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Cited by 1,871Lipoproteins and Cardiovascular HealthLipid metabolism and disordersDiabetes, Cardiovascular Risks, and Lipoproteins

Triglycerides and Cardiovascular Disease: A Scientific Statement From the American Heart Association

Miller, Michael, Stone, Neil J., Ballantyne, Christie, Bittner, Vera, Criqui, Michael H., Ginsberg, Henry N., Goldberg, Anne Carol, Howard, William James +6 more·2011·Circulation
DOI 10.1161/cir.0b013e3182160726
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Abstract

For the purpose of this statement, CVD is inclusive of coronary heart disease and coronary artery disease.

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Crossref · 10.1161/cir.0b013e3182160726

Cites

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Statistics

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Claims the paper makes

0 of 523 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The increases in triglycerides primarily were observed in younger age groups (20 to 49 years old).

    “However, the increases in triglycerides primarily were observed in younger age groups (20 to 49 years old), and overall, triglyceride levels continue to be higher than in less industrialized societies (Section 12.1).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites NHANES 1988-1994

      Not checked in the free run.

    • cites NHANES 1999-2008

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    • Rests on an assumption: NHANES surveys provide representative estimates of the US adult population's triglyceride levels.
  • Findingown data

    There was no appreciable change in the prevalence of triglyceride levels ≥150 mg/dL between NHANES 1988-1994 and 1999-2008.

    “Overall, 31% of the adult US population has a triglyceride level Ն150 mg/dL, with no appreciable change between NHANES 1988 -1994 and 1999 -2008.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites NHANES 1988-1994

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    • cites NHANES 1999-2008

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    • Rests on an assumption: NHANES surveys provide representative estimates of the US adult population's triglyceride levels.
  • Findingown data

    The prevalence of triglyceride levels ≥200 mg/dL was highest in Mexican American men ≥30 years old and women ≥40 years old (21% to 36%).

    “The prevalence of triglyceride levels Ն200 mg/dL was also highest in Mexican American men (Ն30 years old) and women (Ն40 years old; 21% to 36%), followed by non-Hispanic white men (30 to 69 years old, 20% to 25%).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites NHANES 1999-2008

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    • Rests on an assumption: NHANES surveys provide representative estimates of the US adult population's triglyceride levels.
  • Findingcitation

    Increases in fasting serum triglyceride levels observed between surveys conducted in 1976-1980 and 1999-2002 coincided with adjustments in the classification of hypertriglyceridemia.

    “Accordingly, increases in fasting serum triglyceride levels observed between surveys conducted in 1976 -1980 and 1999 -2002 6 coincided with adjustments in the classification of hypertriglyceridemia 4,10 (Table 1).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [6] 6. Carroll MD, Lacher DA, Sorlie PD, Cleeman JI, Gordon DJ, Wolz M, Grundy SM, Johnson CL. Trends in serum lipids and lipoproteins of adults, 1960 -2002. JAMA. 2005;294:1773-1781.

      Not checked in the free run.

    • cites [4] 4. Consensus Conference: treatment of hypertriglyceridemia. JAMA. 1984; 251:1196 -1200.

      Not checked in the free run.

    • cites [10] 10. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285:2486 -2497. source

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  • Findingown data

    Very high fasting triglyceride levels (≥500 mg/dL) were observed in 1.1% of US adults.

    “High (Ն200 mg/dL) and very high (Ն500 mg/dL) fasting triglyceride levels were observed in 16.2% and 1.1% of adults, respectively, with Mexican Americans being overrepresented at both cut points (19.5% and 1.4%, respectively).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites NHANES 1999-2008

      Not checked in the free run.

    • Rests on an assumption: NHANES surveys provide representative estimates of the US adult population's triglyceride levels.
  • May combine two claims. 163
  • Classified as probably not a substantial claim. 34

  • May combine two claims.

    Findingown data

    Mexican Americans are overrepresented at both the ≥200 mg/dL and ≥500 mg/dL triglyceride cut points (19.5% and 1.4%, respectively).

    “High (Ն200 mg/dL) and very high (Ն500 mg/dL) fasting triglyceride levels were observed in 16.2% and 1.1% of adults, respectively, with Mexican Americans being overrepresented at both cut points (19.5% and 1.4%, respectively).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites NHANES 1999-2008

      Not checked in the free run.

    • Rests on an assumption: NHANES surveys provide representative estimates of the US adult population's triglyceride levels.

  • May combine two claims.

    Findingown data

    The highest prevalence rates of triglyceride levels ≥150 mg/dL were observed in Mexican American men 50-59 years old (58.8%) and Mexican American women ≥70 years old (50.5%).

    “Within each group, the highest prevalence rates were observed in Mexican American men (50 to 59 years old, 58.8%) and Mexican American women (Ն70 years old, 50.5%),”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites NHANES 1999-2008

      Not checked in the free run.

    • Rests on an assumption: NHANES surveys provide representative estimates of the US adult population's triglyceride levels.

  • May combine two claims.

    Findingown data

    Over the past 20 years, there were small increases in median triglyceride levels in both men (122 versus 119 mg/dL) and women (106 versus 101 mg/dL).

    “Over the past 20 years, there were small increases in median triglyceride levels in both men (122 versus 119 mg/dL) and women (106 versus 101 mg/dL).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites NHANES 1988-1994

      Not checked in the free run.

    • cites NHANES 1999-2008

      Not checked in the free run.

    • Rests on an assumption: NHANES surveys provide representative estimates of the US adult population's triglyceride levels.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Overall, triglyceride levels in the US continue to be higher than in less industrialized societies.

    “However, the increases in triglycerides primarily were observed in younger age groups (20 to 49 years old), and overall, triglyceride levels continue to be higher than in less industrialized societies (Section 12.1).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among ethnicities in NHANES 1999-2008, Mexican Americans have the highest rate of triglyceride levels ≥150 mg/dL (34.9%), followed by non-Hispanic whites (33%) and blacks (15.6%).

    “Among ethnicities, Mexican Americans have the highest rates (34.9%),followed by non-Hispanic whites (33%) and blacks (15.6%) in NHANES 1999 -2008 (Table 2).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites NHANES 1999-2008

      Not checked in the free run.

    • Rests on an assumption: NHANES surveys provide representative estimates of the US adult population's triglyceride levels.

  • May combine two claims.

    Findingown data

    The prevalence of triglyceride levels ≥500 mg/dL was relatively low (1% to 2%), but Mexican American men 50-59 years of age exhibited the highest rate (9%) in NHANES 1999-2008.

    “Although the prevalence of triglyceride levels Ն500 mg/dL was relatively low (1% to 2%), Mexican American men 50 to 59 years of age exhibited the highest rate (9%) in NHANES 1999 -2008.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites NHANES 1999-2008

      Not checked in the free run.

    • Rests on an assumption: NHANES surveys provide representative estimates of the US adult population's triglyceride levels.

  • May combine two claims.

    Findingcitation

    With adjustment for age and sex, triglycerides showed a strong, stepwise association with both CVD and ischemic stroke.

    “With adjustment for age and sex, triglycerides showed a strong, stepwise association with both CVD and ischemic stroke; however, after adjustment for standard risk factors and for HDL-C and non-HDL-C, the associations for both CVD and stroke were no longer significant.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17] 17. Di Angelantonio E, Sarwar N, Perry P, Kaptoge S, Ray KK, Thompson A, Wood AM, Lewington S, Sattar N, Packard CJ, Collins R, Thompson SG, Danesh J; Emerging Risk Factors Collaboration. Major lipids, apolipoproteins, and risk of vascular disease. JAMA. 2009;302: 1993-2000. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    Most of these earlier studies did not measure HDL-C.

    “Most of these earlier studies did not measure HDL-C.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In women, the association was more robust in univariate analysis (relative risk 1.76 per mmol/L) and after adjustment for HDL-C (relative risk 1.37, 95% CI 1.13 to 1.66).

    “In women, the association was more robust in both univariate analysis (relative risk 1.76 per mmol/L) and after adjustment for HDL-C (relative risk 1.37, 95% confidence interval 1.13 to 1.66).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [36] 36. Hokanson JE, Austin MA. Plasma triglyceride level is a risk factor for cardiovascular disease independent of high-density lipoprotein choles- terol level: a meta-analysis of population-based prospective studies. J Cardiovasc Risk. 1996;3:213-219. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    The triglyceride level explained most of the risk of the pattern B phenotype and was a stronger covariate than LDL-C, IDL cholesterol, or HDL-C.

    “However, the triglyceride level explained most of the risk of the pattern B phenotype and was a stronger covariate than LDL-C, intermediate-density lipoprotein (IDL) cholesterol, or HDL-C.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [35] 35. Austin MA, Breslow JL, Hennekens CH, Buring JE, Willett WC, Krauss RM. Low-density lipoprotein subclass patterns and risk of myocardial infarction. JAMA. 1988;260:1917-1921. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Direct incubation of mouse peritoneal macrophages with TRL increases macrophage cell triglyceride and fatty acid content and increases expression of macrophage inflammatory proteins.

    “For example, direct incubation of mouse peritoneal macrophages with TRL increases macrophage cell triglyceride and fatty acid content; more importantly, this incubation increases expression of macrophage inflammatory proteins, including tumor necrosis factor-␣, interleukin-1␤, monocyte chemotactic protein-1, intercellular adhesion molecule-1, and matrix metalloproteinase-3. 83,84”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [83] 83. Van Eck M, Zimmermann R, Groot PH, Zechner R, Van Berkel TJ. Role of macrophage-derived lipoprotein lipase in lipoprotein metabolism and atherosclerosis. Arterioscler Thromb Vasc Biol. 2000;20:E53-E62.

      Not checked in the free run.

    • cites [84] 84. Saraswathi V, Hasty AH. The role of lipolysis in mediating the proin- flammatory effects of very low density lipoproteins in mouse peritoneal macrophages. J Lipid Res. 2006;47:1406 -1415. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    A mutation in APOC3 was identified in association with low triglyceride levels, reduced coronary artery calcification, and suggestion of familial longevity.

    “Recently, a mutation in APOC3 was identified in association with low triglyceride levels, reduced coronary artery calcification, and suggestion of familial longevity.75”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [75] 75. Pollin TI, Damcott CM, Shen H, Ott SH, Shelton J, Horenstein RB, Post W, McLenithan JC, Bielak LF, Peyser PA, Mitchell BD, Miller M, O'Connell JR, Shuldiner AR. A null mutation in human APOC3 confers a favorable plasma lipid profile and apparent cardioprotection. Science. 2008;322:1702-1705. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Apo CIII can activate adhesion and proinflammatory molecule expression and impair endothelial nitric oxide production and insulin signaling pathways.

    “These include activation of adhesion and proinflammatory molecule expression and impairment of endothelial nitric oxide production and insulin signaling pathways.74,76 -80”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [74] 74. Ooi EM, Barrett PH, Chan DC, Watts GF. Apolipoprotein C-III: under- standing an emerging cardiovascular risk factor. Clin Sci (Lond). 2008; 114:611-624. source

      Not checked in the free run.

    • cites [76] 76. Caron S, Staels B. Apolipoprotein CIII: a link between hypertriglycer- idemia and vascular dysfunction? Circ Res. 2008;103:1348 -1350.

      Not checked in the free run.

    • cites [77] 77. Kawakami A, Aikawa M, Alcaide P, Luscinskas FW, Libby P, Sacks FM. Apolipoprotein CIII induces expression of vascular cell adhesion molecule-1 in vascular endothelial cells and increases adhesion of monocytic cells. Circulation. 2006;114:681-687.

      Not checked in the free run.

    • cites [78] 78. Kawakami A, Aikawa M, Libby P, Alcaide P, Luscinskas FW, Sacks FM. Apolipoprotein CIII in apolipoprotein B lipoproteins enhances the adhesion of human monocytic cells to endothelial cells. Circulation. 2006;113:691-700.

      Not checked in the free run.

    • cites [79] 79. Kawakami A, Osaka M, Tani M, Azuma H, Sacks FM, Shimokado K, Yoshida M. Apolipoprotein CIII links hyperlipidemia with vascular endothelial cell dysfunction. Circulation. 2008;118:731-742.

      Not checked in the free run.

    • cites [80] 80. Kawakami A, Osaka M, Aikawa M, Uematsu S, Akira S, Libby P, Shimokado K, Sacks FM, Yoshida M. Toll-like receptor 2 mediates apolipoprotein CIII-induced monocyte activation. Circ Res. 2008;103: 1402-1409.

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Postprandial TRL increases the expression of proinflammatory genes, induces apoptosis, and accentuates the inflammatory response of cultured endothelial cells to TNF-α.

    “Postprandial TRL (ppTG) has also been shown to increase the expression of proinflammatory genes (eg, interleukin-6, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, and monocyte chemotactic protein-1), 65 induce apoptosis, 66 and accentuate the inflammatory response of cultured endothelial cells to tumor necrosis factor-␣.67”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [65] 65. Norata GD, Grigore L, Raselli S, Redaelli L, Hamsten A, Maggi F, Eriksson P, Catapano AL. Post-prandial endothelial dysfunction in hy- pertriglyceridemic subjects: molecular mechanisms and gene expression studies. Atherosclerosis. 2007;193:321-327.

      Not checked in the free run.

    • cites [66] 66. Shin HK, Kim YK, Kim KY, Lee JH, Hong KW. Remnant lipoprotein particles induce apoptosis in endothelial cells by NAD(P)H oxidase- mediated production of superoxide and cytokines via lectin-like oxidized low-density lipoprotein receptor-1 activation: prevention by cilostazol. Circulation. 2004;109:1022-1028. source

      Not checked in the free run.

