Author + information
- Kwang Kon Koh, MD, PhD∗ ()
- ↵∗Vascular Medicine and Atherosclerosis Unit, Department of Cardiovascular Medicine, Gachon University, Gil Medical Center, 774 Beongil 21, Namdongdaero, Namdong-Gu, Incheon, South Korea
The Schwartz et al. (1) paper reported that among patients with acute coronary syndrome treated effectively with statins, fasting triglycerides (Tg) predict long-term and short-term cardiovascular risk. Triglyceride-rich lipoproteins may be an important additional target for therapy (1).
Lowering low-density lipoprotein cholesterol (LDL-C) is the primary target in the management of dyslipidemia in patients at high risk of cardiovascular disease. However, patients who have achieved LDL-C levels below the currently recommended targets may still experience cardiovascular events. This may result, in part, from elevated Tg levels (2). Atherogenic dyslipidemia, characterized by high Tg, low levels of high-density lipoprotein cholesterol (HDL-C), and small, dense LDL particles, is a typical phenotype of dyslipidemia in subjects with insulin resistance and metabolic syndrome. On the other hand, raised Tg concentrations are strongly associated with low concentrations of HDL-C, and the past 15 years have been dominated by HDL research, with less focus on Tg. However, the understanding from genetic studies and randomized trials that low HDL-C might not be a cause of cardiovascular disease as originally thought has generated renewed interest in raised Tg (3). Indeed, a study investigated the causal role of HDL-C and Tg using multiple instrumental variables for Mendelian randomization and reported that the genetic findings supported a causal effect of Tg on coronary heart disease risk (4).
It is obvious that statins are the first-line drug for the treatment of dyslipidemia. However, a strategy to reduce high Tg and modify the small, dense LDL particles is required. In this regard, statin-based combined with fibrates, peroxisome proliferator-activated receptor agonists may be recommended in addition to therapeutic lifestyle changes if patients still experience cardiovascular events. The cost effectiveness of these combinations should also be evaluated (5).
Please note: Dr. Koh has reported that he has no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation