Non-fasting triglycerides predict incident acute myocardial infarction among those with favourable HDL-cholesterol: Cohort Norway *

Abstract

Aims

to prospectively evaluate the risk of acute myocardial infarction (AMI) associated with non-fasting triglyceride levels.

Methods

a health survey of 140,790 Norwegians free of known coronary heart disease at baseline (1994–2003) were followed through December 2009 via record linkages to the Cause of Death Registry and hospital discharge diagnoses in the CVDNOR project, and evaluated in Cox proportional hazards analyses.

Results

a total of 3219 (4.8%) men and 1434 (1.9%) women developed an AMI. Women had a steeper gradient risk with increasing triglyceride decile than men, where the highest (≥2.88 mmol/l) compared to the lowest decile (<0.7 mmol/l) was associated with an age-adjusted 4.7-fold excess risk in women in contrast to a 2.8-fold excess risk in men (interaction term, p < 0.001). A significant at-risk HDL-C (<1.0 mmol/l for men and <1.3 mmol/l for women) by triglyceride interaction term was observed. HRs increased with increasing triglyceride quartile in participants with a favourable HDL-C after multivariable adjustment (p for trend <0.001), but triglycerides did not significantly predict AMI among those with low HDL-C. For those with favourable HDL-C, net reclassification index identified a 10% and 14% improvement in classification for men and women, respectively.

Conclusion

non-fasting triglyceride levels among individuals with favourable HDL-C may help identify a subset of individuals at risk for CHD. Further research is warranted in evaluating non-fasting triglycerides in CHD prediction.

Keywords

Acute myocardial infarction lipids

Get full access to this article

View all access options for this article.

References

Gotto

Jr . Triglyceride: the forgotten risk factor. Circulation 1998; 97: 1027–1028.

Hokanson

Austin

. Plasma triglyceride level is a risk factor for cardiovascular disease independent of high-density lipoprotein cholesterol level: a meta-analysis of population-based prospective studies. J Cardiovasc Risk 1996; 3: 213–219.

Abdel-Maksoud

Hokanson

. The complex role of triglycerides in cardiovascular disease. Semin Vasc Med 2002; 2: 325–333.

Sarwar

Danesh

Eiriksdottir

. Triglycerides and the risk of coronary heart disease: 10,158 incident cases among 262,525 participants in 29 Western prospective studies. Circulation 2007; 115: 450–458.

Di Angelantonio

Sarwar

Perry

. Major lipids, apolipoproteins, and risk of vascular disease. JAMA 2009; 302: 1993–2000.

Brunzell

Davidson

Furberg

. Lipoprotein management in patients with cardiometabolic risk: consensus conference report from the American Diabetes Association and the American College of Cardiology Foundation. J Am Coll Cardiol 2008; 51: 1512–1524.

Rashid

Watanabe

Sakaue

. Mechanisms of HDL lowering in insulin resistant, hypertriglyceridemic states: the combined effect of HDL triglyceride enrichment and elevated hepatic lipase activity. Clin Biochem 2003; 36: 421–429.

Zilversmit

. Atherogenesis: a postprandial phenomenon. Circulation 1979; 60: 473–485.

Kolovou

Anagnostopoulou

Daskalopoulou

. Clinical relevance of postprandial lipaemia. Curr Med Chem 2005; 12: 1931–1945.

10.

Nordestgaard

Benn

Schnohr

. Nonfasting triglycerides and risk of myocardial infarction, ischemic heart disease, and death in men and women. JAMA 2007; 298: 299–308.

11.

Bansal

Buring

Rifai

. Fasting compared with nonfasting triglycerides and risk of cardiovascular events in women. JAMA 2007; 298: 309–316.

12.

Lindman

Veierod

Tverdal

. Nonfasting triglycerides and risk of cardiovascular death in men and women from the Norwegian Counties Study. Eur J Epidemiol 2010; 25: 789–798.

13.

Stensvold

Tverdal

Urdal

. Non-fasting serum triglyceride concentration and mortality from coronary heart disease and any cause in middle aged Norwegian women. BMJ 1993; 307: 1318–1322.

14.

Austin

. Triacylglycerol and coronary heart disease. Proc Nutr Soc 1997; 56: 667–670.

15.

Patel

Barzi

Jamrozik

. Serum triglycerides as a risk factor for cardiovascular diseases in the Asia-Pacific region. Circulation 2004; 110: 2678–2686.

16.

Rubies-Prat

Ordonez-Llanos

Martin

. Low-density lipoprotein particle size, triglyceride-rich lipoproteins, and glucose tolerance in non-diabetic men with essential hypertension. Clin Exp Hypertens 2001; 23: 489–500.

17.

Dobiasova

Frohlich

. The plasma parameter log (TG/HDL-C) as an atherogenic index: correlation with lipoprotein particle size and esterification rate in apoB-lipoprotein-depleted plasma (FER(HDL)). Clin Biochem 2001; 34: 583–588.

18.

Ohta

Saku

Takata

. Fractional esterification rate of cholesterol in high density lipoprotein (HDL) can predict the particle size of low density lipoprotein and HDL in patients with coronary heart disease. Atherosclerosis 1997; 135: 205–212.