    • cites [67] 67. Ting HJ, Stice JP, Schaff UY, Hui DY, Rutledge JC, Knowlton AA, Passerini AG, Simon SI. Triglyceride-rich lipoproteins prime aortic endothelium for an enhanced inflammatory response to tumor necrosis factor-alpha. Circ Res. 2007;100:381-390. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    RLPs can accelerate senescence and interfere with the function of endothelial progenitor cells.

    “Liu et al 64 have shown that these particles can accelerate senescence and interfere with the function of endothelial progenitor cells; these cells play an important role in the organismal reparative response to in vivo vessel wall injury.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [64] 64. Liu L, Wen T, Zheng XY, Yang DG, Zhao SP, Xu DY, Lu GH. Remnant-like particles accelerate endothelial progenitor cells senescence and induce cellular dysfunction via an oxidative mechanism. Atherosclerosis. 2009;202:405-414.

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    A high-fat diet increases the level of circulating endothelial cell microparticles more effectively than a low-fat diet and is correlated with ppTG levels.

    “That is, a high-fat diet increases the level of these particles more effectively than a low-fat diet and is correlated with ppTG levels.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [68] 68. Ferreira AC, Peter AA, Mendez AJ, Jimenez JJ, Mauro LM, Chirinos JA, Ghany R, Virani S, Garcia S, Horstman LL, Purow J, Jy W, Ahn YS, de Marchena E. Postprandial hypertriglyceridemia increases circulating levels of endothelial cell microparticles. Circulation. 2004;110: 3599 -3603.

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In the NHLBI Family Heart Study of 5381 subjects from 1245 families, FCHL and FHTG were diagnosed in 10.2% and 12.3% of 334 random control families, respectively, and in 16.7% and 20.5% of 293 families with at least 1 case of premature CVD.

    “However, this was reexamined in the National Heart, Lung, and Blood Institute's Family Heart Study, which studied 5381 subjects from 1245 families.90 FCHL and FHTG were diagnosed in 10.2% and 12.3% of 334 random control families, respectively, and in 16.7% and 20.5% of 293 families with at least 1 case of premature CVD.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [90] 90. Hopkins PN, Heiss G, Ellison RC, Province MA, Pankow JS, Eckfeldt JH, Hunt SC. Coronary artery disease risk in familial combined hyper- lipidemia and familial hypertriglyceridemia: a case-control comparison from the National Heart, Lung, and Blood Institute Family Heart Study. Circulation. 2003;108:519 -523.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Overall, alcohol abuse and gallstone disease account for at least 80% of all cases of acute pancreatitis, with hypertriglyceridemia contributing ≈10% of cases.

    “Overall, alcohol abuse and gallstone disease account for at least 80% of all cases of acute pancreatitis, with hypertriglyceridemia contributing Ϸ10% of cases.105,134”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [105] 105. Ewald N, Hardt PD, Kloer HU. Severe hypertriglyceridemia and pan- creatitis: presentation and management. Curr Opin Lipidol. 2009;20: 497-504. source

      Not checked in the free run.

    • cites [134] 134. Banks PA, Conwell DL, Toskes PP. The management of acute and chronic pancreatitis. Gastroenterol Hepatol (N Y). 2010;6(suppl 3): 1-16.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    In some populations, such as French Canadians, as many as 70% of cases can be traced to a single founder.

    “In some populations, such as French Canadians, as many as 70% of cases can be traced to a single founder.104”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [104] 104. Ma Y, Henderson HE, Murthy V, Roederer G, Monsalve MV, Clarke LA, Normand T, Julien P, Gagne C, Lambert M, Davignon J, Lupien PJ, Brunzell J, Hayden MR. A mutation in the human lipoprotein lipase gene as the most common cause of familial chylomicronemia in French Canadians. N Engl J Med. 1991;324:1761-1766.

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Triglyceride distribution is markedly skewed, which necessitates categorical definitions or log transformations.

    “First, the distribution is markedly skewed, which necessitates categorical definitions or log transformations.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Evidence from prospective studies supports a stronger link between triglycerides and CVD risk in people with lower levels of HDL-C and LDL-C and with T2DM.

    “Finally, evidence from prospective studies of the triglyceride association supports a stronger link with CVD risk in people with lower levels of HDL-C 13,14 and LDL-C 13,14 and with T2DM.15,16”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [13] 13. Criqui MH, Heiss G, Cohn R, Cowan LD, Suchindran CM, Bangdiwala S, Kritchevsky S, Jacobs DR Jr, O'Grady HK, Davis CE. Plasma triglyceride level and mortality from coronary heart disease. N Engl J Med. 1993;328:1220 -1225.

      Not checked in the free run.

    • cites [14] 14. Laakso M, Lehto S, Penttila ¨I, Pyo ¨ra ¨la ¨K. Lipids and lipoproteins predicting coronary heart disease mortality and morbidity in patients with non-insulin-dependent diabetes. Circulation. 1993;88:1421-1430.

      Not checked in the free run.

    • cites [15] 15. West KM, Ahuja MM, Bennett PH, Czyzyk A, De Acosta OM, Fuller JH, Grab B, Grabauskas V, Jarrett RJ, Kosaka K. The role of circulating glucose and triglyceride concentrations and their interactions with other "risk factors" as determinants of arterial disease in nine diabetic popu- lation samples from the WHO multinational study. Diabetes Care. 1983;6:361-369.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Triglyceride variability is high and increases with the level of triglyceride.

    “Second, variability is high (Section 10) and increases with the level of triglyceride.12”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] 12. Jacobs DR Jr, Barrett-Connor E. Retest reliability of plasma cholesterol and triglyceride: the Lipid Research Clinics Prevalence Study. Am J Epidemiol. 1982;116:878 -885.

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Higher VLDL triglyceride output activates cholesteryl ester transfer protein, which results in triglyceride enrichment of LDL and HDL.

    “Higher VLDL triglyceride output activates cholesteryl ester transfer protein, which results in triglyceride enrichment of LDL and HDL (Figure 4).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Apo CIII is a 79-amino acid glycoprotein that is a major component of circulating TRL and is correlated with triglyceride levels.

    “Apo CIII is a 79-amino acid glycoprotein that is a major component of circulating TRL and is correlated with triglyceride levels.74”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [74] 74. Ooi EM, Barrett PH, Chan DC, Watts GF. Apolipoprotein C-III: under- standing an emerging cardiovascular risk factor. Clin Sci (Lond). 2008; 114:611-624. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The persistence of fasting chylomicronemia leads to a syndrome characterized by eruptive xanthomas, lipemia retinalis, and hepatosplenomegaly and is associated, although not invariably, with acute pancreatitis.

    “The persistence of fasting chylomicronemia leads to a syndrome characterized by eruptive xanthomas, lipemia retinalis, and hepatosplenomegaly and is associated, although not invariably, with acute pancreatitis.94,95”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [94] 94. Leaf DA. Chylomicronemia and the chylomicronemia syndrome: a practical approach to management. Am J Med. 2008;121:10 -12.

      Not checked in the free run.

    • cites [95] 95. Chait A, Brunzell JD. Chylomicronemia syndrome. Adv Intern Med. 1992;37:249 -273.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Macrophages are a rich source of LPL in the vessel wall, and expression of LPL by macrophages could play a role in accelerating atherogenesis by a mechanism that depends on interaction with circulating TRL.

    “Macrophages are a rich source of LPL in the vessel wall, 81 and expression of LPL by macrophages could play a role in accelerating atherogenesis by a mechanism that depends on interaction with circulating TRL.82”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [81] 81. Babaev VR, Fazio S, Gleaves LA, Carter KJ, Semenkovich CF, Linton MF. Macrophage lipoprotein lipase promotes foam cell formation and atherosclerosis in vivo. J Clin Invest. 1999;103:1697-1705.

      Not checked in the free run.

    • cites [82] 82. Goldberg IJ. Lipoprotein lipase and lipolysis: central roles in lipoprotein metabolism and atherogenesis. J Lipid Res. 1996;37:693-707.

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    TRLs may interfere with the ability of HDL to suppress inflammatory responses in cultured endothelial cells and the capacity of apo AI or HDL to promote sterol efflux from monocytes or macrophages.

    “TRLs may interfere with the ability of HDL to suppress inflammatory responses in cultured endothelial cells and the capacity of apo AI or HDL to promote sterol efflux from monocytes or macrophages.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    TRLs impair endothelial cell-dependent vasodilation, enhance the recruitment and attachment of monocytes to endothelium, may be directly cytotoxic, and produce apoptosis in isolated vessel wall cells.

    “TRLs also impair endothelial cell-dependent vasodilation, enhance the recruitment and attachment of monocytes to endothelium, may be directly cytotoxic, and produce apoptosis in isolated vessel wall cells.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    TRLs contain much less CE than LDL particles on a per particle basis, but in pathophysiological states such as poorly controlled DM, CEs can become enriched in this fraction.

    “Although TRLs contain much less CE than LDL particles on a per particle basis, there are pathophysiological states (eg, poorly controlled diabetes mellitus [DM]) in which CEs can become enriched in this fraction.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    The generation of FFA by LPL is regulated by cofactors such as insulin and thyroid hormone.

    “The generation of FFA by LPL is regulated by cofactors such as insulin and thyroid hormone.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Final conclusions about atherogenicity and clinical significance of lowering triglyceride levels as a surrogate of TRL particles must be based on in vivo studies that use appropriate models of human dyslipidemia in RCTs.

    “However, although the results from in vitro studies provide important pathophysiological context and proof of concept, final conclusions about atherogenicity and clinical significance of lowering triglyceride levels as a surrogate of TRL particles must be based on in vivo studies that use appropriate models of human dyslipidemia in randomized controlled trials (RCTs), as will be elaborated on in”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The severity of hypertriglyceridemia is related to the extent of the loss of fat, and mechanisms include decreased storage capacity of fat, with delayed clearance of TRLs and increased hepatic lipid synthesis.

    “The severity of hypertriglyceridemia is related to the extent of the loss of fat, 161 and mechanisms include decreased storage capacity of fat, with delayed clearance of TRLs and increased hepatic lipid synthesis.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [161] 161. Simha V, Garg A. Lipodystrophy: lessons in lipid and energy metabo- lism. Curr Opin Lipidol. 2006;17:162-169.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    Additional genetic syndromes in the differential diagnosis of hypertriglyceridemia include mixed or familial combined hyperlipidemia, type III dysbetalipoproteinemia, and familial hypertriglyceridemia.

    “Additional genetic syndromes in the differential diagnosis of hypertriglyceridemia include mixed or familial combined hyperlipidemia (FCHL), type III dysbetalipoproteinemia, and familial hypertriglyceridemia (FHTG).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    These young patients present with the chylomicronemia syndrome and an increased risk for pancreatitis and may be homozygous for either LPL deficiency, apo CII deficiency, or APOA5 and GPIHBP1 loss-of-function mutations.

    “These young patients present with the chylomicronemia syndrome and an increased risk for pancreatitis and may be homozygous for either LPL deficiency, apo CII deficiency, or the more recently described APOA5 and GPIHBP1 loss-of-function mutations.[91][92][93]102,103”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [91] 91. Brunzell JD. Familial lipoprotein lipase deficiency and other causes of chylomicronemia syndrome. In: Scriver CR, Beaudet AL, Sly WS, Valle D, eds. The Metabolic and Molecular Base of Inherited Disease. New York, NY: McGraw-Hill; 1995:1913-1932.

      Not checked in the free run.

    • cites [92] 92. Priore Oliva C, Pisciotta L, Li Volti G, Sambataro MP, Cantafora A, Bellocchio A, Catapano A, Tarugi P, Bertolini S, Calandra S. Inherited apolipoprotein A-V deficiency in severe hypertriglyceridemia. Arte- rioscler Thromb Vasc Biol. 2005;25:411-417.

      Not checked in the free run.

    • cites [93] 93. Hegele RA. Monogenic dyslipidemias: window on determinants of plasma lipoprotein metabolism. Am J Hum Genet. 2001;69:1161-1177.

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    In these cases, triglyceride concentrations exceed 1000 mg/dL, and when exacerbated by weight gain, certain medications, or metabolic perturbations can lead to the chylomicronemia syndrome and increased risk of pancreatitis.

    “In these cases, triglyceride concentrations exceed 1000 mg/dL, and when exacerbated by weight gain, certain medications (Table 5) or metabolic perturbations can lead to the chylomicronemia syndrome and increased risk of pancreatitis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    Although there is no single threshold of triglyceride concentration above which pancreatitis may occur, increased risk is defined arbitrarily by levels exceeding 1000 mg/L.

    “Although there is no single threshold of triglyceride concentration above which pancreatitis may occur, increased risk is defined arbitrarily by levels exceeding 1000 mg/L.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Excess visceral fat in patients with IR may further expose the liver to higher levels of FFAs via the portal circulation, and increased flux of FFAs to the liver contributes to increased secretion of VLDL.

    “Excess visceral fat in patients with IR may further expose the liver to higher levels of FFAs via the portal circulation, and increased flux of FFAs to the liver contributes to increased secretion of VLDL.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisenone given

    Patients with heterozygous LPL deficiency present with elevated triglyceride levels and low HDL-C, but in association with excess alcohol, steroids, estrogens, poorly controlled DM, hypothyroidism, renal disease, or the third trimester of pregnancy, triglyceride levels can rapidly exceed 2000 mg/dL and produce the clinical sequelae of the chylomicronemia syndrome.

    “Patients with heterozygous LPL deficiency present with elevated triglyceride levels and low HDL-C, but in association with excess alcohol, steroids, estrogens, poorly controlled DM, hypothyroidism, renal disease, or the third trimester of pregnancy, triglyceride levels can rapidly exceed 2000 mg/dL and produce the clinical sequelae of the chylomicronemia syndrome.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    Hypertriglyceridemia is seen in many lipodystrophic disorders, often in association with low HDL-C.

    “Hypertriglyceridemia is seen in many lipodystrophic disorders, often in association with low HDL-C.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    In type III disorder, apo B is not a useful marker of overall atherogenicity, and non-HDL-C would be a more appropriate target.

