TRIGLYCERIDES AND ASCVD
Elevated triglycerides are an independent risk factor for the development of atherosclerotic cardiovascular disease (ASCVD) based on both prospective longitudinal cohorts and Mendelian randomization studies. Triglyceride levels are a part of routine lipid profiles and have been measured for decades in the clinic setting. However, unless they are >500 mg/dL, the average health care provider does nothing to treat them when they exceed the normal range (>150 mg/dL) but remain less than the qualifying threshold for severe hypertriglyceridemia. This is understandable since the recent PROMINENT (Pemafibrate to Reduce Cardiovascular OutcoMes by Reducing Triglycerides IN patiENts With diabeTes) trial using pemafibrate[1] demonstrated no benefit in diabetic patients with hypertriglyceridemia, and REDUCE-IT (A Study of AMR101 to Evaluate Its Ability to Reduce Cardiovascular Events in High-Risk Patients With Hypertriglyceridemia and on Statin)[2] revealed benefit with icosapent ethyl, but the benefit was independent of triglyceride reduction. There is a disconnect between evidence supporting triglycerides as independent participants in atherogenesis and the results of prospective randomized studies using lipid-modifying medications that lower triglycerides. Are triglycerides a true risk factor for ASCVD, or is it the lipoproteins that carry them that are the pathogenetic culprit?
J Am Coll Cardiol. 2024;84(11) © 2024