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Triglycerides and Small, Dense Low-Density Lipoprotein

Enas A. Enas, MD
JAMA. 1998;280(23):1990-1991. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-23-jbk1216.
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To the Editor.—In a recent meta-analysis of 17 prospective studies involving 47,000 subjects, elevated triglyceride levels were associated with an increase in coronary artery disease (CAD) risk of 30% in men and 75% in women.1 In 1 study, the 8-year incidence of CAD was 14% in subjects with triglyceride levels of 1.60 to 2.50 mmol/L (142-221 mg/dL) vs 9.5% in those with cholesterol levels of about 8.00 mmol/L (310 mg/dL).2 Miller et al3 found an odds ratio (OR) for CAD of 1.5 with a fasting triglyceride level of 1.13 mmol/L (100 mg/dL), whereas Stampfer et al4 found an OR of 1.4 per 1.13 mmol/L (100 mg/dL) increase in nonfasting triglycerides. An increase in triglycerides of 1.00 mmol/L (90 mg/dL) has the same effect on the extent of coronary atherosclerosis as would aging 10 years. Consequently, I was fascinated by the observations by Dr Lamarche and associates5 showing higher prevalence and OR for CAD with triglycerides than with other lipoproteins: triglyceride level about 1.52 mmol/L (135 mg/dL), prevalence, 77%, OR, 3.5; low-density lipoprotein (LDL) cholesterol level about 3.70 mmol/L (143 mg/dL), prevalence, 68%, OR, 2.4; small, dense LDL, prevalence, 69%, OR, 2.5; and apolipoprotein B level about 1.1 g/L, prevalence, 69%, OR, 2.7.


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