    “In this disorder, apo B is not a useful marker of overall atherogenicity, as in FCHL; non-HDL-C would be a more appropriate target.148”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [148] 148. Sniderman AD, Hogue JC, Bergeron J, Gagne C, Couture P. Non-HDL cholesterol and apoB in dyslipidaemia. Clin Sci (Lond). 2008;114: 149 -155.

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    FHTG is genetically heterogeneous, and its expression is accentuated by the presence of a secondary factor such as obesity or IR.

    “It is genetically heterogeneous, and its expression is accentuated by the presence of a secondary factor such as obesity or IR.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Participants with a normal BMI (<25) were more likely to have triglyceride levels <150 mg/dL (43%) and <200 mg/dL (39%).

    “Participants with a normal BMI (Ͻ25 kg/m 2 ) were more likely to have triglyceride levels Ͻ150 mg/dL (43%) and Ͻ200 mg/dL (39%).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [153] 153. Ford ES, Li C, Zhao G, Pearson WS, Mokdad AH. Hypertriglyceridemia and its pharmacologic treatment among US adults. Arch Intern Med. 2009;169:572-578. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    FHTG has a population prevalence of ~5% to 10% and is defined by familial occurrence of isolated high VLDL levels with triglyceride values most commonly in the 200 to 500 mg/dL range.

    “FHTG has a population prevalence of Ϸ5% to 10% and is defined by the familial occurrence of isolated high VLDL levels with triglyceride values most commonly in the 200 to 500 mg/dL range.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Common variants in APOA5, GCKR, LPL, and APOB have been identified, supporting a role for both common and rare variants responsible for hypertriglyceridemia.

    “Specifically, common variants in APOA5, glucose kinase regulatory protein (GCKR), LPL, and APOB have been identified, thereby supporting a role for both common and rare variants responsible for hypertriglyceridemia. 151”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [151] 151. Johansen CT, Wang J, Lanktree MB, Cao H, McIntyre AD, Ban MR, Martins RA, Kennedy BA, Hassell RG, Visser ME, Schwartz SM, Voight BF, Elosua R, Salomaa V, O'Donnell CJ, Dallinga-Thie GM, Anand SS, Yusuf S, Huff MW, Kathiresan S, Hegele RA. Excess of rare variants in genes identified by genome-wide association study of hyper- triglyceridemia. Nat Genet. 2010;42:684 -687. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    A consequence of excessive fat combined with impaired clearance or storage of triglycerides in subcutaneous fat is ectopic fat deposition in skeletal muscle, liver, and myocardium, which may result in IR, nonalcoholic fatty liver disease, and pericardial fat.

    “A consequence of excessive fat combined with impaired clearance or storage of triglycerides in subcutaneous fat is ectopic fat deposition in skeletal muscle, liver, and myocardium, which may result in IR, nonalcoholic fatty liver disease, and pericardial fat.157,158”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [157] 157. Despre ´s JP, Lemieux I, Bergeron J, Pibarot P, Mathieu P, Larose E, Rode ´s-Cabau J, Bertrand OF, Poirier P. Abdominal obesity and the metabolic syndrome: contribution to global cardiometabolic risk [pub- lished correction appears in Arterioscler Thromb Vasc Biol. 2008;28: e151]. Arterioscler Thromb Vasc Biol. 2008;28:1039 -1049. source

      Not checked in the free run.

    • cites [158] 158. Rosito GA, Massaro JM, Hoffmann U, Ruberg FL, Mahabadi AA, Vasan RS, O'Donnell CJ, Fox CS. Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample: the Framingham Heart Study. Circulation. 2008;117:605-613.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Approximately 35% of T2DM adults have fasting triglyceride levels >=200 mg/dL associated with decreased HDL-C and small, dense LDL particles.

    “In addition, Ϸ35% of T2DM adults have fasting triglyceride levels Ն200 mg/dL 168 associated with decreased HDL-C and small, dense LDL particles.41,53,112,113,169,170”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [168] 168. Resnick HE, Foster GL, Bardsley J, Ratner RE. Achievement of American Diabetes Association clinical practice recommendations among U.S. adults with diabetes, 1999 -2002: the National Health and Nutrition Examination Survey. Diabetes Care. 2006;29:531-537.

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Homozygosity for the rare apo E2 isoform is necessary for expression of type III but not sufficient; additional factors such as obesity, T2DM, or hypothyroidism are generally required for expression of the type III phenotype.

    “Homozygosity for the rare apo E2 isoform, which displays defective binding to the LDL receptor compared with the most common apo E3 isoform, is necessary for the expression of type III, but it is not sufficient.Rather, additional factors (eg, obesity, T2DM, or hypothyroidism) are generally required for expression of the type III phenotype”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Familial type III hyperlipoproteinemia or dysbetalipoproteinemia is due to accumulation of cholesterol-rich VLDL, which results in a higher ratio of core CE to triglyceride (>0.3) than in normal VLDL (0.2).

    “Familial type III hyperlipoproteinemia or dysbetalipoproteinemia is due to the accumulation of cholesterol-rich VLDL, 146,147 which results in a higher ratio of core CE to triglyceride (Ͼ0.3) than in normal VLDL (0.2).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [146] 146. Breslow JL. Genetics of lipoprotein abnormalities associated with coronary artery disease susceptibility. Annu Rev Genet. 2000;34: 233-254.

      Not checked in the free run.

    • cites [147] 147. Mahley RW, Huang Y, Rall SC Jr. Pathogenesis of type III hyperlipo- proteinemia (dysbetalipoproteinemia): questions, quandaries, and par- adoxes. J Lipid Res. 1999;40:1933-1949. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In NHANES 1999-2006 youths, only 5.9% of normal-weight participants had high triglyceride levels (>=150 mg/dL), whereas 13.8% and 24% of overweight or obese individuals had elevated triglyceride levels.

    “A similar trend was reported recently for youths in the NHANES Survey 1999 -2006 154 ; only 5.9% of participants in the normalweight category had high triglyceride levels (Ն150 mg/dL), whereas 13.8% and 24% of overweight or obese individuals had elevated triglyceride levels.154”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [154] 154. Centers for Disease Control and Prevention. Prevalence of abnormal lipid levels among youths: United States, 1999 -2006 [published cor- rection appears in MMWR Morb Mortal Wkly Rep. 2010;59:78]. MMWR Morb Mortal Wkly Rep. 2010;59:29 -33.

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Subcutaneous fat may serve as a protective factor with regard to the metabolic consequences of obesity; a relative paucity (lipodystrophy) is associated with hypertriglyceridemia.

    “Subcutaneous fat may serve as a protective factor with regard to the metabolic consequences of obesity 159 ; a relative paucity (ie, lipodystrophy) is associated with hypertriglyceridemia.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [159] 159. Porter SA, Massaro JM, Hoffmann U, Vasan RS, O'Donnel CJ, Fox CS. Abdominal subcutaneous adipose tissue: a protective fat depot? Diabetes Care. 2009;32:1068 -1075.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    FCHL is characterized by multiple lipoprotein abnormalities due to hepatic overproduction of apo B-containing VLDL, IDL, and LDL, whereby apo B levels exceed the 90th percentile.

    “FCHL is characterized by multiple lipoprotein abnormalities due to hepatic overproduction of apo B-containing VLDL, IDL, and LDL, whereby apo B levels exceed the 90th percentile.87,88”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [87] 87. Goldstein JL, Schrott HG, Hazzard WR, Bierman EL, Motulsky AG. Hyperlipidemia in coronary heart disease, II: genetic analysis of lipid levels in 176 families and delineation of a new inherited disorder, combined hyperlipidemia. J Clin Invest. 1973;52:1544 -1568.

      Not checked in the free run.

    • cites [88] 88. Brunzell JD, Schrott HG, Motulsky AG, Bierman EL. Myocardial infarction in the familial forms of hypertriglyceridemia. Metabolism. 1976;25:313-320.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Other factors (low HDL-C, elevated glucose, or elevated blood pressure) independently predicted CVD and all-cause mortality in RCTs.

    “Rather, other factors (eg, low HDL-C, elevated glucose, or elevated blood pressure) independently predicted CVD and all-cause mortality in RCTs.184 -187”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [184] 184. Schwartz GG, Olsson AG, Szarek M, Sasiela WJ. Relation of charac- teristics of metabolic syndrome to short-term prognosis and effects of intensive statin therapy after acute coronary syndrome: an analysis of the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) trial. Diabetes Care. 2005;28:2508 -2513. source

      Not checked in the free run.

    • cites [185] 185. Suzuki T, Katz R, Jenny NS, Zakai NA, LeWinter MM, Barzilay JI, Cushman M. Metabolic syndrome, inflammation, and incident heart failure in the elderly: the Cardiovascular Health Study. Circ Heart Fail. 2008;1:242-248.

      Not checked in the free run.

    • cites [186] 186. Kasai T, Miyauchi K, Kurata T, Ohta H, Okazaki S, Miyazaki T, Kajimoto K, Kubota N, Daida H. Prognostic value of the metabolic syndrome for long-term outcomes in patients undergoing percutaneous coronary intervention. Circ J. 2006;70:1531-1537.

      Not checked in the free run.

    • cites [187] 187. Anderson JL, Horne BD, Jones HU, Reyna SP, Carlquist JF, Bair TL, Pearson RR, Lappe ´DL, Muhlestein JB; Intermountain Heart Collab- orative (IHC) Study. Which features of the metabolic syndrome predict the prevalence and clinical outcomes of angiographic coronary artery disease? Cardiology. 2004;101:185-193.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    In summary, T1DM may be associated with elevations of VLDL triglyceride and LDL-C if glycemic control is poor or if the patient is ketotic.

    “In summary, T1DM may be associated with elevations of VLDL triglyceride and LDL-C if glycemic control is poor or if the patient is ketotic.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisereasoning

    In T1DM, triglycerides correlate closely with glycemic control, and marked hyperlipidemia can be found in patients with DM and ketoacidosis.

    “In T1DM, triglycerides correlate closely with glycemic control, and marked hyperlipidemia can be found in patients with DM and ketoacidosis.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    A triglyceride level >200 mg/dL is present in ~50% of those with CKD, often in association with low HDL-C.

    “A triglyceride level Ͼ200 mg/dL is present in Ϸ50% of those with CKD, often in association with low HDL-C.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    TRLs and RLPs in particular are atherogenic.

    “As discussed previously in this statement, TRLs and RLPs in particular are atherogenic.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The value of non-HDL-C in CVD risk assessment was first proposed by Frost and Havel in 1998, and this relationship has now been confirmed in many studies.

    “The value of non-HDL-C in CVD risk assessment was first proposed by Frost and Havel in 1998, 61 and this relationship has now been confirmed in many studies. [203]3][204][205][206][207][208][209][210][211][212][213][214][215][216]”
    Quote in the paperNot a substantial claim0 of 10 sources checked
    • cites [61] 61. Frost PH, Havel RJ. Rationale for use of non-high-density lipoprotein cholesterol rather than low-density lipoprotein cholesterol as a tool for lipoprotein cholesterol screening and assessment of risk and therapy. Am J Cardiol. 1998;81:26B-31B. source

      Not checked in the free run.

    • cites [203] 203. Miller M, Ginsberg HN, Schaefer EJ. Relative atherogenicity and pre- dictive value of non-high-density lipoprotein cholesterol for coronary heart disease. Am J Cardiol. 2008;101:1003-1008. source

      Not checked in the free run.

    • cites [204] 204. Rainwater DL, McMahan CA, Malcom GT, Scheer WD, Roheim PS, McGill HC Jr, Strong JP; PDAY Research Group. Lipid and apolipo- protein predictors of atherosclerosis in youth: apolipoprotein concen- trations do not materially improve prediction of arterial lesions in PDAY subjects. Arterioscler Thromb Vasc Biol. 1999;19:753-761. source

      Not checked in the free run.

    • cites [205] 205. Martin SS, Qasim AN, Mehta NN, Wolfe M, Terembula K, Schwartz S, Iqbal N, Schutta M, Bagheri R, Reilly MP. Apolipoprotein B but not LDL cholesterol is associated with coronary artery calcification in type 2 diabetic whites. Diabetes. 2009;58:1887-1892. 206. 104. Orakzai SH, Nasir K, Blaha M, Blumenthal RS, Raggi P. Non-HDL cholesterol is strongly associated with coronary artery calcification in asymptomatic individuals. Atherosclerosis. 2009;202:289 -295. source

      Not checked in the free run.

    • cites [206]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [207] 207. Blankenhorn DH, Alaupovic P, Wickham E, Chin HP, Azen SP. Pre- diction of angiographic change in native human coronary arteries and aortocoronary bypass grafts: lipid and nonlipid factors. Circulation. 1990;81:470 -476. source

      Not checked in the free run.

    • cites [208] 208. Lu W, Resnick HE, Jablonski KA, Jones KL, Jain AK, Howard WJ, Robbins DC, Howard BV. Non-HDL cholesterol as a predictor of cardiovascular disease in type 2 diabetes: the Strong Heart Study. Diabetes Care. 2003;26:16 -23. source

      Not checked in the free run.

    • cites [209] 209. Liu J, Sempos CT, Donahue RP, Dorn J, Trevisan M, Grundy SM. Non-high-density lipoprotein and very-low-density lipoprotein choles- terol and their risk predictive values in coronary heart disease. Am J Cardiol. 2006;98:1363-1368. source

      Not checked in the free run.

    • cites [210] 210. Ridker PM, Rifai N, Cook NR, Bradwin G, Buring JE. Non-HDL cholesterol, apolipoproteins A-I and B100, standard lipid measures, lipid ratios, and CRP as risk factors for cardiovascular disease in women. JAMA. 2005;294:326 -333. source

      Not checked in the free run.

