Are high Triglycerides an independent risk factor for heart disease?
A quote from the great series on heart health on Sigma Nutrition:
“High circulating triglycerides (TGs) have historically been considered an independent risk factor for CVD. However, after adjusting for non-HDL-cholesterol (which is a simple formula of TC minus HDL-C, with the remaining value representing cholesterol content of all pro-atherogenic lipoproteins) this association has been shown to be null.”
However, I just watched a recent video by Gil Carvalho who said that there may be benefit for those who are on statins to lower LDL but still have high triglycerides in consuming fish oil. If LDL is lowered by medication, does the triglyceride still matter?
I think that addressing apoB-containing lipoprotein fractions and insulin resistance should be the dominant focuses of therapy, however hypertriglyceridemia does seem to be associated with residual atherosclerotic risk, even after the apoB fraction has been addressed. The issue is whether this is directly due to the triglyceride level (in which case, treating it directly should lower risk) or if that is more a correlation (for example, with insulin resistance or other factors). I tend towards the latter interpretation; as a result, in practice I do not routinely treat patients with fibrate drugs unless their triglyceride level is so high that it puts them at risk of pancreatitis. The use of fish oil in this situation as mentioned by Dr. Carvalho would indeed lower triglycerides, but is also likely to have numerous other effects and potential mechanisms of benefit, so I would not use that evidence to say that it is purely addressing TG-mediated risk. Hopefully this makes sense.