title: Triglycerides:  a case for treatment?
abstract: OBJECTIVE
  To discuss the relevance of triglycerides to cardiovascular disease (CVD) risk.
  
  
  RESULTS
  Triglycerides are a commonly measured component of lipid profiles. Raised triglycerides are a component of the metabolic syndrome and are strongly associated with future risk of diabetes as well as cardiovascular disease. Triglyceride-rich particles form a component of cardiovascular risk above that delineated by low density lipoprotein (LDL) cholesterol. Elevated triglycerides are a marker of atherogenic small dense LDL, excess baseline and residual CVD risk even after statin therapy. Additional methods to lower triglycerides include niacin, fibrates and omega-3 fatty acids. Trials in monotherapy with both niacin and fibrates suggest some benefit in reducing CVD events based on evidence mostly derived from older studies. However, endpoint trials of adding either niacin or fenofibrate to statins have not shown any benefit, except possibly in patients with an increased atherogenic index (triglyceride : HDL-C ratio), or have been underpowered. Trials of omega-3 fatty acids have been performed at doses insufficient to affect lipid profiles in populations with inadequate control of LDL-C but did reduce CVD events.
  
  
  CONCLUSIONS
  Further trials of lipid-lowering agents beyond statins will be required in patients with LDL-C adequately controlled on statin therapy.
authors.affiliation: Guy's and St Thomas' Hospitals, London, Lambeth, UK. Anthony.Wierzbicki@kcl.ac.uk
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Wierzbicki
authors.forename: Rosemary E
authors.initials: RE
authors.lastname: Clarke
authors.forename: Adie
authors.initials: A
authors.lastname: Viljoen
authors.forename: Dimitri P
authors.initials: DP
authors.lastname: Mikhailidis
mesh_terms: D000924:Anticholesteremic Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use; D058607:Fibric Acids / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015228:Hypertriglyceridemia / Q000188:drug therapy*; D018570:Risk Assessment / Q000379:methods; D014280:Triglycerides / Q000097:blood*; D014481:United States / Q000453:epidemiology
chemical_list: D000924:Anticholesteremic Agents; D015525:Fatty Acids, Omega-3; D058607:Fibric Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D014280:Triglycerides