    • cites [211] 211. Bittner V, Hardison R, Kelsey SF, Weiner BH, Jacobs AK, Sopko G; Bypass Angioplasty Revascularization Investigation. Non-high-density lipoprotein cholesterol levels predict five-year outcome in the Bypass Angioplasty Revascularization Investigation (BARI). Circulation. 2002; 106:2537-2542. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Pioglitazone lowers triglyceride levels by increasing LPL-mediated lipolysis, whereas VLDL secretion remains unchanged.

    “However, pioglitazone lowers triglyceride levels by increasing LPL-mediated lipolysis, whereas VLDL secretion remains unchanged.178”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [178] 178. Nagashima K, Lopez C, Donovan D, Ngai C, Fontanez N, Bensadoun A, Fruchart-Najib J, Holleran S, Cohn JS, Ramakrishnan R, Ginsberg HN. Effects of the PPARgamma agonist pioglitazone on lipoprotein metab- olism in patients with type 2 diabetes mellitus. J Clin Invest. 2005;115: 1323-1332. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Causes of hypertriglyceridemia in DM include increased hepatic VLDL production and defective removal of chylomicrons and CMRs, which often reflects poor glycemic control.

    “Causes of hypertriglyceridemia in DM include increased hepatic VLDL production and defective removal of chylomicrons and CMRs, which often reflects poor glycemic control.171”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [171] 171. Kreisberg RA. Diabetic dyslipidemia. Am J Cardiol. 1998;82:67U-73U.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In adults, non-HDL-C correlates with coronary calcification and CVD progression.

    “In adults, non-HDL-C correlates with coronary calcification 205,206 and CVD progression.207”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [205] 205. Martin SS, Qasim AN, Mehta NN, Wolfe M, Terembula K, Schwartz S, Iqbal N, Schutta M, Bagheri R, Reilly MP. Apolipoprotein B but not LDL cholesterol is associated with coronary artery calcification in type 2 diabetic whites. Diabetes. 2009;58:1887-1892. 206. 104. Orakzai SH, Nasir K, Blaha M, Blumenthal RS, Raggi P. Non-HDL cholesterol is strongly associated with coronary artery calcification in asymptomatic individuals. Atherosclerosis. 2009;202:289 -295.

      Not checked in the free run.

    • cites [206]

      Not checked in the free run.

    • cites [207] 207. Blankenhorn DH, Alaupovic P, Wickham E, Chin HP, Azen SP. Pre- diction of angiographic change in native human coronary arteries and aortocoronary bypass grafts: lipid and nonlipid factors. Circulation. 1990;81:470 -476.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Individuals with T2DM and mild to moderate hypertriglyceridemia exhibit the pattern B profile of LDL (smaller, denser particles) described by Austin and Krauss; these particles may be more susceptible to oxidative modification and catabolism via macrophage scavenger receptors than pattern A LDL particles.

    “Thus, individuals with T2DM and mild to moderate hypertriglyceridemia exhibit the pattern B profile of LDL (smaller, denser particles) described by Austin and Krauss 180 ; these particles may be more susceptible to oxidative modification and catabolism via macrophage scavenger receptors than pattern A LDL particles.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [180] 180. Austin MA, Krauss RM. LDL density and atherosclerosis. JAMA. 1995; 273:115.

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    In untreated or poorly controlled T1DM, LPL activity will be low, and ppTG levels will in turn be increased.

    “In untreated or poorly controlled T1DM, LPL activity will be low, and ppTG levels will in turn be increased.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    T2DM is often accompanied by high triglyceride levels, reduced HDL-C, and the presence of smaller CE-depleted LDL particles.

    “In contrast, T2DM is often accompanied by high triglyceride levels, reduced HDL-C, and the presence of smaller CE-depleted LDL particles.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Non-HDL-C can be assessed in the nonfasting state and is more accurately determined because it does not depend on fasting triglyceride concentrations, as calculated LDL-C does.

    “Non-HDL-C can be assessed in the nonfasting state 22,217 and is more accurately determined because it does not depend on fasting triglyceride concentrations, as calculated LDL-C does.61”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [22] 22. Bansal S, Buring JE, Rifai N, Mora S, Sacks FM, Ridker PM. Fasting compared with nonfasting triglycerides and risk of cardiovascular events in women. JAMA. 2007;298:309 -316. source

      Not checked in the free run.

    • cites [217] 217. Mora S, Rifai N, Buring JE, Ridker PM. Fasting compared with non- fasting lipids and apolipoproteins for predicting incident cardiovascular events. Circulation. 2008;118:993-1001.

      Not checked in the free run.

    • cites [61] 61. Frost PH, Havel RJ. Rationale for use of non-high-density lipoprotein cholesterol rather than low-density lipoprotein cholesterol as a tool for lipoprotein cholesterol screening and assessment of risk and therapy. Am J Cardiol. 1998;81:26B-31B.

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Results from RCTs to date cannot be extrapolated to milder forms of CKD, and therefore, an RCT is warranted in this subgroup.

    “Results from RCTs to date cannot be extrapolated to milder forms of CKD, and therefore, an RCT is warranted in this subgroup.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Therapies such as metformin and the thiazolidinediones can lower plasma triglyceride concentrations 10% to 15% and 15% to 25%, respectively.

    “Therapies such as metformin and the thiazolidinediones can lower plasma triglyceride concentrations 10% to 15% and 15% to 25%, respectively.177”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [177] 177. van Wijk JP, de Koning EJ, Martens EP, Rabelink TJ. Thiazolidin- ediones and blood lipids in type 2 diabetes. Arterioscler Thromb Vasc Biol. 2003;23:1744 -1749.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Rosiglitazone does not affect triglyceride levels, although the basis for this difference is unclear.

    “Rosiglitazone does not affect triglyceride levels, although the basis for this difference is unclear.179”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [179] 179. Ginsberg H, Plutzky J, Sobel BE. A review of metabolic and cardio- vascular effects of oral antidiabetic agents: beyond glucose-level lowering. J Cardiovasc Risk. 1999;6:337-346.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The primary abnormality in CKD subjects is reduced catabolism of TRL, which results in elevated levels of RLPs and prolonged ppTG that begins during the early stages of CKD.

    “The primary abnormality in CKD subjects is reduced catabolism of TRL, 131 which results in elevated levels of RLPs and prolonged ppTG that begins during the early stages of CKD.194”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [131] 131. Vaziri ND. Causes of dysregulation of lipid metabolism in chronic renal failure. Semin Dial. 2009;22:644 -651.

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Although elevated triglyceride is highly prevalent in subjects with MetS, it is less predictive of CVD outcomes than other MetS components, relegating triglyceride level as an important biomarker rather than a prognosticator of CVD.

    “Thus, although elevated triglyceride is highly prevalent in subjects with MetS, it is less predictive of CVD outcomes than other MetS components, thus relegating triglyceride level as an important biomarker rather than a prognosticator of CVD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisereasoning

    Insulin therapy rapidly reverses this condition, which results in improved clearance of chylomicron triglyceride from plasma.

    “Insulin therapy rapidly reverses this condition, which results in improved clearance of chylomicron triglyceride from plasma.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Treatment with hypoglycemic agents has a variable drug-dependent effect on plasma lipid levels.

    “Treatment with hypoglycemic agents has a variable drug-dependent effect on plasma lipid levels.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Although apo AI levels are reduced consistently, correction of hypertriglyceridemia does not usually alter apo AI levels.

    “Although apo AI levels are reduced consistently, correction of hypertriglyceridemia does not usually alter apo AI levels.53,181”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [53] 53. Ginsberg HN. Lipoprotein physiology in nondiabetic and diabetic states: relationship to atherogenesis. Diabetes Care. 1991;14:839 -855.

      Not checked in the free run.

    • cites [181] 181. Horowitz BS, Goldberg IJ, Merab J, Vanni TM, Ramakrishnan R, Ginsberg HN. Increased plasma and renal clearance of an exchangeable pool of apolipoprotein A-I in subjects with low levels of high density lipoprotein cholesterol. J Clin Invest. 1993;91:1743-1752.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The ratio of triglycerides to HDL-C is linked to IR in whites but not in blacks.

    “It is linked to IR in whites 233,234 (but not in blacks)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [233]

      Not checked in the free run.

    • cites [234] 234. Sumner AE, Finley KB, Genovese DJ, Criqui MH, Boston RC. Fasting triglyceride and the triglyceride-HDL cholesterol ratio are not markers of insulin resistance in African Americans. Arch Intern Med. 2005;165: 1395-1400.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The ratio of triglycerides to HDL-C is linked to small, dense LDL particles and higher LDL particle numbers.

    “and to small, dense LDL particles and higher LDL particle numbers.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [233]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [235] 235. Hanak V, Munoz J, Teague J, Stanley A Jr, Bittner V. Accuracy of the triglyceride to high-density lipoprotein cholesterol ratio for prediction of the low-density lipoprotein phenotype B. Am J Cardiol. 2004;94: 219 -222. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Non-Hispanic black women and men have the lowest non-HDL-C levels, whites are intermediate, and Mexican Americans have the highest level.

    “Non-Hispanic black women and men have the lowest non-HDL-C levels, whites are intermediate, and Mexican Americans have the highest level.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [219] 219. Gardner CD, Winkleby MA, Fortmann SP. Population frequency distri- bution of non-high-density lipoprotein cholesterol (Third National Health and Nutrition Examination Survey [NHANES III], 1988 -1994). Am J Cardiol. 2000;86:299 -304.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Among adults, age-adjusted non-HDL-C concentrations are lower among women than men, increase with age through age 65 years (to a greater degree in women than in men), and decline in individuals >65 years of age (more so in men than in women).

    “Among adults, age-adjusted non-HDL-C concentrations are lower among women than men, increase with age through age 65 years (to a greater degree in women than in men), and decline in individuals Ͼ65 years of age (more so in men than in women).209”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [209] 209. Liu J, Sempos CT, Donahue RP, Dorn J, Trevisan M, Grundy SM. Non-high-density lipoprotein and very-low-density lipoprotein choles- terol and their risk predictive values in coronary heart disease. Am J Cardiol. 2006;98:1363-1368.

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  • Classified as probably not a substantial claim.

    Premisecitation

    In view of additional data and standardization since ATP III 2001, a panel of international experts has recommended a revision of this assessment.

    “in view of additional data and in the presence of standardization that has accrued since ATP III was released in 2001, a panel of international experts has recommended a revision of this assessment.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [229] 229. Barter PJ, Ballantyne CM, Carmena R, Castro Cabezas M, Chapman MJ, Couture P, de Graaf J, Durrington PN, Faergeman O, Frohlich J, Furberg CD, Gagne C, Haffner SM, Humphries SE, Jungner I, Krauss RM, Kwiterovich P, Marcovina S, Packard CJ, Pearson TA, Reddy KS, Rosenson R, Sarrafzadegan N, Sniderman AD, Stalenhoef AF, Stein E, Talmud PJ, Tonkin AM, Walldius G, Williams KM. Apo B versus cholesterol in estimating cardiovascular risk and in guiding therapy: report of the thirty-person/ten-country panel. J Intern Med. 2006;259: 247-258.

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Among women, non-HDL-C levels were inversely related to education.

    “Among women, non-HDL-C levels were inversely related to education.219”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [219] 219. Gardner CD, Winkleby MA, Fortmann SP. Population frequency distri- bution of non-high-density lipoprotein cholesterol (Third National Health and Nutrition Examination Survey [NHANES III], 1988 -1994). Am J Cardiol. 2000;86:299 -304.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Mexican Americans and overweight adolescents had the highest rates (13% and 17.8% respectively) of impaired fasting glucose, which was associated with significantly higher fasting insulin, dyslipidemia, and hypertension.

    “Mexican Americans and overweight adolescents had the highest rates (13% and 17.8% respectively) of impaired fasting glucose, which was associated with significantly higher fasting insulin, dyslipidemia, and hypertension.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [299] 299. Williams DE, Cadwell BL, Cheng YJ, Cowie CC, Gregg EW, Geiss LS, Engelgau MM, Narayan KM, Imperatore G. Prevalence of impaired fasting glucose and its relationship with cardiovascular disease risk factors in US adolescents, 1999 -2000. Pediatrics. 2005;116:1122-1126.

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  • May combine two claims.

    Premisecitation

    Plasma tubes contain ethylenediaminetetraacetic acid and reduce triglyceride levels by 3% compared with serum because of relative dilution of nondiffusible components in plasma.

    “plasma tubes contain ethylenediaminetetraacetic acid and reduce triglyceride levels by 3% compared with serum because of the relative dilution of nondiffusible components in plasma.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [247] 247. Laboratory Methods Committee of the Lipid Research Clinics Program of the National Heart, Lung, and Blood Institute. Cholesterol and tri- glyceride concentrations in serum/plasma pairs. Clin Chem. 1977;23: 60 -63.

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    Triglyceride levels are reduced by approximately 12% after 20 to 30 minutes and by 15% to 20% by 40 minutes after positional changes.

    “triglyceride levels are reduced by Ϸ12% after 20 to 30 minutes and by 15% to 20% by 40 minutes”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [245] 245. Miller M, Bachorik PS, Cloey TA. Normal variation of plasma lipo- proteins: postural effects on plasma concentrations of lipids, lipo- proteins, and apolipoproteins. Clin Chem. 1992;38:569 -574.

      Not checked in the free run.

    • cites [246] 246. Hagan RD, Upton SJ, Avakian EV, Grundy S. Increases in serum lipid and lipoprotein levels with movement from the supine to standing position in adult men and women. Prev Med. 1986;15:18 -27.

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  • May combine two claims.

    Premisecitation

    Approximately 1 in 5 children with a BMI above the 95th percentile are hypertriglyceridemic, a rate that is 7-fold higher than for nonobese children 6 to 10 years of age.