19.

Packard

. Triacylglycerol-rich lipoproteins and the generation of small, dense low-density lipoprotein. Biochem Soc Trans 2003; 31(Pt 5): 1066–1069.

20.

Ansell

Fonarow

Fogelman

. The paradox of dysfunctional high-density lipoprotein. Curr Opin Lipidol 2007; 18: 427–434.

21.

Jeppesen

Hein

Suadicani

. High triglycerides and low HDL cholesterol and blood pressure and risk of ischemic heart disease. Hypertension 2000; 36: 226–232.

22.

Castelli

. Epidemiology of triglycerides: a view from Framingham. Am J Cardiol 1992; 70: 3H–9H.

23.

Abdel-Maksoud

Eckel

Hamman

. Risk of coronary heart disease is associated with triglycerides and high-density lipoprotein cholesterol in women and non-high-density lipoprotein cholesterol in men. J Clin Lipidol 2012; 6: 374–381.

24.

Jeppesen

Hein

Suadicani

. Triglyceride concentration and ischemic heart disease: an eight-year follow-up in the Copenhagen Male Study. Circulation 1998; 97: 1029–1036.

25.

Assmann

Schulte

. The importance of triglycerides: results from the Prospective Cardiovascular Munster (PROCAM) Study. Eur J Epidemiol 1992; 8(Suppl 1): 99–103.

26.

Criqui

Heiss

Cohn

. Plasma triglyceride level and mortality from coronary heart disease. N Engl J Med 1993; 328: 1220–1225.

27.

Arsenault

Rana

Stroes

. Beyond low-density lipoprotein cholesterol: respective contributions of non-high-density lipoprotein cholesterol levels, triglycerides, and the total cholesterol/high-density lipoprotein cholesterol ratio to coronary heart disease risk in apparently healthy men and women. J Am Coll Cardiol 2009; 55: 35–41.

28.

Naess

Sogaard

Arnesen

. Cohort profile: cohort of Norway (CONOR). Int J Epidemiol 2008; 37: 481–485.

29.

Rabanal

Lindman

Selmer

. Ethnic differences in risk factors and total risk of cardiovascular disease based on the Norwegian CONOR study. Eur J Prev Cardiol 2013; 20: 1013–1021.

30.

Sulo

Igland

Nygård

. Favourable trends in incidence of AMI Norway during 2001-2009 do not include younger adults: a CVDNOR project. Eur J Prev Cardiol 2013. Epub ahead of print 11 July 2013. DOI: 10.1177/2047487313495993.

31.

Sulo

G IJ

Vollset

Nygård

. Cardiovascular disease and diabetes mellitus in Norway during 1994–2009. CVDNOR – a nationwide research project. Nor J Epidemiol. 23: 101–107.

32.

Third Report of the National Cholesterol Education Program (NCEP). Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106: 3143–3421.

33.

Desquilbet

Mariotti

. Dose-response analyses using restricted cubic spline functions in public health research. Statistics in Medicine 2010; 29: 1037–1057.

34.

Pencina

D'Agostino

Sr Steyerberg

. Extensions of net reclassification improvement calculations to measure usefulness of new biomarkers. Statistics in Medicine 2011; 30: 11–21.

35.

Pencina

D'Agostino

Sr D'Agostino

Jr . Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Statistics in Medicine 2008; 27: 157–172.

36.

Ramjee

Sperling

Jacobson

. Non-high-density lipoprotein cholesterol versus apolipoprotein B in cardiovascular risk stratification: do the math. J Am Coll Cardiol 2011; 58: 457–463.

37.

Boekholdt

Arsenault

Mora

. Association of LDL cholesterol, non-HDL cholesterol, and apolipoprotein B levels with risk of cardiovascular events among patients treated with statins: a meta-analysis. JAMA 2012; 307: 1302–1309.

38.

Huxley

Barzi

Woodward

. Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies. BMJ 2006; 332: 73–78.

39.

Rivellese

Riccardi

Vaccaro

. Cardiovascular risk in women with diabetes. Nutr Metab Cardiovasc Dis 2010; 20: 474–480.

40.

Wilson

Meigs

Sullivan

. Prediction of incident diabetes mellitus in middle-aged adults: the Framingham Offspring Study. Arch Intern Med 2007; 167: 1068–1074.

41.

Preis

Pencina

Mann

. Early-adulthood cardiovascular disease risk factor profiles among individuals with and without diabetes in the Framingham Heart Study. Diabetes Care 2013; 36: 1590–1596.

42.

Jeppesen

Hein

Suadicani

. High triglycerides/low high-density lipoprotein cholesterol, ischemic electrocardiogram changes, and risk of ischemic heart disease. Am Heart J 2003; 145: 103–108.

43.

Sarwar

Sandhu

Ricketts

. for the Triglyceride Coronary Disease Genetics Consortium and Emerging Risk Factors Collaboration. Triglyceride-mediated pathways and coronary disease: collaborative analysis of 101 studies. Lancet 2010; 375: 1634–1639.