Advertisement

Differentiating the effects of raising low levels of high-density lipoprotein cholesterol versus lowering normal triglycerides: further insights from the veterans affairs high-density lipoprotein intervention trial

  • Michael Miller
    Correspondence
    Address for reprints: Michael Miller, MD, Division of Cardiology, University of Maryland Hospital, 22 South Greene, RM S3B06, Baltimore, Maryland 21201
    Affiliations
    Division of Cardiology, University of Maryland Hospital, Baltimore, Maryland, USA
    Search for articles by this author

      Abstract

      In the Veterans Affairs High-Density Lipoprotein Intervention Trial (VA-HIT), a 6% increase in high-density lipoprotein cholesterol (HDL-C) was associated with a 22% reduction in the incidence of fatal and nonfatal myocardial infarction and death from coronary artery disease. A curvilinear correlation was demonstrated between incremental changes in HDL-C and outcome. However, triglyceride levels, which decreased by 31%, were not predictive of clinical events. Some design limitations may be implicated in this lack of statistical correlation between triglycerides and outcome. Evidence from other studies, notably the Framingham Heart Study, the Prospective Cardiovascular Münster Heart Study (PROCAM), and the Baltimore Coronary Observational Long-Term Study (COLTS) suggest that the triglyceride cutpoint of 200 mg/dL is too high. The Bezafibrate Infarction Prevention (BIP) trial found a significant correlation between reduction in death from coronary artery disease and nonfatal MI and reduced triglycerides in a subset of patients with baseline triglycerides >200 mg/dL.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Rubins HB, Robins S, Collins D, Fye CL, Anderson JW, Elam MB, Faas FH, Linares E, Schaefer EJ, Schectman G, Wilt TJ, Wittes J. For the Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group. Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. N Engl J Med 1999;341:410–418.

      2. Robins SJ, Colllins D, Rubins HB. Relation of baseline lipids and lipid changes with gemfibrozil to cardiovascular endpoints in the VA-High Density Lipoprotein Intervention Trial (VA-HIT) [abstract]. Circulation 1999;100(suppl):I-238.

        • Patsch J.R.
        • Miesenbock G.
        • Hopferwieser T.
        • Muhlberger V.
        • Knapp E.
        • Dunn J.K.
        • Gotto A.M.
        • Patsch W.
        Relation of triglyceride metabolism and coronary artery disease.
        Arterioscler Thromb. 1992; 12: 1336-1345
      3. Cohn JS, McNamara Jr, Krasinkski SD, Russell RM, Schaefer EJ. Role of triglyceride-rich lipoproteins from the liver and intestine in the etiology of postprandial peaks in plasma triglyceride concentration. Metabolism 1989;38:484–490.

        • Miller M.
        • Bachorik P.S.
        • Cloey T.A.
        Normal variation of plasma lipoproteins.
        Clin Chem. 1992; 38: 569-574
      4. Miller M. The epidemiology of triglyceride as a coronary artery disease risk factor. Clin Cardiol 1999;22(6 suppl):II1–II6.

      5. Castelli WP. Cholesterol and lipids in the risk of coronary artery disease: the Framingham Heart Study. Can J Cardiol 1988;4:5A–10A.

        • Assmann G.
        • Schulte H.
        Relation of high-density lipoprotein cholesterol and triglycerides to incidence of atherosclerotic coronary artery disease (the PROCAM experience).
        Am J Cardiol. 1992; 70: 733-737
        • Miller M.
        • Seidler A.
        • Moalemi A.
        • Pearson T.A.
        Normal triglyceride levels and coronary artery disease events.
        J Am Coll Cardiol. 1998; 31: 1252-1257
        • Austin M.A.
        • King M.-C.
        • Vranizan K.M.
        • Krauss R.M.
        Atherogenic lipoprotein phenotype.
        Circulation. 1990; 82: 495-506
        • Manninen V.
        • Tenkanen L.
        • Koskinen P.
        • Huttunen J.K.
        • Manttari M.
        • Heinonen O.P.
        • Frick M.H.
        Joint effects of serum triglyceride and LDL cholesterol and HDL cholesterol concentrations on coronary heart disease risk in the Helsinki Heart Study.
        Circulation. 1992; 85: 37-46
      6. Goldbourt U, Brunner D, Behar S, Reicher-Reiss H. Baseline characteristics of patients participating in the Bezafibrate Infarction Prevention (BIP) study. Eur Heart J 1998;19:H42–H47.

      7. Anonymous. Secondary prevention by raising HDL cholesterol and reducing triglycerides in patients with coronary artery disease: the Bezafibrate Infarction Prevention (BIP) study. Circulation 2000;102:21–27.