    “Approximately 1 in 5 children with a BMI above the 95th percentile are hypertriglyceridemic, a rate that is 7-fold higher than for nonobese children 6 to 10 years of age.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [294] 294. Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. The relation of overweight to cardiovascular risk factors among children and ado- lescents: the Bogalusa Heart Study. Pediatrics. 1999;103:1175-1182. source

      Not checked in the free run.

    • cites [295] 295. Daniels SR, Jacobson MS, McCrindle BW, Eckel RH, Sanner BM. American Heart Association Childhood Obesity Research Summit: executive summary. Circulation. 2009;119:2114 -2123. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Each additional daily serving of sugar-sweetened beverages was associated with a 2.25-mg/dL increase in triglyceride levels, as well as increases in IR, LDL-C, and systolic blood pressure and a decrease in HDL-C.

    “Each additional daily serving of sugar-sweetened beverages was associated with a 2.25-mg/dL increase in triglyceride levels, as well as increases in IR, LDL-C, and systolic blood pressure and a decrease in HDL-C.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [300] 300. Bremer AA, Auinger P, Byrd RS. Relationship between insulin resistance-associated metabolic parameters and anthropometric mea- surements with sugar-sweetened beverage intake and physical activity levels in US adolescents: findings from the 1999 -2004 National Health and Nutrition Examination Survey. Arch Pediatr Adolesc Med. 2009; 163:328 -335.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    NHANES 1999-2006 identified a triglyceride level >=150 mg/dL in 11.4% of boys and 8.8% of girls 12 to 19 years of age, with the highest rate (16.4%) in the 18-to 19-year-old group.

    “More recent data from NHANES 1999 -2006 identified a triglyceride level Ն150 mg/dL in 11.4% of boys and 8.8% of girls 12 to 19 years of age, with the highest rate (16.4%) in the 18-to 19-year-old group.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [154] 154. Centers for Disease Control and Prevention. Prevalence of abnormal lipid levels among youths: United States, 1999 -2006 [published cor- rection appears in MMWR Morb Mortal Wkly Rep. 2010;59:78]. MMWR Morb Mortal Wkly Rep. 2010;59:29 -33.

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The fasting state only represents a small proportion of time spent each day and therefore understates levels that are attained in the postprandial state.

    “the fasting state only represents a small proportion of time spent each day and therefore understates levels that are attained in the postprandial state.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Early pathophysiological changes in arteries begin soon after birth and accelerate during adolescence.

    “the early pathophysiological changes in arteries begin soon after birth and accelerate during adolescence.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [289] 289. McGill HC Jr, McMahan CA, Zieske AW, Sloop GD, Walcott JV, Troxclair DA, Malcom GT, Tracy RE, Oalmann MC, Strong JP; Patho- biological Determinants of Atherosclerosis in Youth (PDAY) Research Group. Associations of coronary heart disease risk factors with the intermediate lesion of atherosclerosis in youth. Arterioscler Thromb Vasc Biol. 2000;20:1998 -2004.

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  • May combine two claims.

    Premisecitation

    The prevalence of triglyceride levels >=150 mg/dL has increased among US women >=20 years of age from 24.6% in 1988-1994 to 29.9% in 1999-2000, with stabilization at 26.8% (1999-2008).

    “The prevalence of triglyceride levels Ն150 mg/dL has increased among US women Ն20 years of age from 24.6% in 1988 -1994 to 29.9% in 1999 -2000, 307 with stabilization at 26.8% (1999 -2008; Table 2).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [307] 307. Ford ES, Giles WH, Mokdad AH. Increasing prevalence of the meta- bolic syndrome among U.S. adults. Diabetes Care. 2004;27:2444 -2449. 308. 108. McNeill AM, Rosamond WD, Girman CJ, Golden SH, Schmidt MI, East HE, Ballantyne CM, Heiss G. The metabolic syndrome and 11-year risk of incident cardiovascular disease in the atherosclerosis risk in commu- nities study. Diabetes Care. 2005;28:385-390.

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  • May combine two claims.

    Premisecitation

    The magnitude of change attributable to aging was similar to that associated with the menopausal transition; both were substantially greater than changes directly attributable to decreases in estradiol or increases in follicle stimulating hormone.

    “The magnitude of change attributable to aging was similar to that associated with the menopausal transition; both were substantially greater than changes directly attributable to decreases in estradiol or increases in follicle stimulating hormone.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [335] 335. Derby CA, Crawford SL, Pasternak RC, Sowers M, Sternfeld B, Matthews KA. Lipid changes during the menopause transition in relation to age and weight: the Study of Women's Health Across the Nation. Am J Epidemiol. 2009;169:1352-1361.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Orally administered exogenous estrogens increase triglyceride levels, whereas exogenously administered progestins tend to ameliorate this estrogen-induced hypertriglyceridemia to varying degrees depending on dose and type of progestin.

    “Orally administered exogenous estrogens increase triglyceride levels, whereas exogenously administered progestins tend to ameliorate this estrogen-induced hypertriglyceridemia to varying degrees depending on dose and type of progestin.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [336] 336. The Writing Group for the PEPI Trial. Effects of estrogen or estrogen/ progestin regimens on heart disease risk factors in postmenopausal women: the Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial [published correction appears in JAMA. 1995;274:1676]. JAMA. 1995;273:199 -208.

      Not checked in the free run.

    • cites [337] 337. Godsland IF. Effects of postmenopausal hormone replacement therapy on lipid, lipoprotein, and apolipoprotein (a) concentrations: analysis of studies published from 1974 -2000. Fertil Steril. 2001;75:898 -915. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Higher triglyceride levels among female newborns than among male newborns have been reported.

    “Although higher triglyceride levels among female newborns than among male newborns have been reported”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [305] 305. Bansal N, Cruickshank JK, McElduff P, Durrington PN. Cord blood lipoproteins and prenatal influences. Curr Opin Lipidol. 2005;16: 400 -408. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In pregnancy, women experience a physiological hyperlipidemia due to enhanced lipolytic activity in adipose tissue, with >2-fold increases in circulating triglyceride levels during the third trimester.

    “In pregnancy, women experience a “physiological hyperlipidemia” due to enhanced lipolytic activity in adipose tissue, with Ͼ2-fold increases in circulating triglyceride levels during the third trimester.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [109] 109. Herrera E, Amusquivar E, Lo ´pez-Soldado I, Ortega H. Maternal lipid metabolism and placental lipid transfer. Horm Res. 2006;65(suppl 3):59 -64.

      Not checked in the free run.

    • cites [110] 110. Mazurkiewicz JC, Watts GF, Warburton FG, Slavin BM, Lowy C, Koukkou E. Serum lipids, lipoproteins and apolipoproteins in pregnant non-diabetic patients. J Clin Pathol. 1994;47:728 -731.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Some studies find a hypertriglyceridemia-associated shift toward smaller, denser LDL particle size, whereas others have shown a shift toward larger, buoyant LDL particles in late pregnancy.

    “Although some studies find a hypertriglyceridemia-associated shift toward smaller, denser LDL particle size, 323,324 others have shown a shift toward larger, buoyant LDL particles in late pregnancy.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [323] 323. Silliman K, Shore V, Forte TM. Hypertriglyceridemia during late pregnancy is associated with the formation of small dense low-density lipoproteins and the presence of large buoyant high-density lipoproteins. Metabolism. 1994;43:1035-1041.

      Not checked in the free run.

    • cites [324] 324. Hubel CA, Shakir Y, Gallaher MJ, McLaughlin MK, Roberts JM. Low-density lipoprotein particle size decreases during normal pregnancy in association with triglyceride increases. J Soc Gynecol Investig. 1998;5:244 -250.

      Not checked in the free run.

    • cites [325] 325. Winkler K, Wetzka B, Hoffmann MM, Friedrich I, Kinner M, Baumstark MW, Wieland H, Ma ¨rz W, Zahradnik HP. Low density lipoprotein (LDL) subfractions during pregnancy: accumulation of buoyant LDL with advancing gestation. J Clin Endocrinol Metab. 2000; 85:4543-4550.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Although most studies suggest increases in the 20% to 30% range, triglyceride level increases of as much as 57% (and decreases in LDL particle size) have been reported in some populations.

    “Although most studies suggest increases in the 20% to 30% range, triglyceride level increases of as much as 57% (and decreases in LDL particle size) have been reported in some populations.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [321] 321. Foulon T, Payen N, Laporte F, Bijaoui S, Dupont G, Roland F, Gros- lambert P. Effects of two low-dose oral contraceptives containing ethi- nylestradiol and either desogestrel or levonorgestrel on serum lipids and lipoproteins with particular regard to LDL size. Contraception. 2001; 64:11-16.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The increase in triglyceride levels occurred despite the fact that the use of lipid-lowering medications among adult women >=20 years of age increased from 3.5% to 8% between the 1988-1994 and the 1999-2002 surveys.

    “This increase occurred despite the fact that the use of lipid-lowering medications among adult women Ն20 years of age increased from 3.5% to 8% between the 1988 -1994 and the 1999 -2002 surveys.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] 6. Carroll MD, Lacher DA, Sorlie PD, Cleeman JI, Gordon DJ, Wolz M, Grundy SM, Johnson CL. Trends in serum lipids and lipoproteins of adults, 1960 -2002. JAMA. 2005;294:1773-1781.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    As women transition through menopause in middle age, triglyceride levels increase, but it is not clear how much of this increase is mediated by aging and accompanying lifestyle changes versus a consequence of menopausal hormonal transition.

    “As women transition through menopause in middle age, triglyceride levels increase, but it is not clear how much of this increase is mediated by aging and accompanying lifestyle changes (eg, reduced physical activity) versus a consequence of menopausal hormonal transition.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [330] 330. Davis CE, Pajak A, Rywik S, Williams DH, Broda G, Pazucha T, Ephross S. Natural menopause and cardiovascular disease risk factors: the Poland and US Collaborative Study on Cardiovascular Disease Epidemiology. Ann Epidemiol. 1994;4:445-448.

      Not checked in the free run.

    • cites [331] 331. Lindquist O, Bengtsson C, Lapidus L. Relationships between the menopause and risk factors for ischaemic heart disease. Acta Obstet Gynecol Scand Suppl. 1985;130:43-47.

      Not checked in the free run.

    • cites [332] 332. Bonithon-Kopp C, Scarabin PY, Darne B, Malmejac A, Guize L. Menopause-related changes in lipoproteins and some other cardiovas- cular risk factors. Int J Epidemiol. 1990;19:42-48.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Population-based data in US adults indicate that compared with men, triglyceride levels are lower in young and middle-aged females and among non-Hispanic whites, blacks, and Mexican Americans; in contrast, older women have higher levels than men in all ethnic groups.

    “Population-based data in US adults indicate that compared with men triglyceride levels are lower in young and middle-aged females and among non-Hispanic whites, blacks, and Mexican Americans; in contrast, older women have higher levels than men in all ethnic groups.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] 6. Carroll MD, Lacher DA, Sorlie PD, Cleeman JI, Gordon DJ, Wolz M, Grundy SM, Johnson CL. Trends in serum lipids and lipoproteins of adults, 1960 -2002. JAMA. 2005;294:1773-1781.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the CARDIA study, oral contraceptive users had higher triglyceride levels than nonusers, despite their use being associated with lower fasting glucose levels and reduced odds of DM.

    “In the CARDIA study (Coronary Artery Risk Development in Young Adults), which did not distinguish between various formulations, oral contraceptive users had higher triglyceride levels than nonusers, despite their use being associated with lower fasting glucose levels and reduced odds of DM.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [319] 319. Kim C, Siscovick DS, Sidney S, Lewis CE, Kiefe CI, Koepsell TD. Oral contraceptive use and association with glucose, insulin, and diabetes in young adult women: the CARDIA Study: Coronary Artery Risk Devel- opment in Young Adults. Diabetes Care. 2002;25:1027-1032. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    This difference is present in women as young as 18 to 24 years of age and persists thereafter.

    “This difference is present in women as young as 18 to 24 years of age and persists thereafter.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [315]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Both IR and hyperestrogenemia represent causative factors for the development or amplification of hypertriglyceridemia during pregnancy.

    “Both IR 326 and hyperestrogenemia 327 represent causative factors for the development or amplification of hypertriglyceridemia during pregnancy”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [326] 326. McIntyre HD, Chang AM, Callaway LK, Cowley DM, Dyer AR, Radaelli T, Farrell KA, Huston-Presley L, Amini SB, Kirwan JP, Catalano PM; Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study Cooperative Research Group. Hormonal and metabolic factors associated with variations in insulin sensitivity in human pregnancy. Diabetes Care. 2010;33:356 -360.

      Not checked in the free run.

    • cites [327] 327. Montelongo A, Lasuncio ´n MA, Pallardo LF, Herrera E. Longitudinal study of plasma lipoproteins and hormones during pregnancy in normal and diabetic women. Diabetes. 1992;41:1651-1659.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In adolescence, girls experience a decrease in triglycerides, whereas boys experience an increase, likely due to a greater degree of IR among males.

    “In adolescence, girls experience a decrease in triglycerides, whereas boys experience an increase, likely due to a greater degree of IR among males.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [306] 306. Moran A, Jacobs DR Jr, Steinberger J, Steffen LM, Pankow JS, Hong CP, Sinaiko AR. Changes in insulin resistance and cardiovascular risk during adolescence: establishment of differential risk in males and females. Circulation. 2008;117:2361-2368.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Recent studies have reported no change in basal VLDL triglyceride and apo B 100 kinetics and triglyceride levels during the menstrual cycle.

    “Recent studies have reported no change in basal VLDL triglyceride and apo B 100 kinetics 312 and triglyceride levels, 313”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [312] 312. Magkos F, Patterson BW, Mittendorfer B. No effect of menstrual cycle phase on basal very-low-density lipoprotein triglyceride and apolipo- protein B-100 kinetics. Am J Physiol Endocrinol Metab. 2006;291: E1243-E1249. 313. 109. Barnett JB, Woods MN, Lamon-Fava S, Schaefer EJ, McNamara JR, Spiegelman D, Hertzmark E, Goldin B, Longcope C, Gorbach SL. Plasma lipid and lipoprotein levels during the follicular and luteal phases of the menstrual cycle. J Clin Endocrinol Metab. 2004;89:776 -782.

