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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