**2.3 Triglycerides**

The relationship between hypertriglyceridemia and CVD was determined in the populationbased Stockholm prospective study (Carlson et al., 1979). In this study, 3,486 subjects were followed for 14.5 years. An independent relation between hypertriglyceridemia and CVD was observed in this study, which was stronger than the relationship between hypercholesterolemia and CVD. Meta-analysis of several large population–based prospective studies showed similar results (Hokanson & Austin, 1996). Based on this study, the univariate risk ratio (RR) of triglyceride, independent of HDL and other CVD risk factors, among men was 1.32 (95 percent CI, 1.26 to 1.39) and among women was 1.76 (95 percent CI, 1.50 to 2.07).

As mentioned previously in the HHS study, not only there is an interaction between triglycerides and total cholesterol/HDL ratio, but also an inverse association between triglycerides and HDL levels exists (Rosenson, 2011). Additionally, hypertriglyceridemia is associated with increased mortality in patients with known CHD and also reduces the

 <sup>8</sup> Helsinki Heart Study

In the Lipid Research Clinics study, the Framingham heart Study and the HHS8 the ratio of LDL to HDL was shown to be the best predictor of cardiovascular events (Manninen et al., 1992; Kinosian et al., 1994). In HHS study, the risk of new coronary events such as myocardial infarction and sudden cardiac death in patients with LDL/HDL ≥ 5 and a concomitant serum triglycerides ≥ 200 mg /dl, was fourfold more than patients with lower LDL/HDL ratio and triglycerides levels. Overall, among men, an LDL/HDL ratio of ≥ 6.4 had 2–14 percent higher predictive value than serum total cholesterol or LDL levels. Among women the predictive value of LDL/HDL ≥ 5.6 was 25–45 percent greater than serum total

**men women** 

**HDL (mg/dl) Multiplier for cardiovascular risk** 

75 Longevity syndrome Longevity syndrome

Table 3. Inverse relation between plasma HDL-cholesterol levels and cardiovascular risk in

The relationship between hypertriglyceridemia and CVD was determined in the populationbased Stockholm prospective study (Carlson et al., 1979). In this study, 3,486 subjects were followed for 14.5 years. An independent relation between hypertriglyceridemia and CVD was observed in this study, which was stronger than the relationship between hypercholesterolemia and CVD. Meta-analysis of several large population–based prospective studies showed similar results (Hokanson & Austin, 1996). Based on this study, the univariate risk ratio (RR) of triglyceride, independent of HDL and other CVD risk factors, among men was 1.32 (95 percent CI, 1.26 to 1.39) and among women was 1.76 (95

As mentioned previously in the HHS study, not only there is an interaction between triglycerides and total cholesterol/HDL ratio, but also an inverse association between triglycerides and HDL levels exists (Rosenson, 2011). Additionally, hypertriglyceridemia is associated with increased mortality in patients with known CHD and also reduces the

30 1.82 ---- 35 1.49 ---- 40 1.22 1.94 45 1.00 1.55 50 0.82 1.25 55 0.67 1.00 60 0.55 0.80 65 0.45 0.64 70 ---- 0.52

cholesterol or LDL level (Kinosian et al., 1994).

Legend: HDL: High Density Lipoprotein.

men and women.

**2.3 Triglycerides** 

percent CI, 1.50 to 2.07).

<sup>8</sup> Helsinki Heart Study

event–free survival after coronary artery bypass graft surgery (CABG) (Haim et al., 1999; Sprecher et al., 2000).

Nevertheless, because hypertriglyceridemia is an independent risk factor for CVD, measurement of triglycerides as a part of routine cholesterol screening is recommended by NECP ATPIII guidelines (Haim et al., 1999). Fasting triglyceride measurement is important for evaluating the risk of heart disease especially in cases who are suffering from diabetes, glucose intolerance, insulin resistance syndrome, obesity and low HDL. Although, triglyceride measurement is commonly done after 8–12 hours fasting, an association between nonfasting triglyceride levels and CVD is also present (Nordestgaard et al., 2007; Bansal et al., 2007).