      Not checked in the free run.

    • cites [313]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Prevalence is highest among Mexican American women, intermediate among non-Hispanic white women, and lowest among black women.

    “Prevalence is highest among Mexican American women, intermediate among non-Hispanic white women, and lowest among black women”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [308] source

      Not checked in the free run.

    • cites [309] 309. Park YW, Zhu S, Palaniappan L, Heshka S, Carnethon MR, Heymsfield SB. The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988 -1994. Arch Intern Med. 2003;163: 427-436.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Women who develop DM experience a greater rise in triglyceride levels and have an overall more adverse lipid profile than men who develop DM.

    “Women who develop DM experience a greater rise in triglyceride levels and have an overall more adverse lipid profile than men who develop DM.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [310] 310. Walden CE, Knopp RH, Wahl PW, Beach KW, Strandness E Jr. Sex differences in the effect of diabetes mellitus on lipoprotein triglyceride and cholesterol concentrations. N Engl J Med. 1984;311:953-959. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Current guidelines for CVD prevention in women encourage fasting triglyceride levels <150 mg/dL and non-HDL-C <130 mg/dL through TLC.

    “Current guidelines for CVD prevention in women encourage fasting triglyceride levels Ͻ150 mg/dL and non-HDL-C Ͻ130 mg/dL through TLC.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [304] 304. Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, Lloyd-Jones DM, Newby LK, Pina IL, Roger VL, Shaw LJ, Zhao D, Beckie TM, Bushnell C, D'Armiento J, Kris-Etherton PM, Fang J, Ganiats TG, Gomes AS, Gracia CR, Haan CK, Jackson EA, Judelson DR, Kelepouris E, Lavie CJ, Moore A, Nussmeier NA, Ofili E, Oparil S, Ouyang P, Pinn VW, Sherif K, Smith SC, Jr, Sopko G, Chandra-Strobos N, Urbina EM, Vaccarino V, Wenger NK. Effectiveness-based guidelines for the pre- vention of cardiovascular disease in women-2011 update: a guideline from the American Heart Association. Circulation. 2011;123: 1243-

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Mexican American women have the highest triglyceride levels, whereas non-Hispanic white women have intermediate levels, and black women have the lowest levels.

    “Mexican American women have the highest triglyceride levels, whereas non-Hispanic white women have intermediate levels, and black women have the lowest levels.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] 6. Carroll MD, Lacher DA, Sorlie PD, Cleeman JI, Gordon DJ, Wolz M, Grundy SM, Johnson CL. Trends in serum lipids and lipoproteins of adults, 1960 -2002. JAMA. 2005;294:1773-1781.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Non-Hispanic blacks often possess lower levels of triglycerides; the mechanism for this inherent difference may be increased LPL activity.

    “non-Hispanic blacks often possess lower levels of triglycerides; the mechanism for this inherent difference may be increased LPL activity.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [350] 350. Sumner AE, Cowie CC. Ethnic differences in the ability of triglyceride levels to identify insulin resistance. Atherosclerosis. 2008;196:696 -703.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A weight loss of 5% to 10% results in a 20% decrease in triglycerides, approximately a 15% reduction in LDL-C, and an 8% to 10% increase in HDL-C.

    “A weight loss of 5% to 10% results in a 20% decrease in triglycerides, approximately a 15% reduction in LDL-C, and an 8% to 10% increase in HDL-C.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [386] 386. Van Gaal LF, Mertens IL, Ballaux D. What is the relationship between risk factor reduction and degree of weight loss? Eur Heart J Suppl. 2005;7(suppl L):L21-L26.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisereasoning

    Because documentation for a specific threshold in triglyceride-induced pancreatitis is lacking, levels associated with increased risk are arbitrarily defined as triglyceride levels >=1000 mg/dL.

    “Because documentation for a specific threshold in triglyceride-induced pancreatitis is lacking, levels associated with increased risk are arbitrarily defined as triglyceride levels Ն1000 mg/dL”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [105] 105. Ewald N, Hardt PD, Kloer HU. Severe hypertriglyceridemia and pan- creatitis: presentation and management. Curr Opin Lipidol. 2009;20: 497-504. source

      Not checked in the free run.

    • cites [353] 353. Fortson MR, Freedman SN, Webster PD 3rd. Clinical assessment of hyperlipidemic pancreatitis. Am J Gastroenterol. 1995;90:2134 -2139.

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Taken together, these data raise the possibility that an optimal fasting triglyceride level may be <100 mg/dL; similarly, an optimal nonfasting triglyceride level may be <150 mg/dL because of the <50% anticipated increase in postprandial triglyceride levels after a fat load.

    “Taken together, these data raise the possibility that an optimal fasting triglyceride level may be Ͻ100 mg/dL; similarly, an optimal nonfasting triglyceride level may be Ͻ150 mg/dL because of the Ͻ50% anticipated increase in ppTG levels after a fat load”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Eliminating dietary trans fatty acids, which increase triglycerides and atherogenic lipoproteins (ie, lipoprotein[a], LDL-C) and are linked to increased cardiovascular risk.

    “One intervention is to eliminate dietary trans fatty acids, which increase triglycerides and atherogenic lipoproteins (ie, lipoprotein[a], LDL-C) 382 and are linked to increased cardiovascular risk.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [382] 382. Kreisberg RA, Oberman A. Medical management of hyperlipidemia/ dyslipidemia. J Clin Endocrinol Metab. 2003;88:2445-2461. source

      Not checked in the free run.

    • cites [383] 383. Mozaffarian D, Stampfer MJ. Removing industrial trans fat from foods. BMJ. 2010;340:c1826.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The approximately 25% rise in triglyceride levels in US adults during the past several decades has coincided with higher caloric intake and higher rates of juvenile obesity and T2DM.

    “the Ϸ25% rise in triglyceride levels in US adults during the past several decades 6 that has coincided with higher caloric intake 9 and higher rates of juvenile obesity and T2DM 8”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [6] 6. Carroll MD, Lacher DA, Sorlie PD, Cleeman JI, Gordon DJ, Wolz M, Grundy SM, Johnson CL. Trends in serum lipids and lipoproteins of adults, 1960 -2002. JAMA. 2005;294:1773-1781.

      Not checked in the free run.

    • cites [9] 9. Johnson RK, Appel LJ, Brands M, Howard BV, Lefevre M, Lustig RH, Sacks F, Steffen LM, Wylie-Rosett J; on behalf of American Heart Association Nutrition Committee of the Council on Nutrition, Physical Activity, and Metabolism and the Council on Epidemiology and Pre- vention. Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation. 2009;120: 1011-1020.

      Not checked in the free run.

    • cites [8] 8. Daniels SR, Arnett DK, Eckel RH, Gidding SS, Hayman LL, Kumanyika S, Robinson TN, Scott BJ, St Jeor S, Williams CL. Over- weight in children and adolescents: pathophysiology, consequences, prevention, and treatment. Circulation. 2005;111:1999 -2012.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    This often occurs without a sufficient increase in waist circumference that meets the criteria of MetS as defined by ATP III, thereby resulting in a lower threshold for abnormal waist circumference for South Asians and several other ethnic groups; a BMI of 23 kg/m2 in South Asians corresponds to a BMI of 25 kg/m2 in whites.

    “This often occurs without a sufficient increase in waist circumference that meets the criteria of MetS as defined by ATP III, thereby resulting in a lower threshold for abnormal waist circumference for South Asians and several other ethnic groups; a BMI of 23 kg/m 2 in South Asians corresponds to a BMI of 25 kg/m 2 in whites.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [347] 347. Misra A, Khurana L. The metabolic syndrome in South Asians: epide- miology, determinants, and prevention. Metab Syndr Relat Disord. 2009;7:497-514.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A study of 185 blacks in whom IR was documented by the euglycemic-hyperinsulinemic clamp procedure demonstrated mean triglyceride levels (109 mg/dL) below the cut point for elevated triglyceride used in MetS, although they were higher than in the insulin-sensitive cohort (mean 77 mg/dL).

    “A study of 185 blacks in whom IR was documented by the euglycemic-hyperinsulinemic clamp procedure demonstrated mean triglyceride levels (109 mg/dL) below the cut point for elevated triglyceride used in MetS, although they were higher than in the insulin-sensitive cohort (mean 77 mg/dL).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [351] 351. Stein E, Kushner H, Gidding S, Falkner B. Plasma lipid concentrations in nondiabetic African American adults: associations with insulin resistance and the metabolic syndrome. Metabolism. 2007;56:954 -960.

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  • May combine two claims.

    Premisecitation

    Elevations in triglyceride levels serve as a biomarker for visceral adiposity, IR, DM, and nonalcoholic hepatic steatosis (fatty liver).

    “The elevations in triglyceride levels serve as a biomarker for visceral adiposity, IR, DM, and nonalcoholic hepatic steatosis (fatty liver).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [156] 156. Nicklas BJ, Penninx BW, Ryan AS, Berman DM, Lynch NA, Dennis KE. Visceral adipose tissue cutoffs associated with metabolic risk factors for coronary heart disease in women. Diabetes Care. 2003;26: 1413-1420.

      Not checked in the free run.

    • cites [157] 157. Despre ´s JP, Lemieux I, Bergeron J, Pibarot P, Mathieu P, Larose E, Rode ´s-Cabau J, Bertrand OF, Poirier P. Abdominal obesity and the metabolic syndrome: contribution to global cardiometabolic risk [pub- lished correction appears in Arterioscler Thromb Vasc Biol. 2008;28: e151]. Arterioscler Thromb Vasc Biol. 2008;28:1039 -1049. source

      Not checked in the free run.

    • cites [360] 360. Kashyap SR, Diab DL, Baker AR, Yerian L, Bajaj H, Gray-McGuire C, Schauer PR, Gupta M, Feldstein AE, Hazen SL, Stein CM. Triglyceride levels and not adipokine concentrations are closely related to severity of nonalcoholic fatty liver disease in an obesity surgery cohort. Obesity (Silver Spring). 2009;17:1696 -1701.

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  • May combine two claims.

    Premisecitation

    The Strong Heart Study, a cross-sectional prospective observational study of 4600 American Indians, found a moderate elevation in triglyceride levels and a significantly increased prevalence of T2DM to have contributed to incident CVD.

    “the Strong Heart Study, a cross-sectional prospective observational study of 4600 American Indians, 348 found a moderate elevation in triglyceride levels and a significantly increased prevalence of T2DM to have contributed to incident CVD.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [348] 348. Howard BV, Lee ET, Cowan LD, Fabsitz RR, Howard WJ, Oopik AJ, Robbins DC, Savage PJ, Yeh JL, Welty TK. Coronary heart disease prevalence and its relation to risk factors in American Indians: the Strong Heart Study. Am J Epidemiol. 1995;142:254 -268.

      Not checked in the free run.

    • cites [349] 349. Howard BV, Lee ET, Cowan LD, Devereux RB, Galloway JM, Go OT, Howard WJ, Rhoades ER, Robbins DC, Sievers ML, Welty TK. Rising tide of cardiovascular disease in American Indians: the Strong Heart Study. Circulation. 1999;99:2389 -2395.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Other potentially adverse clinical manifestations of chylomicronemia include retinal thrombosis and, in rare cases, blindness.

    “other potentially adverse clinical manifestations of chylomicronemia include retinal thrombosis 358 and, in rare cases, blindness.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [358] 358. Nagra PK, Ho AC, Dugan JD Jr. Lipemia retinalis associated with branch retinal vein occlusion. Am J Ophthalmol. 2003;135:539 -542.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Populations from South Asia, including India, Pakistan, Sri Lanka, Bangladesh, and Nepal, have an increased prevalence of MetS and T2DM compared with Europeans.

    “Populations from South Asia, including India, Pakistan, Sri Lanka, Bangladesh, and Nepal, have an increased prevalence of MetS and T2DM compared with Europeans.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [345] 345. Forouhi NG, Sattar N. CVD risk factors and ethnicity: a homogeneous relationship? Atheroscler Suppl. 2006;7:11-19.

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    Blacks with MetS or T2DM may not possess high triglyceride levels as commonly as observed in other ethnic groups, thereby attenuating the predictive value of triglycerides or triglycerides-to-HDL ratios in this subgroup to identify IR.

    “Thus, blacks with MetS or T2DM may not possess high triglyceride levels as commonly as observed in other ethnic groups, thereby attenuating the predictive value of triglycerides or triglycerides-to-HDL ratios in this subgroup to identify IR.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [234] 234. Sumner AE, Finley KB, Genovese DJ, Criqui MH, Boston RC. Fasting triglyceride and the triglyceride-HDL cholesterol ratio are not markers of insulin resistance in African Americans. Arch Intern Med. 2005;165: 1395-1400.

      Not checked in the free run.

    • cites [350] 350. Sumner AE, Cowie CC. Ethnic differences in the ability of triglyceride levels to identify insulin resistance. Atherosclerosis. 2008;196:696 -703.

      Not checked in the free run.

    • cites [352] 352. Sharma MD, Pavlik VN. Dyslipidaemia in African Americans, His- panics and whites with type 2 diabetes mellitus and hypertension. Diabetes Obes Metab. 2001;3:41-45.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Borderline-high and high triglyceride levels (150 to 500 mg/dL) are not associated with pancreatitis, but they are correlated with atherogenic RLPs and apo CIII-enriched particles.

