Miller M
Center for Preventative Cardiology, University of Maryland School of Medicine, Baltimore 21201-1595, USA.
Eur Heart J. 1998 Jul;19 Suppl H:H18-22.
There has been considerable controversy over whether elevated levels of triglycerides, or hypertriglyceridaemia, is an independent risk factor in coronary heart disease (CHD). Discrepancies between findings of univariate and multivariate statistical analyses are likely to be due to the strong inverse correlation between plasma triglyceride levels and high density lipoprotein cholesterol. Convincing evidence of a link between elevated triglyceride levels and CHD has been reported in a meta-analysis of patients whose plasma triglyceride levels were measured in the fasting state. Further evidence has come from several angiographic studies that have examined the relationship between plasma triglyceride levels and the progression of coronary artery disease (CAD). It is critical that the threshold of placebo triglyceride, above which hypertriglyceridaemia is recognized, is set at an appropriate level. This will ensure that patients at potential risk of CHD receive appropriate lipid-lowering treatment. In an 18-year follow-up study, incidence and severity of stenosis correlated with plasma triglyceride level. At a triglyceride level of 100 mg. dl-1, which current guidelines would consider to be low risk, patients had a reduced chance of survival from coronary events. These findings suggest that the present classification of triglyceride levels in the assessment of CAD risk may need to be redefined.
甘油三酯水平升高（即高甘油三酯血症）是否为冠心病（CHD）的独立危险因素一直存在很大争议。单变量和多变量统计分析结果之间的差异可能是由于血浆甘油三酯水平与高密度脂蛋白胆固醇之间存在强烈的负相关。在一项对空腹状态下测量血浆甘油三酯水平的患者进行的荟萃分析中，已报告了甘油三酯水平升高与冠心病之间存在关联的令人信服的证据。更多证据来自多项血管造影研究，这些研究探讨了血浆甘油三酯水平与冠状动脉疾病（CAD）进展之间的关系。至关重要的是，将高于此水平即被认定为高甘油三酯血症的安慰剂甘油三酯阈值设定在适当水平。这将确保有冠心病潜在风险的患者接受适当的降脂治疗。在一项为期18年的随访研究中，狭窄的发生率和严重程度与血浆甘油三酯水平相关。在甘油三酯水平为100mg·dl-1时（当前指南会认为这是低风险水平），患者因冠心病事件存活的几率降低。这些发现表明，目前在评估CAD风险时对甘油三酯水平的分类可能需要重新定义。
