Bruckert E, Emmerich J, Delahaye F, Richard J L, Thomas D
Service d'endocrinologie-métabolisme, groupe hospitalier Pitié-Salpêtrière, Paris.
Arch Mal Coeur Vaiss. 1992 Oct;85 Spec No 3:29-35.
The role of triglycerides in cardiovascular disease is a controversial subject. Despite differences of opinion, present data allow a certain number of conclusions to be drawn. Hyperchylomicronemia is not associated with atherosclerosis, whereas type III hyperlipidemia is very atherogenic. These two abnormalities are, however, rare, and the majority of hypertriglyceridemias are, in practice, associated with increased very low density lipoproteins. Many epidemiological trials do not identify hypertriglyceridemia as an independent risk factor when the cholesterol and, in particular, the HDL cholesterol levels, are taken into consideration. Nevertheless, these results must be interpreted with caution as hypertriglyceridemia represents a very heterogeneous entity which is closely related to many factors which affect coronary risk (hypertension, insulin resistance, sedentarity, and even tobacco consumption). Therefore, hypertriglyceridemia and hypo-HDL-emia may be the result of the same primary abnormality; as the HDL-cholesterol level is more stable, it is the parameter which will be identified as a protective factor in epidemiological trials. The available data is insufficient to affirm that therapeutic lowering of triglycerides is accompanied by a reduced coronary risk because none of the large scale trials were designed to analyse this problem. Despite these epidemiological data, the measurement of serum triglyceride levels remains important in patients with hyperlipidemia.
甘油三酯在心血管疾病中的作用是一个有争议的话题。尽管存在意见分歧，但现有数据仍能得出一些结论。高乳糜微粒血症与动脉粥样硬化无关，而III型高脂血症则具有很强的致动脉粥样硬化性。然而，这两种异常情况较为罕见，实际上大多数高甘油三酯血症都与极低密度脂蛋白增加有关。在考虑胆固醇，尤其是高密度脂蛋白胆固醇水平时，许多流行病学试验并未将高甘油三酯血症确定为独立的危险因素。然而，这些结果必须谨慎解读，因为高甘油三酯血症是一个非常异质性的实体，与许多影响冠心病风险的因素密切相关（高血压、胰岛素抵抗、久坐不动，甚至吸烟）。因此，高甘油三酯血症和低高密度脂蛋白血症可能是同一原发性异常的结果；由于高密度脂蛋白胆固醇水平更稳定，它是在流行病学试验中将被确定为保护因素的参数。现有数据不足以证实降低甘油三酯的治疗会伴随冠心病风险降低，因为没有一项大规模试验旨在分析这个问题。尽管有这些流行病学数据，但对于高脂血症患者，测量血清甘油三酯水平仍然很重要。
