Increased Risk of Myocardial Infarction in Men With Both Hypertriglyceridemia and Elevated HDL Cholesterol
To the Editor:
By the use of a sophisticated statistical method, Jeppesen and colleagues have confirmed that hypertriglyceridemia is an independent risk factor for coronary events in the general male population.1 2 3 4 5 In addition, they made the interesting observation that hypertriglyceridemia increased the risk of myocardial infarction even in the presence of high levels of HDL cholesterol that are considered cardioprotective. Because hypertriglyceridemia in most cases is associated with low HDL cholesterol levels, the coincidence of hypertriglyceridemia and high HDL cholesterol had a low prevalence (3.6%). As a result, the number of myocardial infarctions in this group was also very low (13). Due to the low number of observations, it is important to verify this interesting finding in another study.
We investigated the cooperative effects of hypertriglyceridemia and HDL cholesterol in an 8-year follow-up of 4849 male participants (aged 40 to 64 years) of the Prospective Cardiovascular Münster (PROCAM) study.5 During this time, 181 definite nonfatal myocardial infarctions, 49 fatal myocardial infarctions, and 28 sudden cardiac deaths were observed. Forty-one men suffered nonfatal stroke, and 179 men died of stroke or noncardiovascular diseases. In addition, 4381 men survived the 8-year follow up without any coronary event or stroke. In men with triglyceride levels below 150 mg/dL, the incidence of coronary events decreased from 10.1% if HDL cholesterol was below 35 mg/dL (24 events among 237 case subjects) to 4.5% if HDL cholesterol levels ranged between 35 and 55 mg/dL (82/1918) and to 1.3% if HDL cholesterol exceeded 55 mg/dL (8/642). In men with triglyceride levels between 150 and 200 mg/dL, the incidences of coronary events in the respective HDL ranges were 12.1% (19/157), 4.3% (25/578), and 4.6% (3/65). Triglyceride levels higher than 200 mg/dL were associated with increased incidences of coronary events both in men with HDL cholesterol levels below 35 mg/dL (58/371, 15.6%) and in men with HDL cholesterol levels above 55 mg/dL (7/58, 12.1%) compared with men with intermediate HDL cholesterol levels (32/613, 5.2%). Compared with the entire unaffected population, the risk for coronary events was increased by a factor of 2.2 in hypertriglyceridemic men with high HDL cholesterol (95% CI, 1.04 to 4.67). Together, the observations in the Copenhagen Male Study and the PROCAM study suggest that the coincidence of hypertriglyceridemia and elevated HDL cholesterol increases the risk for myocardial infarction.
- Copyright © 1999 by American Heart Association
Jeppesen J, Hein HO, Suadicani P, Gyntelberg F. Triglyceride concentration and ischemic heart disease: an eight-year follow-up in the Copenhagen Male Study. Circulation. 1998;97:1029–1036.
Austin MA. Plasma triglyceride and coronary artery disease. Arterioscler Thromb. 1991;11:2–13.
Bainton D, Miller NE, Bolton CH, Yarnell JW, Sweetnam PM, Baker IA, Lewis B, Elwood PC. Plasma triglyceride and high density lipoprotein cholesterol as predictors of ischaemic heart disease in British men: the Caerphilly and Speedwell Collaborative Heart Disease Studies. Br Heart J. 1992;68:60–66.