Triglycerides and cardiovascular disease
Triglycerides and cardiovascular disease
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DOI：
10.1016/s0140-6736(14)61177-6
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发表时间：
2014-08-16
期刊：
影响因子：
168.9
通讯作者：
Varbo, Anette
中科院分区：
文献类型：
--
作者：
Nordestgaard, Borge G.;Varbo, Anette
在他汀类药物引入后，临床重点首先集中在降低低密度脂蛋白胆固醇上，然后集中在提高高密度脂蛋白胆固醇的可能性上，而较少关注降低甘油三酯。然而，遗传研究的理解和随机试验的负面结果--低高密度脂蛋白胆固醇可能不会像最初认为的那样导致心血管疾病--现在重新引发了人们对提高甘油三酯浓度的兴趣。流行病学和遗传学证据也支持甘油三酯、残余胆固醇或富含甘油三酯的脂蛋白升高是心血管疾病和全因死亡的另一个原因，这也推动了这种新的兴趣。甘油三酯可以在非禁食或禁食状态下测量，甘油三酯浓度为2-10 mmoL/L表示患心血管疾病的风险增加，超过10 mmoL/L表示患急性胰腺炎和可能的心血管疾病的风险增加。尽管显示降低甘油三酯对心血管有益的随机试验很少，但新的降低甘油三酯的药物正在开发中，大规模试验已经启动，有望为降低甘油三酯是否降低心血管疾病的风险提供确凿证据。
After the introduction of statins, clinical emphasis first focussed on LDL cholesterol-lowering, then on the potential for raising HDL cholesterol, with less focus on lowering triglycerides. However, the understanding from genetic studies and negative results from randomised trials that low HDL cholesterol might not cause cardiovascular disease as originally thought has now generated renewed interest in raised concentrations of triglycerides. This renewed interest has also been driven by epidemiological and genetic evidence supporting raised triglycerides, remnant cholesterol, or triglyceride-rich lipoproteins as an additional cause of cardiovascular disease and all-cause mortality. Triglycerides can be measured in the non-fasting or fasting states, with concentrations of 2-10 mmol/L conferring increased risk of cardiovascular disease, and concentrations greater than 10 mmol/L conferring increased risk of acute pancreatitis and possibly cardiovascular disease. Although randomised trials showing cardiovascular benefit of triglyceride reduction are scarce, new triglyceride-lowering drugs are being developed, and large-scale trials have been initiated that will hopefully provide conclusive evidence as to whether lowering triglycerides reduces the risk of cardiovascular disease.