Relation of high-density lipoprotein cholesterol and triglycerides to incidence of atherosclerotic coronary artery disease (the PROCAM experience)
Abstract
The incidence of atherosclerotic coronary artery disease (CAD) was assessed in 4,559 male participants (aged 40 to 64 years) from the Prospective Cardiovascular Münster study, over a 6-year follow-up period. During this time, 186 study participants developed atherosclerotic CAD (134 definite nonfatal myocardial infarctions and 52 definite atherosclerotic CAD deaths including 21 sudden cardiac deaths and 31 fatal myocardial infarctions). Univariate analysis revealed a significant association between the incidence of atherosclerotic CAD and high-density lipoprotein (HDL) cholesterol (p less than 0.001) and triglycerides (p less than 0.001). The relation to HDL cholesterol remained after adjustment for other risk factors. By contrast, the relation between the incidence of atherosclerotic CAD and triglycerides disappeared if, in a multivariate analysis by means of a multiple logistic function, cholesterol or HDL cholesterol were taken into account. However, the data suggested that hypertriglyceridemia is a powerful additional coronary risk factor, when excessive triglycerides coincide with a high ratio of plasma low-density lipoprotein cholesterol to HDL cholesterol (greater than 5.0). Even though the prevalence of this subgroup was only 4.3%, it included a quarter of all atherosclerotic CAD events observed.
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Post hoc analyses of clinical trials suggest that patients who have both high triglyceride and low HDL-C tend to benefit more from treatment than those who do not.
“post hoc analyses of clinical trials suggest that patients who have both adverse markers tend to benefit more from treatment than those who do not.”
From Triglycerides and Cardiovascular Disease: A Scientific Statement From the American Heart Association (2011) · cites this paper as [232]
The joint occurrence of high triglyceride level and low HDL-C strongly predicts CVD in observational studies.
“It strongly predicts CVD in observational studies”
From Triglycerides and Cardiovascular Disease: A Scientific Statement From the American Heart Association (2011) · cites this paper as [232]
Observational studies and clinical trials have consistently demonstrated the lowest risk of incident and recurrent CVD in association with the lowest fasting triglyceride levels.
“observational studies and clinical trials 3,232,367,374 -380 that have consistently demonstrated the lowest risk of incident and recurrent CVD in association with the lowest fasting triglyceride levels.”
From Triglycerides and Cardiovascular Disease: A Scientific Statement From the American Heart Association (2011) · cites this paper as [232]
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- Authors
- Assmann, G., & Schulte, H.
- Affiliations
- University of Münster (DE)
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 1992-09
- Volume
- 70
- Issue
- 7
- Pages
- 733-737
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W2007542782
- Cited by
- 872
- References
- 0
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 11 · 2023: 6 · 2022: 13 · 2021: 9 · 2020: 14 · 2019: 14 · 2018: 12 · 2017: 9 · 2016: 17 · 2015: 19 · 2014: 17 · 2013: 20 · 2012: 22
- FWCI
- 34.62
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Keywords
- coronary artery disease, HDL cholesterol, triglycerides, hypertriglyceridemia, coronary risk factors, myocardial infarction, sudden cardiac death, LDL/HDL ratio
- MeSH terms
- Adult, Coronary Artery Disease, Female, Germany, West, Humans, Cholesterol, HDL, Male, Myocardial Infarction, Prospective Studies, Risk Factors, Time Factors, Hypertriglyceridemia, Incidence, Prevalence, Multivariate Analysis, Death, Sudden, Cardiac
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