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Triglycerides “increasingly crucial” in management of cardiovascular risk

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – A Scientific Statement issued by the American Heart Association notes that in the US, mean triglyceride levels have increased over the past 3 decades while mean LDL cholesterol levels have declined.

“Therefore, the purpose of this scientific statement is to update clinicians on the increasingly crucial role of triglycerides in the evaluation and management of CVD risk and highlight approaches aimed at minimizing the adverse public health-related consequences associated with hypertriglyceridemic states,” write Dr. Michael Miller, of the University of Maryland, and colleagues in the May 24 issue of Circulation.

In their summary of the 42-page document, the authors say their review reaffirms that triglyceride is not directly atherogenic but represents an important biomarker of CVD risk because of its association with atherogenic remnant particles and apo CIII

Measurements of non-HDL-C and/or apo B, the panel advises, “may be especially useful in those with prominent triglyceride/HDL abnormalities in which LDL-C measurements may underestimate true atherosclerotic vascular risk.”

The statement recommends a revised classification of triglyceride levels. Optimal fasting triglyceride levels are defined as less than 100 mg/dL. Fasting levels of 150-199 mg/dL are designated borderline high; 200-499 mg/dL is high; 500 mg/dL or greater is very high.

A nonfasting screening level of <200 mg/dL is considered normal and requires no further testing, the report suggests. The statement notes that multiple interventions, aimed at lifestyle changes, have additive triglyceride-lowering effects. For example, a weight loss of 5%-10% lowers triglycerides by 20%, and changes in dietary fats and carbohydrates can produce another 20% reduction. Add aerobic activity and marine omega-3 products and “reductions of 50% or more in triglyceride levels may be attained through intensive therapeutic lifestyle change.” When triglycerides are very high, use of triglyceride-lowering medication to prevent pancreatitis is “reasonable.” However, “What remains to be established is whether these modalities favorably influence CVD outcomes beyond proven therapies (eg, statins),” Dr. Miller and colleagues conclude. Therefore, more clinical trials are needed. They also point out that the statement is not intended to be a specific guideline, “but will be of value to the Adult Treatment Panel IV (ATP IV) of the National Cholesterol Education Program, from which evidence-based guidelines will ensue.” Reference:
CTriglycerides and Cardiovascular Disease: A Scientific Statement From the American Heart Association

Circulation 2011;123.