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Changes in Triglyceride Levels and Risk for Coronary Heart Disease in Young Men

Amir Tirosh, MD, PhD; Assaf Rudich, MD, PhD; Tzippora Shochat, MSc; Dorit Tekes-Manova, MD; Eran Israeli, MD; Yaakov Henkin, MD; Ilan Kochba, MD; and Iris Shai, RD, PhD
[+] Article and Author Information

From Sheba Medical Center, Tel-Hashomer, Israel; The S. Daniel Abraham Center for Health and Nutrition, Soroka Medical Center, and Ben-Gurion University of the Negev, Beer-Sheva, Israel; and Israel Defense Forces Medical Corps, Zrifin, Israel.


Note: Drs. Tirosh and Rudich contributed equally to this work.

Acknowledgment: The authors thank the Israel Diabetes Research Group for valuable support and advice, and Dr. M.J. Stamper, Harvard School of Public Health, for valuable discussions during the early stages of this work.

Grant Support: By Ben-Gurion University of the Negev, Beer-Sheva, Israel, and funds from the Israel Defense Forces National Budget.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Iris Shai, RD, PhD, Department of Epidemiology and Health Systems Evaluation, The S. Daniel Abraham International Center for Health and Nutrition, Ben-Gurion University of the Negev, PO Box 653, Beer-Sheva 84105, Israel; e-mail, irish@bgu.ac.il.

Current Author Addresses: Dr. Tirosh: Department of Internal Medicine A, Sheba Medical Center, Tel-Hashomer, Israel.

Dr. Rudich: Department of Clinical Biochemistry, The S. Daniel Abraham International Center for Health and Nutrition, Ben-Gurion University of the Negev, PO Box 653, Beer-Sheva 84105, Israel.

Ms. Shochat and Drs. Tekes-Manova, Israeli, and Kochba: Medical Corps Headquarters, Israel Defense Forces, Zrifin, Israel.

Dr. Henkin: Soroka University Medical Center, Ben-Gurion University of the Negev, PO Box 653, Beer-Sheva 84105, Israel.

Dr. Shai: Department of Epidemiology and Health Systems Evaluation, The S. Daniel Abraham International Center for Health and Nutrition, Ben-Gurion University of the Negev, PO Box 653, Beer-Sheva 84105, Israel.

Author Contributions: Conception and design: A. Tirosh, A. Rudich, D. Tekes-Manova, E. Israeli, I. Kochba, I. Shai.

Analysis and interpretation of the data: A. Tirosh, A. Rudich, I. Shai.

Drafting of the article: A. Tirosh, A. Rudich, I. Shai.

Critical revision of the article for important intellectual content: A. Tirosh, A. Rudich, Y. Henkin, I. Shai.

Final approval of the article: A. Tirosh, I. Shai.

Provision of study materials or patients: A. Tirosh, D. Tekes-Manova, E. Israeli, I. Kochba, I. Shai.

Statistical expertise: A. Tirosh, T. Shochat, I. Shai.

Obtaining of funding: E. Israeli.

Administrative, technical, or logistic support: D. Tekes-Manova, E. Israeli, I. Kochba.

Collection and assembly of data: T. Shochat.


Ann Intern Med. 2007;147(6):377-385. doi:10.7326/0003-4819-147-6-200709180-00007
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We analyzed the data of 13 953 untreated, apparently healthy men (26 to 45 years of age) with fasting serum triglyceride levels lower than 3.39 mmol/L (<300 mg/dL). At time 1, age-adjusted LDL cholesterol and fasting plasma glucose levels, BMI, blood pressure, and proportion of current smokers were more likely to increase across quintiles of triglycerides, whereas HDL cholesterol levels and the proportion of men who were physically active and who reported eating breakfast regularly were more likely to decrease (Table 1).

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Figure 1.
Changes in selected lifestyle variables associated with 5-year changes, without medications, in triglyceride levels between time 1 and time 2.

Tertiles were defined as low, the bottom tertile of triglyceride level (median at time 1, 0.68 mmol/L [60 mg/dL]; median at time 2, 0.79 mmol/L [70 mg/dL]), or high, the top tertile of triglyceride level (median at time 1, 2.08 mmol/L [184 mg/dL]; median at time 2, 2.48 mmol/L [220 mg/dL]). *Engagement in physical activity for a minimum of 20 minutes, 3 times per week.

