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Low triglyceride concentrations may be cardiac risk factor

Results presented at the American Heart Association meeting in New Orleans last week showed that patients with triglyceride concentrations as low as 1.1 mmol/l (10 mg/dl) were more than twice as likely to develop heart disease than those with lower concentrations.

The issue of whether triglycerides are an independent risk factor for heart disease remains controversial as high concentrations are usually associated with other changes, such as a low concentration of high density lipoprotein cholesterol and a high concentration of low density lipoprotein cholesterol. It is generally accepted, however, that fasting serum triglyceride concentrations below 2.2 mmol/l are normal.

Dr Michael Miller, an assistant professor of medicine at the University of Maryland School of Medicine, said: "People with triglyceride levels in the low hundreds had about the same risk for heart disease as those with diabetes. In the light of that we may need to re-evaluate current guidelines."

Dr Miller and colleagues analysed data collected at the Johns Hopkins hospital in Baltimore in 1977-8 on 460 men and women aged 30-80 years with suspected coronary artery disease or atherosclerosis. Between 1993 and 1995 they tracked these patients down and determined how many had died, experienced a myocardial infarction, or needed coronary revascularisation.

After adjusting for other risk factors--such as smoking, hypertension, diabetes, lack of physical activity, low concentrations of high density lipoprotein cholesterol, and high concentrations of low density lipoprotein cholesterol--the researchers found that triglyceride was an independent risk factor for heart disease. Triglyceride concentrations were a significant predictor of heart disease at 2.2 mmol/l, 1.7 mmol/l, and 1.1 mmol/l.

Professor Gilbert Thompson, professor of clinical lipidology at the Hammersmith Hospital, said: "We have probably underestimated the importance of triglycerides in the past." Guidelines from the European Atherosclerosis Society two years ago did suggest that one aim of treatment should be to bring triglyceride concentrations below 2.3 mmol/l. "This study suggests the ideal level should be even lower, and certainly any new guidelines which are produced should take this into account," he said.--JACQUI WISE, BMJ

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