Management of Hypertriglyceridemia for Prevention of Cardiovascular Diseases

Chee Jeong Kim

doi:10.12997/jla.2013.2.2.53

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Kim: Management of Hypertriglyceridemia for Prevention of Cardiovascular Diseases

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Journal of Lipid and Atherosclerosis 2013; 2(2): 53-60.

Published online: 31 December 2013

DOI: https://doi.org/10.12997/jla.2013.2.2.53

Management of Hypertriglyceridemia for Prevention of Cardiovascular Diseases

Chee Jeong Kim

Division of Cardiology, Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Korea.

Corresponding Author: Chee Jeong Kim, Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, 224-1 Heukseokdong, Dongjakku, Seoul 156-070, Korea. Tel: +82-2-6299-1398, Fax: +82-2-822-2769, cjkim@cau.ac.kr

Received 28 October 2013 Revised 25 November 2013 Accepted 9 December 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Hypertriglyceridemia has been considered as a risk factor for cardiovascular diseases. However, triglyceride levels are influenced by many clinical and lipid risk factors. When triglyceride levels are adjusted by these variables, the effect of hypertriglyceridemia as a cardiovascular risk factor becomes minimal or negligible. Therefore, the association of hypertriglyceridemia with cardiovascular diseases is uncertain.

The effect of triglyceride-lowering drugs on cardiovascular diseases is also unclear. These drugs failed to reduce cardiovascular events in relatively high risk patients with variable lipid profiles. However, subgroup analysis showed the cardioprotective effects in selected patients.

It is clinically important whether a patient with hypertriglyceridemia should be treated with drug therapy or not. This paper discusses this issue based on limited data of published reports.

Keywords: Hypertriglyceridemia, Cardiovascular prevention

Figures and Tables

Table 1

Effect of fibrate and nicotinic acid on prevention of coronary artery disease (CAD) in patients with hypercholesterolemia in early stage studies before statin era

+; Effective, 0; Ineffective, -; Adverse for Prevention of CHD

References

1. Hokanson JE, Austin MA. Plasma triglyceride level is a risk factor for cardiovascular disease independent of high-density lipoprotein cholesterol level: a meta-analysis of population-based prospective studies. J Cardiovasc Risk. 1996; 3:213–219.

2. Sarwar N, Danesh J, Eiriksdottir G, Sigurdsson G, Wareham N, Bingham S, et al. Triglycerides and the risk of coronary heart disease: 10,158 incident cases among 262,525 participants in 29 western prospective studies. Circulation. 2007; 115:450–458.

3. Emerging Risk Factors Collaboration. Di Angelantonio E, Sarwar N, Perry P, Kaptoge S, Ray KK, et al. Major lipids, apolipoproteins, and risk of vascular disease. JAMA. 2009; 302:1993–2000.

4. Jun M, Foote C, Lv J, Neal B, Patel A, Nicholls SJ, et al. Effects of fibrates on cardiovascular outcomes: a systematic review and meta-analysis. Lancet. 2010; 375:1875–1884.

5. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001; 285:2486–2497.

6. Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Catapano AL, Reiner Z, De Backer G, Graham I, et al. ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Atherosclerosis. 2011; 217:Suppl 1. S1–S44.

7. A co-operative trial in the primary prevention of ischaemic heart disease using clofibrate. Report from the Committee of Principal Investigators. Br Heart J. 1978; 40:1069–1118.

8. Carlson LA, Rosenhamer G. Reduction of mortality in the Stockholm Ischaemic Heart Disease Secondary Prevention Study by combined treatment with clofibrate and nicotinic acid. Acta Med Scand. 1988; 223:405–418.

9. Clofibrate and niacin in coronary heart disease. JAMA. 1975; 231:360–381.

10. Trial of clofibrate in the treatment of ischaemic heart disease. Five-year study by a group of physicians of the Newcastle upon Tyne region. Br Med J. 1971; 4:767–775.

11. Frick MH, Elo O, Haapa K, Heinonen OP, Heinsalmi P, Helo P, et al. Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors, and incidence of coronary heart disease. N Engl J Med. 1987; 317:1237–1245.

12. Manninen V, Tenkanen L, Koskinen P, Huttunen JK, Mänttäri M, Heinonen OP, et al. Joint effects of serum triglyceride and LDL cholesterol and HDL cholesterol concentrations on coronary heart disease risk in the Helsinki Heart Study. Implications for treatment. Circulation. 1992; 85:37–45.

13. Rubins HB, Robins SJ, Collins D, Fye CL, Anderson JW, Elam MB, et al. Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group. Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. N Engl J Med. 1999; 341:410–418.

