Cited by 702Lipoproteins and Cardiovascular HealthDiabetes, Cardiovascular Risks, and LipoproteinsCardiovascular Health and Risk Factors

Epidemiology as a Guide to Clinical Decisions: The Association between Triglyceride and Coronary Heart Disease

Hulley, Stephen B., Rosenman, Ray H., Bawol, Richard D., Brand, Richard J.·1980·New England Journal of Medicine

Abstract

The hypothesis that triglyceride is a cause of coronary heart disease, although unconfirmed and never universally accepted, has nonetheless strongly influenced the practice of preventive medicine. We have examined the epidemiologic association between triglyceride and coronary heart disease to evaluate the validity of inferring that there is a causal relation between the two. Neither the evidence from published studies nor an analysis of data from the Western Collaborative Group Study provides strong support for the causal hypothesis. Information from other scientific disciplines is also meager, contrasting with the coherence of diverse evidence supporting the hypothesis that cholesterol is a cause of coronary heart disease. These arguments fall short of disproving the belief that lowering triglyceride will prevent coronary heart disease, especially since triglyceride and cholesterol are inextricably associated through mutual lipoprotein carriers. But we propose that the ethics of preventive medicine place the burden of proof on the proponents of intervention. We therefore recommend that widespread screening and treatment of healthy persons for hypertriglyceridemia be abandoned until more persuasive evidence becomes available.

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  • 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.”

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Authors
Hulley, S. B., Rosenman, R. H., Bawol, R. D., & Brand, R. J.
Venue
New England Journal of Medicine
Published
1980-06-19
Volume
302
Issue
25
Pages
1383-1389
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W1989258056
Cited by
702
References
88
Citations by year
2025: 4 · 2024: 1 · 2023: 3 · 2022: 2 · 2021: 7 · 2020: 4 · 2019: 5 · 2018: 5 · 2017: 4 · 2016: 7 · 2015: 9 · 2014: 8 · 2013: 7 · 2012: 11
FWCI
53.22
Type
journal article
Language
en
Open access
closed
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • DigitalGeorgetown (Georgetown University Library) (submittedVersion)
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 › Cardiovascular Health and Risk Factors
Keywords
triglycerides, coronary artery disease, hypertriglyceridemia, causal inference, cholesterol, preventive medicine, burden of proof, screening, lipid-lowering therapy, clinical decision-making
MeSH terms
Adult, Cholesterol, Coronary Disease, Decision Making, Epidemiologic Methods, Ethics, Medical, Health Policy, Humans, Middle Aged, Retrospective Studies, Risk, Triglycerides

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