P., Gyntelberg, F. (1998). Triglyceride Concentration and Ischemic Heart Disease : An Eight-Year Follow-up in the Copenhagen Male Study. Circulation 97: 1029-1036 [Abstract] [Full Text]  
• Campos, H., Walsh, B. W., Judge, H., Sacks, F. M. (1997). Effect of Estrogen on Very Low Density Lipoprotein and Low Density Lipoprotein Subclass Metabolism in Postmenopausal Women. J. Clin. Endocrinol. Metab. 82: 3955-3963 [Abstract] [Full Text]  
• Gaziano, J. M., Hennekens, C. H., O'Donnell, C. J., Breslow, J. L., Buring, J. E. (1997). Fasting Triglycerides, High-Density Lipoprotein, and Risk of Myocardial Infarction. Circulation 96: 2520-2525 [Abstract] [Full Text]  
• Jeppesen, J., Hein, H. O., Suadicani, P., Gyntelberg, F. (1997). Relation of High TG–Low HDL Cholesterol and LDL Cholesterol to the Incidence of Ischemic Heart Disease: An 8-Year Follow-up in the Copenhagen Male Study. Arterioscler. Thromb. Vasc. Bio. 17: 1114-1120 [Abstract] [Full Text]  
• Urgert, R., Meyboom, S., Kuilman, M., Rexwinkel, H., Vissers, M. N, Klerk, M., Katan, M. B (1996). Comparison of effect of cafetiere and filtered coffee on serum concentrations of liver aminotransferases and lipids: six month randomised controlled trial. BMJ 313: 1362-1366 [Abstract] [Full Text]  
• Surguchov, A. P., Page, G. P., Smith, L., Patsch, W., Boerwinkle, E. (1996). Polymorphic Markers in Apolipoprotein C-III Gene Flanking Regions and Hypertriglyceridemia. Arterioscler. Thromb. Vasc. Bio. 16: 941-947 [Abstract] [Full Text]  
• Douglas, P. S., Ginsburg, G. S. (1996). The Evaluation of Chest Pain in Women. NEJM 334: 1311-1315 [Full Text]  
• Prisco, D., Caciolli, S., Del Pace, S., Gensini, G. F. (1996). State-of-the-Art Review : Sex and Cardiovascular Risk Factors. CLIN APPL THROMB HEMOST 2: 94-102  
• Senti, M., Pedro-Botet, J., Rubies-Prat, J., Vidal-Barraquer, F. (1996). Secondary Prevention of Coronary Heart Disease in Patients with Extracoronary Atherosclerosis: A Need for Accuracy of Low Density Lipoprotein Determination. ANGIOLOGY 47: 241-246 [Abstract]  
• Njolstad, I., Arnesen, E., Lund-Larsen, P. G. (1996). Smoking, Serum Lipids, Blood Pressure, and Sex Differences in Myocardial Infarction : A 12-Year Follow-up of the Finnmark Study. Circulation 93: 450-456 [Abstract] [Full Text]  
• Burchfiel, C. M., Laws, A., Benfante, R., Goldberg, R. J., Hwang, L.-J., Chiu, D., Rodriguez, B. L., Curb, J. D., Sharp, D. S. (1995). Combined Effects of HDL Cholesterol, Triglyceride, and Total Cholesterol Concentrations on 18-Year Risk of Atherosclerotic Disease. Circulation 92: 1430-1436 [Abstract] [Full Text]  
• Ferrieres, J., Lambert, J., Lussier-Cacan, S., Davignon, J. (1995). Coronary Artery Disease in Heterozygous Familial Hypercholesterolemia Patients With the Same LDL Receptor Gene Mutation. Circulation 92: 290-295 [Abstract] [Full Text]  
• Jeppesen, J., Hollenbeck, C. B., Zhou, M.-Y., Coulston, A. M., Jones, C., Chen, Y.-D. I., Reaven, G. M. (1995). Relation Between Insulin Resistance, Hyperinsulinemia, Postheparin Plasma Lipoprotein Lipase Activity, and Postprandial Lipemia. Arterioscler. Thromb. Vasc. Bio. 15: 320-324 [Abstract] [Full Text]  
• Garber, A. M, Avins, A. L (1995). Triglyceride concentration and coronary heart disease. BMJ 310: 259c-260 [Full Text]  
• Garber, A. M, Avins, A. L (1994). Triglyceride concentration and coronary heart disease. BMJ 309: 1440a-1441 [Full Text]  
• Garber, A M, Avins, A L (1994). Triglyceride concentration and coronary heart disease. BMJ 309: 2-3 [Full Text]  
• Ornish, D., Brown, S. E., Kottke, B. A., Shea, S., Barth, J. D., Bryan, G. K., Hokanson, J. E., Austin, M. A., Ginsberg, H. N., Tall, A. R., Deckelbaum, R. J., Hunninghake, D. B., Criqui, M. H., Heiss, G., Sox, H. C. (1993). Treatment of and Screening for Hyperlipidemia. NEJM 329: 1124-1128 [Full Text]  
• Sox, H. C. (1993). Screening for Lipid Disorders under Health System Reform. NEJM 328: 1269-1271 [Full Text]  
• Sacks, F. M., Tonkin, A. M., Craven, T., Pfeffer, M. A., Shepherd, J., Keech, A., Furberg, C. D., Braunwald, E. (2002). Coronary Heart Disease in Patients With Low LDL-Cholesterol: Benefit of Pravastatin in Diabetics and Enhanced Role for HDL-Cholesterol and Triglycerides as Risk Factors. Circulation 105: 1424-1428 [Abstract] [Full Text]