14. Rubins HB, Robins SJ, Collins D, Nelson DB, Elam MB, Schaefer EJ, et al. Diabetes, plasma insulin, and cardiovascular disease: subgroup analysis from the Department of Veterans Affairs high-density lipoprotein intervention trial (VA-HIT). Arch Intern Med. 2002; 162:2597–2604.

15. Bezafibrate Infarction Prevention (BIP) study. Secondary prevention by raising HDL cholesterol and reducing triglycerides in patients with coronary artery disease. Circulation. 2000; 102:21–27.

16. Keech A, Simes RJ, Barter P, Best J, Scott R, Taskinen MR, et al. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet. 2005; 366:1849–1861.

17. Scott R, O'Brien R, Fulcher G, Pardy C, D'Emden M, Tse D, et al. Effects of fenofibrate treatment on cardiovascular disease risk in 9,795 individuals with type 2 diabetes and various components of the metabolic syndrome: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. Diabetes Care. 2009; 32:493–498.

18. ACCORD Study Group. Ginsberg HN, Elam MB, Lovato LC, Crouse JR 3rd, Leiter LA, et al. Effects of combination lipid therapy in type 2 diabetes mellitus. N Engl J Med. 2010; 362:1563–1574.

19. Kim CJ. Effects of fenofibrate on C-reactive protein levels in hypertriglyceridemic patients. J Cardiovasc Pharmacol. 2006; 47:758–763.

20. Cho JH, Choi YH, Hyeon CW, Kim KJ, Hyun S, Kwon JE, et al. Effect of fenofibrate therapy on blood creatinine levels in patients with hypertension and hypertriglyceridemia. J Lipid Atheroscler. 2013; 2:19–26.

21. Paolini JF, Mitchel YB, Reyes R, Kher U, Lai E, Watson DJ, et al. Effects of laropiprant on nicotinic acid-induced flushing in patients with dyslipidemia. Am J Cardiol. 2008; 101:625–630.

22. AIM-HIGH Investigators. Boden WE, Probstfield JL, Anderson T, Chaitman BR, Desvignes-Nickens P, et al. Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy. N Engl J Med. 2011; 365:2255–2267.

23. Balk EM, Lichtenstein AH, Chung M, Kupelnick B, Chew P, Lau J. Effects of omega-3 fatty acids on serum markers of cardiovascular disease risk: a systematic review. Atherosclerosis. 2006; 189:19–30.

24. Bucher HC, Hengstler P, Schindler C, Meier G. N-3 polyunsaturated fatty acids in coronary heart disease: a meta-analysis of randomized controlled trials. Am J Med. 2002; 112:298–304.

25. Hooper L, Thompson RL, Harrison RA, Summerbell CD, Ness AR, Moore HJ, et al. Risks and benefits of omega 3 fats for mortality, cardiovascular disease, and cancer: systematic review. BMJ. 2006; 332:752–760.

26. Burr ML, Ashfield-Watt PA, Dunstan FD, Fehily AM, Breay P, Ashton T, et al. Lack of benefit of dietary advice to men with angina: results of a controlled trial. Eur J Clin Nutr. 2003; 57:193–200.

27. Marchioli R, Barzi F, Bomba E, Chieffo C, Di Gregorio D, Di Mascio R, et al. Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction: time-course analysis of the results of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI)-Prevenzione. Circulation. 2002; 105:1897–1903.

28. Lee JH, O'Keefe JH, Lavie CJ, Marchioli R, Harris WS. Omega-3 fatty acids for cardioprotection. Mayo Clin Proc. 2008; 83:324–332.

29. Yokoyama M, Origasa H, Matsuzaki M, Matsuzawa Y, Saito Y, Ishikawa Y, et al. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet. 2007; 369:1090–1098.

30. Gissi-HF Investigators. Tavazzi L, Maggioni AP, Marchioli R, Barlera S, Franzosi MG, et al. Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial. Lancet. 2008; 372:1223–1230.

31. Kromhout D, Giltay EJ, Geleijnse JM; Alpha Omega Trial Group. N-3 fatty acids and cardiovascular events after myocardial infarction. N Engl J Med. 2010; 363:2015–2026.

32. ORIGIN Trial Investigators. Bosch J, Gerstein HC, Dagenais GR, Díaz R, Dyal L, et al. N-3 fatty acids and cardiovascular outcomes in patients with dysglycemia. N Engl J Med. 2012; 367:309–318.

33. Rizos EC, Ntzani EE, Bika E, Kostapanos MS, Elisaf MS. Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis. JAMA. 2012; 308:1024–1033.

34. Kim MA. Triglyceride and cardiovascular disease. J Lipid Atheroscler. 2013; 2:1–8.

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