Editorials

The end of triglycerides in cardiovascular risk assessment?

BMJ 1998; 317 doi: http://dx.doi.org/10.1136/bmj.317.7158.553 (Published 29 August 1998) Cite this as: BMJ 1998;317:553

Rumours of death are greatly exaggerated

  1. Naveed Satta, Specialist registrar in clinical biochemistry ([email protected]),
  2. Chris J Packard, Professor in clinical biochemistry.,
  3. John R Petrie, Clinical lecturer
  1. Glasgow Royal Infirmary University NHS Trust, Glasgow G4 OSF
  2. University Department of Medicine and Therapeutics, Western Infirmary, Glasgow G11 6NT

    Although serum triglyceride concentrations are often measured in clinical practice, Garber and Avins1plausibly argued in the BMJ in 1994 that their use in screening for cardiovascular risk was “experimental.” In particular, they argued that there was no evidence that triglycerides values identified those who benefited from further evaluation or treatment and that there was more evidence for measuring high density lipoprotein cholesterol concentrations. Since then the importance of low density lipoprotein cholesterol has been emphasised by landmark trials of statins (WOSCOPS, 4S) in the primary and secondary prevention of coronary heart disease, and cheaper and simpler” direct“ assays have emerged for high density lipoprotein cholesterol. Both these events might have been expected to hasten the demise of triglycerides—but clinicians continue to request triglyceride assays together with measurements of total cholesterol in patients at risk of cardiovascular disease.

    Garber and Avins conceded the biological plausibility of a causal role for triglycerides in coronary heart disease but argued that an association (causal or otherwise) had never been proved. They highlighted the biological variability in fasting serum triglyceride concentrations …

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