    “Although borderline-high and high triglyceride levels (150 to 500 mg/dL) are not associated with pancreatitis, they are correlated with atherogenic RLPs and apo CIII-enriched particles.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [74] 74. Ooi EM, Barrett PH, Chan DC, Watts GF. Apolipoprotein C-III: under- standing an emerging cardiovascular risk factor. Clin Sci (Lond). 2008; 114:611-624. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Raloxifene increased triglyceride levels by 8% in a 3-year study among healthy women but only by 1.5% in the much larger Multiple Outcomes of Raloxifene Evaluation trial, which included women with and without CVD.

    “Raloxifene, for example, increased triglyceride levels by 8% in a 3-year study among healthy women but only by 1.5% in the much larger Multiple Outcomes of Raloxifene Evaluation trial, which included women with and without CVD.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [343] 343. Reid IR, Eastell R, Fogelman I, Adachi JD, Rosen A, Netelenbos C, Watts NB, Seeman E, Ciaccia AV, Draper MW. A comparison of the effects of raloxifene and conjugated equine estrogen on bone and lipids in healthy postmenopausal women. Arch Intern Med. 2004;164: 871-879.

      Not checked in the free run.

    • cites [344] 344. Barrett-Connor E, Grady D, Sashegyi A, Anderson PW, Cox DA, Hoszowski K, Rautaharju P, Harper KD; MORE Investigators (Multiple Outcomes of Raloxifene Evaluation). Raloxifene and cardiovascular events in osteoporotic postmenopausal women: four-year results from the MORE (Multiple Outcomes of Raloxifene Evaluation) randomized trial. JAMA. 2002;287:847-857.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Tamoxifen has been reported to cause marked elevation in triglyceride levels, with rare reports of pancreatitis.

    “tamoxifen has been reported to cause marked elevation in triglyceride levels, 124 with rare reports of pancreatitis”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [124] 124. Hozumi Y, Kawano M, Saito T, Miyata M. Effect of tamoxifen on serum lipid metabolism. J Clin Endocrinol Metab. 1998;83:1633-1635.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Meta-analyses have reported that for every kilogram of weight loss, triglyceride levels decrease approximately 1.9%, or 1.5 mg/dL.

    “Meta-analyses have reported that for every kilogram of weight loss, triglyceride levels decrease Ϸ1.9%, or 1.5 mg/dL.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [388] 388. Anderson JW, Konz EC. Obesity and disease management: effects of weight loss on comorbid conditions. Obes Res. 2001;9(suppl 4): 326S-334S. source

      Not checked in the free run.

    • cites [389] 389. Dattilo AM, Kris-Etherton PM. Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis. Am J Clin Nutr. 1992;56: 320 -328.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    South Asians have increased fat compared with muscle tissue, with a more central distribution of body fat, which has been attributed to the adipose tissue overflow hypothesis.

    “South Asians have increased fat compared with muscle tissue, with a more central distribution of body fat, which has been attributed to the “adipose tissue overflow hypothesis.””
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [346] 346. Bainey KR, Jugdutt BI. Increased burden of coronary artery disease in South-Asians living in North America: need for an aggressive man- agement algorithm. Atherosclerosis. 2009;204:1-10.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A low fasting triglyceride level (ie, <100 mg/dL) is commonly found in underdeveloped societies and countries at low CVD risk (eg, Africa, China, Greece, and Japan), as contrasted with the United States, where mean levels are approximately 15% to 30% higher.

    “A low fasting triglyceride level (ie, Ͻ100 mg/dL) is commonly found in underdeveloped societies and countries at low CVD risk (eg, Africa, China, Greece, and Japan), [361][362][363][364][365][366][367][368][369][370][371][372][373] as contrasted with the United States, where mean levels are Ϸ15% to 30% higher.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [361] 361. Gebre-Yohannes A, Rahlenbeck SI. Coronary heart disease risk factors among blood donors in northwest Ethiopia. East Afr Med J. 1998;75: 495-500.

      Not checked in the free run.

    • cites [362] 362. Vorster HH, Kruger A, Venter CS, Margetts BM, Macintyre UE. Car- diovascular disease risk factors and socio-economic position of Africans in transition: the THUSA study. Cardiovasc J Afr. 2007;18:282-289.

      Not checked in the free run.

    • cites [363] 363. Murray MJ, Murray AB, Murray NJ, Murray MB. Serum cholesterol, triglycerides and heart disease of nomadic and sedentary tribesmen consuming isoenergetic diets of high and low fat content. Br J Nutr. 1978;39:159 -163.

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Although many studies of high-CHO diets have shown increases in triglyceride levels, others (eg, DASH, OmniHeart, and WHI) have shown no effect.

    “Thus, although many studies of high-CHO diets have shown increases in triglyceride levels, others (eg, DASH, OmniHeart, and WHI) have shown no effect.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    TC, LDL-C, HDL-C, and triglyceride levels did not change with the fruits and vegetables diet.

    “TC, LDL-C, HDL-C, and triglyceride levels did not change with the fruits and vegetables diet.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [394] 394. Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, Bray GA, Vogt TM, Cutler JA, Windhauser MM, Lin PH, Karanja N; DASH Collaborative Research Group. A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med. 1997;336: 1117-1124. source

      Not checked in the free run.

    • cites [395] 395. Obarzanek E, Sacks FM, Vollmer WM, Bray GA, Miller ER 3rd, Lin PH, Karanja NM, Most-Windhauser MM, Moore TJ, Swain JF, Bales CW, Proschan MA; DASH Research Group. Effects on blood lipids of a blood pressure-lowering diet: the Dietary Approaches to Stop Hyper- tension (DASH) Trial. Am J Clin Nutr. 2001;74:80 -89. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The association of added sugars with increased obesity, T2DM, dental carries, and decreased diet quality is evident.

    “The association of added sugars with increased obesity, T2DM, dental carries, and decreased diet quality is evident, which is part of the evidence base for recommendations made by other organizations to limit added sugars.409,410”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [409] 409. Dietary Guidelines for Americans. 2005; 6th ed. US Department of Health and Human Services Web site. http://www.healthierus.gov/ dietaryguidelines. Accessed September 13, 2010.

      Not checked in the free run.

    • cites [410] 410. Nishida C, Uauy R, Kumanyika S, Shetty P. The joint WHO/FAO expert consultation on diet, nutrition and the prevention of chronic diseases: process, product and policy implications. Public Health Nutr. 2004;7: 245-250.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Compared with a Western diet, the DASH diet reduced TC (-9.5%), LDL-C (-9.1%), and HDL-C (-9.2%) but did not adversely affect triglycerides.

    “Compared with a Western diet, the DASH diet reduced TC (Ϫ9.5%),LDL-C (Ϫ9.1%), and HDL-C (Ϫ9.2%) but did not adversely affect triglycerides.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [394] 394. Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, Bray GA, Vogt TM, Cutler JA, Windhauser MM, Lin PH, Karanja N; DASH Collaborative Research Group. A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med. 1997;336: 1117-1124. source

      Not checked in the free run.

    • cites [395] 395. Obarzanek E, Sacks FM, Vollmer WM, Bray GA, Miller ER 3rd, Lin PH, Karanja NM, Most-Windhauser MM, Moore TJ, Swain JF, Bales CW, Proschan MA; DASH Research Group. Effects on blood lipids of a blood pressure-lowering diet: the Dietary Approaches to Stop Hyper- tension (DASH) Trial. Am J Clin Nutr. 2001;74:80 -89. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the OmniHeart Trial, compared with baseline levels, triglyceride levels decreased significantly after the high-unsaturated-fat and high-protein diets (-9.3 and -16.4 mg/dL, respectively) but not after the high-CHO diet (increase of 0.1 mg/dL).

    “Compared with baseline levels, triglyceride levels decreased significantly after the highunsaturated-fat and high-protein diets (Ϫ9.3 and Ϫ16.4 mg/dL, respectively) but not after the high-CHO diet (increase of 0.1 mg/dL).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [396] 396. Appel LJ, Sacks FM, Carey VJ, Obarzanek E, Swain JF, Miller ER 3rd, Conlin PR, Erlinger TP, Rosner BA, Laranjo NM, Charleston J, McCarron P, Bishop LM; OmniHeart Collaborative Research Group. Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial. JAMA. 2005;294:2455-2464. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    With few exceptions, implementation of a Mediterranean-style diet versus a low-fat diet is more commonly associated with an approximately 10% to 15% lowering of triglycerides and a reduced prevalence of hypertriglyceridemia.

    “With few exceptions, such as the Lyon Diet Heart Study, 403 which found no significant change in triglyceride levels on a MUFA-enriched versus low-fat, high-n-6 PUFA diet, implementation of a Mediterranean-style diet versus a low-fat diet is more commonly associated with an approximately 10% to 15% lowering of triglycerides and a reduced prevalence of hypertriglyceridemia.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [403] 403. de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascu- lar complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999;99:779 -785. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    GL was positively associated with triglyceride levels in whites but not in blacks or Hispanics.

    “In terms of race/ethnicity, GL was positively associated with triglyceride levels in whites but not in blacks or Hispanics.417”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [417] 417. Shikany JM, Tinker LF, Neuhouser ML, Ma Y, Patterson RE, Phillips LS, Liu S, Redden DT. Association of glycemic load with cardiovascu- lar disease risk factors: the Women's Health Initiative Observational Study. Nutrition. 2010;26:641-647.

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The discrepancy in effects of high-CHO diets on triglycerides may reflect higher fiber intake, higher protein intake, or a combined effect.

    “This discrepancy may reflect higher fiber intake (Ϸ30 g/d; DASH, OmniHeart), higher protein intake (Ͼ15% of energy; DASH, OmniHeart, WHI), or a combined effect.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In Esposito et al, subjects on the intervention diet decreased body weight by 6.2 lb or 2.8 kg (P<0.001) and waist circumference by 0.8 inches or 2 cm (P=0.01) compared with the control group.

    “In addition, subjects on the intervention diet decreased body weight by 6.2 lb or 2.8 kg (PϽ0.001) and waist circumference by 0.8 inches or 2 cm (Pϭ0.01)compared with the control group.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [400] 400. Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, D'Armiento M, D'Andrea F, Giugliano D. Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA. 2004;292:1440 -1446. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a meta-analysis of 19 studies published by the Institute of Medicine comparing low-fat, high-CHO diets versus higher-fat diets, for every 5% decrease in total fat, triglyceride level was predicted to increase by 6% and HDL-C to decrease by 2.2%.

    “In this analysis comparing low-fat, high-CHO diets versus higher-fat diets, for every 5% decrease in total fat, triglyceride level was predicted to increase by 6% and HDL-C to decrease by 2.2%.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [390] 390. Panel on Macronutrients, Panel on the Definition of Dietary Fiber, Subcommittee on Upper References Levels of Nutrients, Subcommittee on Interpretation and Uses of Dietary Reference Intakes, and the Standing Committee on the Scientific Evaluation of Dietary Ref- erence Intakes, Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, DC: National Academies Press; 2005. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The ATP III evidence statement conveyed that very high intakes of carbohydrate (>60 percent of total calories) are accompanied by a reduction in HDL cholesterol and a rise in triglyceride.

    “very high intakes of carbohydrate (Ͼ60 percent of total calories) are accompanied by a reduction in HDL cholesterol and a rise in triglyceride”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [221] 221. National Cholesterol Education Program (U.S.). Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Final Report. Washington, DC: National Institutes of Health, National Heart, Lung, and Blood Institute; 2002. NIH publication No. 02-5215.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a comparison of a Mediterranean-style weight loss diet with low-CHO and low-fat energy-restricted diets, after 6 months triglyceride levels were reduced the most in the low-CHO group (22%), but after 12 months similar reductions were observed in both the low-CHO and Mediterranean-style groups, with minimal change in the low-fat group.

    “After 6 months, triglyceride levels were reduced the most in the low-CHO group (22%), but after 12 months, similar reductions were observed in both the low-CHO and Mediterranean-style groups, with minimal change in the low-fat group.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [439] 439. Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I, Golan R, Fraser D, Bolotin A, Vardi H, Tangi-Rozental O, Zuk-Ramot R, Sarusi B, Brickner D, Schwartz Z, Sheiner E, Marko R, Katorza E, Thiery J, Fiedler GM, Bluher M, Stumvoll M, Stampfer MJ; Dietary Intervention Randomized Controlled Trial (DIRECT) Group. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet [published correction appears in N Engl J Med. 2009;361:2681]. N Engl J Med. 2008;359:229 -241.

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationcitation

    These data support limiting fructose in men and women with borderline or elevated triglyceride levels.

    “These data support limiting fructose in men and women with borderline or elevated triglyceride levels (Figure 5).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [428] 428. Livesey G, Taylor R. Fructose consumption and consequences for gly- cation, plasma triacylglycerol, and body weight: meta-analyses and meta-regression models of intervention studies. Am J Clin Nutr. 2008; 88:1419 -1437.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the Whitehall II Study, GI but not GL correlated with triglyceride levels.

    “whereas in the Whitehall II Study, GI but not GL correlated with triglyceride levels.420”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [420] 420. Mosdøl A, Witte DR, Frost G, Marmot MG, Brunner EJ. Dietary glycemic index and glycemic load are associated with high-density- lipoprotein cholesterol at baseline but not with increased risk of diabetes in the Whitehall II study. Am J Clin Nutr. 2007;86:988 -994.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Fructose metabolism is relatively unregulated compared with glucose metabolism, which is regulated in part by phosphofructokinase.

    “In contrast to glucose metabolism, which is regulated in part by phosphofructokinase, fructose metabolism is relatively unregulated.425”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [425] 425. Stanhope KL, Havel PJ. Endocrine and metabolic effects of consuming beverages sweetened with fructose, glucose, sucrose, or high-fructose corn syrup. Am J Clin Nutr. 2008;88:1733S-1737S. 426. 114. Putnam JJ, Allshouse JE. Food Consumption, Prices, and Expenditures, 1970 -97. Washington, DC: Food and Rural Economics Division, Economic Research Service, US Department of Agriculture; 1999. Sta- tistical Bulletin No. 965. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The Insulin Resistance Atherosclerosis Study found GL but not GI to be positively associated with triglycerides.

