The association between triglycerides and incident cardiovascular disease: What is "optimal"?

Journal Article (Journal Article)

BACKGROUND: Elevated triglycerides (TGs) are associated with increased risk of cardiovascular disease (CVD), but the best way to both measure TGs and assess TG-related risk remains unknown. OBJECTIVE: The objective of the study was to evaluate the association between TGs and CVD and determine whether the average of a series of TG measurements is more predictive of CVD risk than a single TG measurement. METHODS: We examined 15,792 study participants, aged 40-65 years, free of CVD from the Atherosclerosis Risk in Communities and Framingham Offspring studies, using fasting TG measurements across multiple examinations over time. With up to 10 years of follow-up, we assessed time-to-first CVD event, as well as a composite of myocardial infarction, stroke, or cardiovascular death. RESULTS: Compared with a single TG measurement, average TGs over time had greater discrimination for CVD risk (C-statistic, 0.60 vs 0.57). Risk for CVD increased as average TGs rose until an inflection point of ~100 mg/dL in men and ~200 mg/dL in women, above which this risk association plateaued. The relationship between average TGs and CVD remained statistically significant in multivariable modeling adjusting for low-density lipoprotein cholesterol, and interactions were found by sex and high-density lipoprotein cholesterol level. CONCLUSIONS: The average of several TG readings provides incremental improvements for the prediction of CVD relative to a single TG measurement. Regardless of the method of measurement, higher TGs were associated with increased CVD risk, even at levels previously considered "optimal" (<150 mg/dL).

Full Text

Duke Authors

Cited Authors

  • Aberra, T; Peterson, ED; Pagidipati, NJ; Mulder, H; Wojdyla, DM; Philip, S; Granowitz, C; Navar, AM

Published Date

  • 2020

Published In

Volume / Issue

  • 14 / 4

Start / End Page

  • 438 - 447.e3

PubMed ID

  • 32571728

Pubmed Central ID

  • PMC7492406

International Standard Serial Number (ISSN)

  • 1933-2874

Digital Object Identifier (DOI)

  • 10.1016/j.jacl.2020.04.009


  • eng

Conference Location

  • United States