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

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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

DOI 10.1056/nejm198006193022503

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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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Authors: Hulley, S. B., Rosenman, R. H., Bawol, R. D., & Brand, R. J.
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 1980-06-19
Volume: 302
Issue: 25
Pages: 1383-1389
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejm198006193022503
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 › Cardiology and Cardiovascular Medicine › 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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Epidemiology as a Guide to Clinical Decisions: The Association between Triglyceride and Coronary Heart Disease

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