Elevated LDL triglycerides tied to higher risk for ASCVD
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In two prospective cohort studies and a meta-analysis of present and past studies, elevated LDL triglycerides were associated with increased risk for atherosclerotic CVD and its components, researchers reported.
Mie Balling, MD, from the department of clinical biochemistry, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark, and colleagues analyzed participants from the Copenhagen General Population Study who had their LDL triglycerides measured. One cohort consisted of 38,081 individuals (mean age, 60 years; 56% women) who had a direct automated assay (direct LDL triglycerides) and the other consisted of 30,208 individuals (mean age, 63 years, 51% women) who underwent nuclear magnetic resonance spectroscopy (NMR LDL triglycerides).
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LDL triglycerides and ASCVD
The direct LDL triglycerides cohort had 872 people who developed ASCVD during 3 years of follow-up and the NMR LDL triglycerides cohort had 5,766 people who developed ASCVD during 9.2 years of follow-up.
In the direct LDL triglycerides cohort, the HRs per 0.1 mmol/L (0.9 mg/dL) higher direct LDL triglycerides were 1.26 (95% CI, 1.17-1.35) for ASCVD, 1.27 (95% CI, 1.16-1.39) for ischemic heart disease, 1.28 (95% CI, 1.11-1.48) for MI, 1.22 (95% CI, 1.08-1.38) for ischemic stroke and 1.38 (95% CI, 1.21-1.58) for peripheral artery disease, according to the researchers.
In the NMR LDL triglycerides cohort, the HRs per 0.1 mmol/L (0.9 mg/dL) higher NMR LDL triglycerides were 1.26 (95% CI, 1.2-1.33) for ASCVD, 1.33 (95% CI, 1.25-1.41) for ischemic heart disease, 1.41 (95% CI, 1.31-1.52) for MI, 1.13 (95% CI, 1.05-1.23) for ischemic stroke and 1.26 (95% CI, 1.1-1.43) for PAD, Balling and colleagues wrote.
There was no relationship between LDL triglyceride levels and hemorrhagic stroke.
Differences in apolipoprotein B levels did not fully explain the results, the researchers wrote.
Balling and colleagues also conducted a meta-analysis of the present studies plus some past studies (a total of six studies for ischemic heart disease and four studies for each of ASCVD, ischemic stroke and PAD).
The random-effects RRs for the highest quartile compared with the lowest quartile of LDL triglycerides were as follows:
- ASCVD, 1.5 (95% CI, 1.35-1.66);
- ischemic heart disease, 1.62 (95% CI, 1.37-1.93);
- ischemic stroke, 1.3 (95% CI, 1.13-1.49); and
- PAD, 1.53 (95% CI, 1.29-1.81).
“If the found association between elevated LDL triglycerides and the risk of ASCVD were to be used in clinical practice for risk assessment, the measurement of direct LDL triglycerides would be preferred over NMR LDL triglycerides,” Balling and colleagues wrote. “This is because the direct assay for LDL triglycerides can be used on most autoanalyzers already available in clinical chemistry laboratories, thereby allowing inexpensive and fast delivery of results through electronic medical records, just like any other blood test performed for routine use.”
A standardized tool
In a related editorial, P. Barton Duell, MD, FAHA, professor of medicine in the Knight Cardiovascular Institute and division of endocrinology, diabetes and clinical nutrition at Oregon Health & Science University in Portland, wrote that “it is possible that a direct autoanalyzer measurement of LDL triglycerides may provide a readily accessible and standardized tool for assessing ASCVD risk in patients with hypertriglyceridemia in association with standard lipid profile determinations, including LDL cholesterol, non-HDL cholesterol and ApoB.”
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