It’s Triglycerides Stupid: Lets Stop Focusing on LDL-Cholesterol (SCIENCE)

After years of intensive LDL-lowering therapies heart disease is still the leading cause of death, claiming over 600,000 lives annually in the USA alone. Ample evidence suggest elevated serum triglycerides are associated with atherogenesis and cardiovascular risk as well as increased all-cause mortality.

Even lipid experts are urging physicians to focus on triglyceride reduction, not just lowering LDL-cholesterol with statins.

 

 

 

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Links to studies and videos mentioned:

 

Farnier, M., Zeller, M., Masson, D. & Cottin, Y. Triglycerides and risk of atherosclerotic cardiovascular disease: An update. Arch. Cardiovasc. Dis. 114, 132–139 (2021).

Bhatt, D. L. et al. Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia. N. Engl. J. Med. 380, 11–22 (2018).

Zhang, B.-H., Yin, F., Qiao, Y.-N. & Guo, S.-D. Triglyceride and Triglyceride-Rich Lipoproteins in Atherosclerosis. Front. Mol. Biosci. 9, 909151 (2022).
Peng, X. & Wu, H. Inflammatory Links Between Hypertriglyceridemia and Atherogenesis. Curr. Atheroscler. Rep. 24, 297–306 (2022).

 

Show Notes:

00:00 Elevated triglycerides are linked with cardiovascular disease, atherosclerosis, and sudden death.

01:45 LDL lowering drugs do not affect triglycerides.

03:41 Triglycerides and remnant cholesterol are associated with the formation of plaque in vessels throughout your body.

05:45 Total cholesterol minus HDL minus LDL helps you determine your remnant cholesterol.

08:00 Lifestyle changes, fenofibrate drugs, and omega 3 fish oil reduce triglycerides.

11:20 Triglyceride rich lipoproteins promote inflammation and adhesion.

12:00 High triglycerides (fasted and non-fasted) are associated with higher risk of atherosclerotic cardiovascular disease.

13:00 High non-fasted triglycerides are associated with increased risk of myocardial infarction and death.

14:40 Increased triglyceride concentration is associated with a 37% increased risk of cardiovascular disease.

16:30 Statin trials excluded people with high triglycerides.

18:00 Statin treated patients still had elevated high-risk triglycerides.

19:00 Omega 3 fish oil, myoinositol, walking after meals, compressing your feeding window, and limiting processed foods lowers triglycerides.