Circulation, Vol 85, 37-45, Copyright © 1992 by American Heart Association
V Manninen, L Tenkanen, P Koskinen, JK Huttunen, M Manttari, OP Heinonen and MH Frick
BACKGROUND. We studied the joint effect of baseline triglyceride and
lipoprotein cholesterol levels on the incidence of cardiac end points in
the trial group (n = 4,081) of the Helsinki Heart Study, a 5-year
randomized coronary primary prevention trial among dyslipidemic middle-
aged men. The relative risks (RR) were calculated using Cox proportional
hazards models with a dummy variable technique that allows simultaneous
study of subgroup combinations from the placebo and treatment groups.
METHODS AND RESULTS. In the placebo group (n = 2,045), the low density
lipoprotein cholesterol (LDL-C)/high density lipoprotein cholesterol
(HDL-C) ratio was the best single predictor of cardiac events. This ratio
in combination with the serum triglyceride level revealed a high-risk
subgroup: subjects with LDL-C/HDL-C ratio greater than 5 and triglycerides
greater than 2.3 mmol/l had a RR of 3.8 (95% CI, 2.2-6.6) compared with
those with LDL-C/HDL-C ratio less than or equal to 5 and triglyceride
concentration less than or equal to 2.3 mmol/l. In subjects with
triglyceride concentration greater than 2.3 mmol/l and LDL-C/HDL-C ratio
less than or equal to 5, RR was close to unity (1.1), whereas in those with
triglyceride level less than or equal to 2.3 mmol/l and LDL-C/HDL-C ratio
greater than 5, RR was 1.2. The high-risk group with LDL-C/HDL-C ratio
greater than 5 and triglyceride level greater than 2.3 mmol/l profited most
from treatment with gemfibrozil, with a 71% lower incidence of coronary
heart disease events than the corresponding placebo subgroup. In all other
subgroups, the reduction in CHD incidence was substantially smaller.
CONCLUSIONS. Serum triglyceride concentration has prognostic value, both
for assessing coronary heart disease risk and in predicting the effect of
gemfibrozil treatment, especially when used in combination with HDL-C and
LDL-C.
ARTICLES
Joint effects of serum triglyceride and LDL cholesterol and HDL cholesterol concentrations on coronary heart disease risk in the Helsinki Heart Study. Implications for treatment
First Department of Medicine, Helsinki University Central Hospital, Finland.
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H. B. Rubins The Trouble With Triglycerides Arch Intern Med, July 10, 2000; 160(13): 1903 - 1904. [Full Text] [PDF]
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A. L. Avins and J. M. Neuhaus Do Triglycerides Provide Meaningful Information About Heart Disease Risk? Arch Intern Med, July 10, 2000; 160(13): 1937 - 1944. [Abstract] [Full Text] [PDF]
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S. M. Haffner Secondary Prevention of Coronary Heart Disease : The Role of Fibric Acids Circulation, July 4, 2000; 102(1): 2 - 4. [Full Text] [PDF]
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Secondary Prevention by Raising HDL Cholesterol and Reducing Triglycerides in Patients With Coronary Artery Disease : The Bezafibrate Infarction Prevention (BIP) Study Circulation, July 4, 2000; 102(1): 21 - 27. [Abstract] [Full Text] [PDF]
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M. J. Zema Gemfibrozil, nicotinic acid and combination therapy in patients with isolated hypoalphalipoproteinemia: a randomized, open-label, crossover study J. Am. Coll. Cardiol., March 1, 2000; 35(3): 640 - 646. [Abstract] [Full Text] [PDF]
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J. D. Jones and M. L. Chambliss Hypertriglyceridemia and Coronary Heart Disease Arch Fam Med, February 1, 2000; 9(2): 189 - 190. [Full Text] [PDF]
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S. M. Grundy, T. Bazzarre, J. Cleeman, R. B. D’Agostino Sr, M. Hill, N. Houston-Miller, W. B. Kannel, R. Krauss, H. M. Krumholz, R. M. Lauer, et al. Prevention Conference V : Beyond Secondary Prevention : Identifying the High-Risk Patient for Primary Prevention : Medical Office Assessment : Writing Group I Circulation, January 4, 2000; 101 (1): e3 - e11. [Full Text] [PDF]
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D. Steinberg and A. M. Gotto Jr Preventing Coronary Artery Disease by Lowering Cholesterol Levels: Fifty Years From Bench to Bedside JAMA, December 1, 1999; 282(21): 2043 - 2050. [Abstract] [Full Text] [PDF]
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H. Yagyu, S. Ishibashi, Z. Chen, J.-i. Osuga, M. Okazaki, S. Perrey, T. Kitamine, M. Shimada, K. Ohashi, K. Harada, et al. Overexpressed lipoprotein lipase protects against atherosclerosis in apolipoprotein E knockout mice J. Lipid Res., September 1, 1999; 40(9): 1677 - 1685. [Abstract] [Full Text]
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M. Haim, M. Benderly, D. Brunner, S. Behar, E. Graff, H. Reicher-Reiss, and U. Goldbourt Elevated Serum Triglyceride Levels and Long-Term Mortality in Patients With Coronary Heart Disease : The Bezafibrate Infarction Prevention (BIP) Registry Circulation, August 3, 1999; 100(5): 475 - 482. [Abstract] [Full Text] [PDF]
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H. H. Yu, G. S. Ginsburg, M. L. O'Toole, J. D. Otvos, P. S. Douglas, and N. Rifai Acute Changes in Serum Lipids and Lipoprotein Subclasses in Triathletes as Assessed by Proton Nuclear Magnetic Resonance Spectroscopy Arterioscler Thromb Vasc Biol, August 1, 1999; 19(8): 1945 - 1949. [Abstract] [Full Text] [PDF]
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G. B. Schnell, A. Robertson, D. Houston, L. Malley, and T. J. Anderson Impaired brachial artery endothelial function is not predicted by elevated triglycerides J. Am. Coll. Cardiol., June 1, 1999; 33(7): 2038 - 2043. [Abstract] [Full Text] [PDF]
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A. M. Gotto Jr Prognostic and Therapeutic Significance of Low Levels of High-Density Lipoprotein Cholesterol: Current Perspectives Arch Intern Med, May 24, 1999; 159(10): 1038 - 1040. [Full Text] [PDF]
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A. M. Gotto Jr and S. M. Grundy Lowering LDL Cholesterol : Questions From Recent Meta-Analyses and Subset Analyses of Clinical Trial DataIssues From the Interdisciplinary Council on Reducing the Risk for Coronary Heart Disease, Ninth Council Meeting Circulation, March 2, 1999; 99 (8): e1 - e7. [Abstract] [Full Text] [PDF]
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B. Lamarche, A. Tchernof, P. Mauriege, B. Cantin, G. R. Dagenais, P. J. Lupien, and J.-P. Despres Fasting Insulin and Apolipoprotein B Levels and Low-Density Lipoprotein Particle Size as Risk Factors for Ischemic Heart Disease JAMA, June 24, 1998; 279(24): 1955 - 1961. [Abstract] [Full Text] [PDF]
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B. Lamarche, K. D. Uffelman, G. Steiner, P. H. R. Barrett, and G. F. Lewis Analysis of particle size and lipid composition as determinants of the metabolic clearance of human high density lipoproteins in a rabbit model J. Lipid Res., June 1, 1998; 39(6): 1162 - 1172. [Abstract] [Full Text]
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