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Triglycerides are often misunderstood. We look at new evidence on triglyceride lowering and heart disease. An overview of the value and caveats of trigliceryde levels Uploaded 19-12-22New trial on triglyceride lowering. triglyceride-lowering drug vs placebo. participants: high triglycerides, low HDL-cholesterol. LDL-cholesterol was low, only triglycerides were highfibrate reduced triglycerides. HDL-cholesterol went up by 5%no significant change in risk of cardiovascular events (heart attack, stroke or death). why wasn’t risk lower if triglycerides came down?Lipids like triglycerides and cholesterol are carried in our bloodstream in lipoproteins like LDL and VLDL. VLDLs carry mostly triglycerides, LDLs carry mostly cholesterol. in cardiovascular research risk follows number of lipoproteins, not lipid level. so cholesterol and triglycerides are markersusually the higher the cholesterol and triglycerides, the more lipoproteins. VLDLs and LDLs are cousins. VLDLs can turn into LDLs. both carry ApoBthe fibrate didn't reduce apoB so risk didnt go down, regardless of what happens to triglycerides or cholesterol. fibrates lower VLDLs (which carry mostly TGs). So both triglycerides and their carriers go down. But it raises large LDLsVLDLs were reduced by being converted into LDLs. Reducing triglycerides by transforming one ApoB lipoprotein, VLDLs, into another, LDLs, is not helpfulOther trials: lowering triglycerides without lowering apoB doesnt helpgenetics: triglyceride levels have little if any effect on cardiovascular risk when we account for ApoBraising HDL-cholesterol doesn´t help; triglycerides and HDL-cholesterol combined play small if any role in cardiovascular risk accounting for apoB; people with good triglycerides and HDL-cholesterol can still have plaque in their arteriestriglycerides associate with risk at population level; higher triglycerides associate with higher risk; lowering them doesn’t necessarily lower risk high triglycerides reflect overweight, diabetes etc. changing triglycerides directly doesnt necessarily do muchmarkers vs makers. triglycerides, HDL-cholesterol (tracks well with risk but changing HDL-c directly makes little difference), LDL-cholesteroltriglycerides/HDL-cholesterol, total cholesterol/HDL-cholesterol, reflect obesity, diabetes but higher HDL-cholesterol genetically doesn´t affect risktriglycerides can come down without change to apoBhigh triglycerides: chances are i´m overweight or diabetic; if triglycerides come down due to weight loss, they reflect positive changevery high triglycerides can be bad news besides heart disease. pancreatitis and fatty liver. don´t ignore high triglycerides. but don’t assume lower triglycerides mean lower heart disease risk; also can’t assume low triglycerides mean safety. could still have determinants of cardiovascular risk out of whack, like high blood pressure or high ApoBfibrates reduce triglycerides and VLDLs yet risk wasn´t lowerConnect with me:Facebook: https://www.facebook.com/DrGilCarvalho/Twitter: https://twitter.com/NutritionMadeS3Animations: Even Topland @toplandmediaReferences:1-https://www.nejm.org/doi/full/10.1056/NEJMoa22106452-https://jamanetwork.com/journals/jamacardiology/article-abstract/27863343-https://jamanetwork.com/journals/jama/article-abstract/27688504-https://jamanetwork.com/journals/jama/article-abstract/27227705-https://www.nejm.org/doi/full/10.1056/NEJMe22132086-https://pubmed.ncbi.nlm.nih.gov/33870931/7-https://link.springer.com/book/10.1007/978-1-59745-533-68-https://elifesciences.org/articles/58361#s39-https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.119.04199810-https://jamanetwork.com/journals/jama/article-abstract/272277011-https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.100306212-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103514/13-ht Learn more about your ad choices. Visit megaphone.fm/adchoices
