Triglycerides and Cardiovascular Disease A Scientific Statement From the American Heart Association
Triglycerides and Cardiovascular Disease A Scientific Statement From the American Heart Association
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DOI：
10.1161/cir.0b013e3182160726
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发表时间：
2011-05-24
期刊：
影响因子：
37.8
通讯作者：
Pennathur, Subramanian
中科院分区：
文献类型：
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作者：
Miller, Michael;Stone, Neil J.;Pennathur, Subramanian
甘油三酯水平升高与心血管疾病（CVD）之间存在长期关联。然而，甘油三酯直接促进心血管疾病的程度或代表风险的生物标志物已经争论了30年。为此，2次美国国立卫生研究院共识会议评估了甘油三酯在心血管风险评估中的证据作用，并提供了针对高甘油三酯血症的治疗建议。4,5自1993年以来，人们对富含甘油三酯的脂蛋白（trl，即乳糜微粒和极低密度脂蛋白）的动脉粥样硬化性、甘油三酯代谢的遗传和代谢调节因子以及高甘油三酯血症的分类和治疗有了更多的了解。尤其令人不安的是，在美国，自1976年以来，随着肥胖、胰岛素抵抗（IR）和2型糖尿病（T2DM）的日益流行，平均甘油三酯水平一直在上升。6,7相反，平均低密度脂蛋白胆固醇（LDL-C）水平有所下降。因此，本科学声明的目的是让临床医生了解甘油三酯在心血管疾病风险评估和管理中日益重要的作用，并强调旨在最大限度地减少与高甘油三酯血症相关的不良公共健康后果的方法。该声明将通过强调有效的生活方式策略来降低甘油三酯水平和改善整体心脏代谢健康，从而补充最近美国心脏协会关于儿童和青少年肥胖和饮食糖摄入量的科学声明。它不打算作为一个具体的指导方针，但将有价值的成人治疗小组IV （ATP IV）的国家胆固醇教育计划，从循证指南将随之而来。要讨论的主题包括流行病学和心血管疾病风险、民族和种族差异、代谢决定因素、遗传和家庭决定因素、风险因素相关因素以及与营养、体育活动和脂类药物相关的影响。
A long-standing association exists between elevated triglyceride levels and cardiovascular disease*(CVD). 1, 2 However, the extent to which triglycerides directly promote CVD or represent a biomarker of risk has been debated for 3 decades. 3 To this end, 2 National Institutes of Health consensus conferences evaluated the evidentiary role of triglycerides in cardiovascular risk assessment and provided therapeutic recommendations for hypertriglyceridemic states. 4, 5 Since 1993, additional insights have been made vis-a-vis the atherogenicity of triglyceride-rich lipoproteins (TRLs; ie, chylomicrons and very low-density lipoproteins), genetic and metabolic regulators of triglyceride metabolism, and classification and treatment of hypertriglyceridemia. It is especially disconcerting that in the United States, mean triglyceride levels have risen since 1976, in concert with the growing epidemic of obesity, insulin resistance (IR), and type 2 diabetes mellitus (T2DM). 6, 7 In contrast, mean low-density lipoprotein cholesterol (LDL-C) levels have receded. 7 Therefore, the purpose of this scientific statement is to update clinicians on the increasingly crucial role of triglycerides in the evaluation and management of CVD risk and highlight approaches aimed at minimizing the adverse public health–related consequences associated with hypertriglyceridemic states. This statement will complement recent American Heart Association scientific statements on childhood and adolescent obesity8 and dietary sugar intake9 by emphasizing effective lifestyle strategies designed to lower triglyceride levels and improve overall cardiometabolic health. It is not intended to serve as a specific guideline but will be of value to the Adult Treatment Panel IV (ATP IV) of the National Cholesterol Education Program, from which evidence-based guidelines will ensue. Topics to be addressed include epidemiology and CVD risk, ethnic and racial differences, metabolic determinants, genetic and family determinants, risk factor correlates, and effects related to nutrition, physical activity, and lipid medications.