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Figure 2.
Multivariate model showing the association between fasting serum triglyceride levels obtained at 2 measurements 5 years apart and incidence of coronary heart disease.Table 3

The model was adjusted for age, family history of coronary heart disease (positive, negative, or missing information), interval between time 1 and time 2, time-1 levels of fasting plasma high-density lipoprotein cholesterol, glucose, mean arterial blood pressure, and body mass index (as continuous variables), and for changes between time 1 and time 2 in BMI, physical activity (nonactive/nonactive, nonactive/active, active/nonactive, active/active), smoking status (current/current, current/noncurrent, noncurrent/current, noncurrent/noncurrent), and habit of eating breakfast (no/no, no/yes, yes/no, yes/yes). To convert triglyceride values to mmol/L, multiply by 0.0113. Incidence rates and hazard ratios (with 95% CIs) are given in .

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Comments

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Most important thing to be considered with an elevated triglycerides leading to coronary artery dise
Posted on September 27, 2007
Radhakrishnan Ramaraj
University of Arizona College of Medicine
Conflict of Interest: None Declared

Dear Editor,

Tirosh and colleagues have done an excellent observational study on relationship between triglyceride levels and risk of coronary artery disease. (1) There are few points worth mentioning "“ the sample of the population are all males and military personnel which is not representative of the population that we see in our daily clinics and wards. It is also important to note that the triglyceride levels are comparatively higher in women and diabetes; both were excluded in this study.

As already well known, that mild to moderate elevation of fasting plasma triglyceride level is common in patients with diabetes. In adult onset type diabetes, the fasting triglyceride values are highly variable but the prevalence of hypertriglyceridemia is markedly increased over that in age matched control population. Basal triglyceride level is regulated by the rate of production of circulating triglycerides and by the efficiency of their removal. In type 2 diabetes, hypertriglyceridemia results from increased plasma concentrations of VLDL, with or without chylomicronemia; deficient lipoprotein lipase activity; increased cholesteryl ester transfer protein activity; and increased flux of free fatty acids to the liver.(1)

Even though the study did not include people with diabetes; patients with high triglycerides may have sub-clinical diabetes (glucose intolerance) to start with and may have developed subsequent diabetes, putting them at risk of coronary artery disease. So I need to know whether the patients who had coronary angiogram proved CAD were investigated for the presence of diabetes or glucose intolerance at all. The increased prevalence of CAD in hypertriglyceridemia group could be because of diabetes itself playing an important role than triglycerides. As an important point life style modification, diet and exercise improves glycemic control thereby reducing the risk of CAD.

1. Tirosh A, Rudich A, Shochat T, Tekes-Manova D, Israeli E, Henkin Y, Kochba I, Shai I . Changes in Triglyceride Levels and Risk for Coronary Heart Disease in Young Men. Ann Intern Med. 2007;147(6): 377-85

2.Pollex RL, Hegele RA. Genetic determinants of the metabolic syndrome. Nat Clin Pract Cardiovasc Med 2006;3:482-9.

MELANY and Familial Combined Hyperlipidemia
Posted on October 1, 2007
Amnon Schlegel
University of California, San Francisco
Conflict of Interest: None Declared

With such a large and well-characterized study sample, is it possible to determine whether "ethnicity" contributes to either the baseline or second triglyceride level in the MELANY study? Namely, would a post-hoc analysis indicate differences among Eastern European, Central Asian, or North African Jewish subjects? Since familial combined hyperlipidemia is a prevalent, world-wide disease marked by low HDL cholesterol and hypertriglyceridemia, identifying subpopulations (and kindred) in MELANY might help unravel this nefarious disease.

Conflict of Interest:

None declared

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Summary for Patients

Changes in Triglyceride Levels and Risk for Coronary Heart Disease in Young Men

The summary below is from the full report titled “Changes in Triglyceride Levels and Risk for Coronary Heart Disease in Young Men.” It is in the 18 September 2007 issue of Annals of Internal Medicine (volume 147, pages 377-385). The authors are A. Tirosh, A. Rudich, T. Shochat, D. Tekes-Manova, E. Israeli, Y. Henkin, I. Kochba, and I. Shai.

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