Schwandt P
Medical Department II, Klinikum Grosshadern, University of Munich, Federal Republic of Germany.
Drugs. 1990;40 Suppl 1:38-41. doi: 10.2165/00003495-199000401-00009.
Although still the subject of debate, most investigators accept that plasma triglyceride levels are a risk factor for coronary heart disease. Data from epidemiological studies such as the Framingham Heart Study, the Paris Prospective Heart Study and the Stockholm Heart Study have shown that patients with elevated plasma triglyceride levels have a higher incidence of coronary heart disease. In one study, coronary heart disease mortality fell by 36% after continued lowering of plasma triglyceride levels. In patients whose triglyceride levels fell greater than 30%, mortality decreased by 60%. The effect of triglycerides as a risk factor appears to be obscured in studies that use multiple cardiac end-points. Several studies demonstrated a stronger association between plasma triglyceride levels and coronary heart disease in patients with total cholesterol levels less than 5.7 mmol/L, or high density lipoprotein (HDL)-cholesterol levels less than 1 mmol/L. Angiographic data have confirmed these findings and show clearly that elevated triglyceride levels are frequently observed in men with coronary heart disease. Other studies have demonstrated that remnants of triglyceride-rich lipoprotein particles are cytotoxic and atherogenic in vitro and in vivo. Also, patients with familial dys beta-lipoproteinaemia, a condition characterised by high levels of triglyceride-rich very low density lipoprotein (VLDL) particles, have a high risk of atherosclerosis. Thus, there seems to be evidence supporting the atherogenic properties of cholesterylester-rich particles, or remnants thereof.
尽管仍存在争议，但大多数研究人员都认为血浆甘油三酯水平是冠心病的一个危险因素。来自诸如弗雷明汉心脏研究、巴黎前瞻性心脏研究和斯德哥尔摩心脏研究等流行病学研究的数据表明，血浆甘油三酯水平升高的患者患冠心病的几率更高。在一项研究中，持续降低血浆甘油三酯水平后，冠心病死亡率下降了36%。甘油三酯水平下降超过30%的患者，死亡率降低了60%。在使用多种心脏终点指标的研究中，甘油三酯作为危险因素的作用似乎被掩盖了。几项研究表明，在总胆固醇水平低于5.7 mmol/L或高密度脂蛋白（HDL）胆固醇水平低于1 mmol/L的患者中，血浆甘油三酯水平与冠心病之间的关联更强。血管造影数据证实了这些发现，并清楚地表明冠心病男性中经常观察到甘油三酯水平升高。其他研究表明，富含甘油三酯的脂蛋白颗粒残留在体外和体内均具有细胞毒性和致动脉粥样硬化作用。此外，患有家族性异常β-脂蛋白血症（一种以富含甘油三酯的极低密度脂蛋白（VLDL）颗粒水平高为特征的疾病）的患者患动脉粥样硬化的风险很高。因此，似乎有证据支持富含胆固醇酯的颗粒或其残粒具有致动脉粥样硬化特性。