    “the Insulin Resistance Atherosclerosis Study 419 found GL but not GI to be positively associated with triglycerides”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [419] 419. Liese AD, Gilliard T, Schulz M, D'Agostino RB Jr, Wolever TM. Carbohydrate nutrition, glycaemic load, and plasma lipids: the Insulin Resistance Atherosclerosis Study. Eur Heart J. 2007;28:80 -87. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisereasoning

    High CHO intake triggers pancreatic insulin release in response to increased blood glucose.

    “Mechanistically, high CHO intake triggers pancreatic insulin release in response to increased blood glucose.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Insulin activates sterol regulatory element-binding protein (SREBP-1c), a transcription factor that regulates fatty acid and triglyceride synthesis.

    “Insulin, in turn, activates sterol regulatory element-binding protein, (SREBP-1c), a transcription factor that regulates fatty acid and triglyceride synthesis.430”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [430] 430. Horton JD, Goldstein JL, Brown MS. SREBPs: activators of the complete program of cholesterol and fatty acid synthesis in the liver. J Clin Invest. 2002;109:1125-1131.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Alcohol abuse may be associated with hypertriglyceridemia; nearly 1 in 5 hospitalized alcoholics have triglyceride levels exceeding 250 mg/dL.

    “In contrast, alcohol abuse may be associated with hypertriglyceridemia; nearly 1 in 5 hospitalized alcoholics have triglyceride levels exceeding 250 mg/dL.450”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [450] 450. Feinman L, Lieber CS. Ethanol and lipid metabolism. Am J Clin Nutr. 1999;70:791-792. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In Gardner et al, weight loss was greatest on the Atkins diet (4.7 kg) followed by LEARN (2.6 kg), Ornish (2.2 kg), and Zone (1.6 kg), with corresponding reductions in triglyceride levels (3% to 23%).

    “In the study by Gardner et al, 441 which compared the Atkins, Zone, LEARN (Lifestyle, Exercise, Attitudes, Relationships, and Nutrition) and Ornish diets, weight loss was greatest on the Atkins diet (4.7 kg) followed by LEARN (2.6 kg), Ornish (2.2 kg), and Zone (1.6 kg), with corresponding reductions in triglyceride levels (3% to 23%).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [441] 441. Gardner CD, Kiazand A, Alhassan S, Kim S, Stafford RS, Balise RR, Kraemer HC, King AC. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. JAMA. 2007;297:969 -977. source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Fructose enhances lipogenesis and triglyceride synthesis.

    “Fructose enhances lipogenesis and triglyceride synthesis.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In POUNDS LOST, after 2 years, weight loss was similar in participants assigned to low and high protein (15% vs 25%), low and high fat (20% vs 40%), or low and high CHO (65% vs 35%).

    “After 2 years, weight loss was similar in participants assigned to low and high protein (15% versus 25%), low and high fat (20% versus 40%), or low and high CHO (65% versus 35%).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [433] 433. Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD, McManus K, Champagne CM, Bishop LM, Laranjo N, Leboff MS, Rood JC, de Jonge L, Greenway FL, Loria CM, Obarzanek E, Wil- liamson DA. Comparison of weight-loss diets with different compo- sitions of fat, protein, and carbohydrates. N Engl J Med. 2009;360: 859 -873.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Bonow and Eckel concluded that low-CHO diets produced a more robust triglyceride-lowering effect than low-fat diets despite a similar magnitude of weight loss after 1 year.

    “Bonow and Eckel 434 concluded that low-CHO diets produced a more robust triglyceride-lowering effect than low-fat diets despite a similar magnitude of weight loss after 1 year.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [434] 434. Bonow RO, Eckel RH. Diet, obesity, and cardiovascular risk. N Engl J Med. 2003;348:2057-2058. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Unsaturated fatty acids reduce or inhibit SREBP-1c transcription, thereby reducing hepatic fatty acid synthesis and plasma triglycerides.

    “In contrast, unsaturated fatty acids reduce or inhibit SREBP-1c transcription, thereby reducing hepatic fatty acid synthesis 430 and plasma triglycerides.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [430] 430. Horton JD, Goldstein JL, Brown MS. SREBPs: activators of the complete program of cholesterol and fatty acid synthesis in the liver. J Clin Invest. 2002;109:1125-1131.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In Dansinger et al, significant reductions in triglycerides occurred after 2 months on the Atkins and Zone diets, but these effects were no longer significant after 12 months.

    “Although significant reductions in triglycerides occurred after 2 months on the Atkins and Zone diets, these effects were no longer significant after 12 months.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [440] 440. Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ. Com- parison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA. 2005;293:43-53. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Overall, exercise is most effective in lowering triglycerides (e.g., 20% to 30%) when baseline levels are elevated (i.e., >150 mg/dL), activity is moderate to intensive, and total caloric intake is reduced.

    “Overall, exercise is most effective in lowering triglycerides (eg, 20% to 30%) when baseline levels are elevated (ie, Ͼ150 mg/dL), activity is moderate to intensive, and total caloric intake is reduced.481”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [481] 481. Durstine JL, Grandjean PW, Cox CA, Thompson PD. Lipids, lipo- proteins, and exercise. J Cardiopulm Rehabil. 2002;22:385-398.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Additional benefits of exercise include reduction in the ppTG response and attenuation of the triglyceride elevations observed after consumption of a low-fat, high-CHO diet.

    “Additional benefits of exercise include reduction in the ppTG response and attenuation of the triglyceride elevations observed after consumption of a lowfat, high-CHO diet.479”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [479] 479. Gill JM, Hardman AE. Exercise and postprandial lipid metabolism: an update on potential mechanisms and interactions with high-carbohydrate diets (review). J Nutr Biochem. 2003;14:122-132.

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Because the amount needed for significant triglyceride lowering (2 to 4 g) is difficult to attain through diet alone on a daily basis, supplementation with capsules may be needed.

    “Because the amount needed for significant triglyceride lowering (2 to 4 g) is difficult to attain through diet alone on a daily basis, supplementation with capsules may be needed.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Dietary practices or factors associated with elevated triglyceride levels include excess body weight, especially visceral adiposity; simple CHOs, including added sugars and fructose; a high glycemic load; and alcohol.

    “Dietary practices or factors that are associated with elevated triglyceride levels include excess body weight, especially visceral adiposity; simple CHOs, including added sugars and fructose; a high glycemic load; and alcohol.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Although statins have consistently shown benefit in subgroups with or without high triglyceride levels, fibrates have more commonly been shown to provide greater benefit in subgroups with increased triglyceride levels.

    “Although statins have consistently shown benefit in subgroups with or without high triglyceride levels, fibrates have more commonly been shown to provide greater benefit in subgroups with increased triglyceride levels.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In LIPID, each 89-mg/dL decrease in on-treatment triglyceride level in patients given pravastatin significantly decreased CVD risk by 11%, and by 14% after adjustment for nonlipid risk factors.

    “However, in LIPID, although baseline triglyceride level was not significantly associated with CVD risk in patients given placebo, each 89-mg/dL decrease in on-treatment triglyceride level in patients given pravastatin significantly decreased CVD risk by 11%, as well as by 14% after adjustment for nonlipid risk factors.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [500] 500. Simes RJ, Marschner IC, Hunt D, Colquhoun D, Sullivan D, Stewart RA, Hague W, Keech A, Thompson P, White H, Shaw J, Tonkin A; LIPID Study Investigators. Relationship between lipid levels and clinical outcomes in the Long-term Intervention with Pravastatin in Ischemic Disease (LIPID) Trial: to what extent is the reduction in coronary events with pravastatin explained by on-study lipid levels? Circulation. 2002;105:1162-1169. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a comprehensive review of human studies, Harris reported that ~4 g of marine-derived omega-3 PUFA per day decreased serum triglyceride concentrations by 25% to 30%, with accompanying increases of 5% to 10% in LDL-C and 1% to 3% in HDL-C.

    “In a comprehensive review of human studies, Harris 454 reported that Ϸ4 g of marine-derived omega-3 PUFA per day decreased serum triglyceride concentrations by 25% to 30%, with accompanying increases of 5% to 10% in LDL-C and 1% to 3% in HDL-C.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [454] 454. Harris WS. n-3 Fatty acids and serum lipoproteins: human studies. Am J Clin Nutr. 1997;65(suppl):1645S-1654S. 455. 115. Balk E, Chung M, Lichtenstein A, Chew P, Kupelnick B, Lawrence A, DeVine D, Lau J. Effects of Omega-3 Fatty Acids on Cardiovascular Risk Factors and Intermediate Markers of Cardiovascular Disease. Evidence Report/Technology Assessment No. 93 (prepared by Tufts-New England Medical Center Evidence-Based Practice Center under contract No. 290-02-0022). AHRQ publication No. 04-E010-2. 116. Rockville, MD: Agency for Healthcare Research and Quality; 2004. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    On-treatment triglyceride level was not associated with CVD risk in AFCAPS/TexCAPS and was not predictive of CVD event rate or risk reduction in VA-HIT.

    “On-treatment triglyceride level was not associated with CVD risk in AFCAPS/TexCAPS 499 and was not predictive of CVD event rate or risk reduction in VA-HIT.497”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [499] 499. Gotto AM Jr, Whitney E, Stein EA, Shapiro DR, Clearfield M, Weis S, Jou JY, Langendo ¨rfer A, Beere PA, Watson DJ, Downs JR, de Cani JS. Relation between baseline and on-treatment lipid parameters and first acute major coronary events in the Air Force/Texas Coronary Athero- sclerosis Prevention Study (AFCAPS/TexCAPS). Circulation. 2000; 101:477-484. source

      Not checked in the free run.

    • cites [497] 497. Robins SJ, Collins D, Wittes JT, Papademetriou V, Deedwania PC, Schaefer EJ, McNamara JR, Kashyap ML, Hershman JM, Wexler LF, Rubins HB; for the VA-HIT Study Group. Relation of gemfibrozil treatment and lipid levels with major coronary events: VA-HIT: a randomized controlled trial. JAMA. 2001;285:1585-1591. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The ACCORD trial did not show an overall benefit for fibrate therapy added to statin therapy in T2DM, but did show benefit in the subgroup with elevated triglyceride levels (>204 mg/dL) and low HDL-C (<34 mg/dL).

    “The recent Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, which did not show an overall benefit for fibrate therapy added to statin therapy in T2DM, did show benefit in the subgroup with elevated triglyceride levels (Ͼ204 mg/dL) and low HDL-C (Ͻ34 mg/dL).498”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [498] 498. Ginsberg HN, Elam MB, Lovato LC, Crouse JR 3rd, Leiter LA, Linz P, Friedewald WT, Buse JB, Gerstein HC, Probstfield J, Grimm RH, Ismail-Beigi F, Bigger JT, Goff DC Jr, Cushman WC, Simons-Morton DG, Byington RP; ACCORD Study Group. Effects of combination lipid therapy in type 2 diabetes mellitus [published correction appears in N Engl J Med. 2010;362:1748]. 121. N Engl J Med. 2010;362:1563-1574.

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisenone given

    Although marine-derived omega-3 PUFA capsules have been shown to be free of contaminants, their clinical efficacy at high doses (2 to 4 g/d) has yet to be established.

    “Although marine-derived omega-3 PUFA capsules have been shown to be free of contaminants, their clinical efficacy at high doses (2 to 4 g/d) has yet to be established.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In a study of 2906 middle-aged men, moderately intensive activity (jogging 10 miles weekly) versus no activity was associated with a 20% lower fasting triglyceride level; the highest activity level (>20 miles weekly) was also accompanied by the lowest mean fasting triglyceride level (86 mg/dL).

    “Moreover, in a study of 2906 middleaged men, moderately intensive activity (ie, jogging 10 miles weekly) versus no activity was associated with a 20% lower fasting triglyceride level; the highest activity level (Ͼ20 miles weekly) was also accompanied by the lowest mean fasting triglyceride level (86 mg/dL).475”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [475] 475. Kokkinos PF, Holland JC, Narayan P, Colleran JA, Dotson CO, Papa- demetriou V. Miles run per week and high-density lipoprotein choles- terol levels in healthy, middle-aged men: a dose-response relationship. Arch Intern Med. 1995;155:415-420.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Individually, EPA or DHA may reduce triglyceride, ppTG, or CMR levels.

    “Individually, EPA or DHA may reduce triglyceride, 461 ppTG, 462 or CMR 463 levels.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [461] 461. Grimsgaard S, Bonaa KH, Hansen JB, Nordøy A. Highly purified eicosapentaenoic acid and docosahexaenoic acid in humans have similar triacylglycerol-lowering effects but divergent effects on serum fatty acids. Am J Clin Nutr. 1997;66:649 -659.

      Not checked in the free run.

    • cites [462] 462. Hansen JB, Grimsgaard S, Nilsen H, Nordøy A, Bønaa KH. Effects of highly purified eicosapentaenoic acid and docosahexaenoic acid on fatty acid absorption, incorporation into serum phospholipids and post- prandial triglyceridemia. Lipids. 1998;33:131-138. source

      Not checked in the free run.

    • cites [463] 463. Kelley DS, Siegel D, Vemuri M, Mackey BE. Docosahexaenoic acid supplementation improves fasting and postprandial lipid profiles in hypertriglyceridemic men. Am J Clin Nutr. 2007;86:324 -333. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    The content of EPA/DHA per capsule is highly variable and ranges from 300 mg to ~850 mg.

    “The content of EPA/DHA per capsule is highly variable and ranges from 300 mg to Ϸ850 mg.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    Triglyceride is not directly atherogenic but represents an important biomarker of CVD risk because of its association with atherogenic remnant particles and apo CIII.

    “This scientific statement reviews the pivotal role of triglycerides in lipid metabolism and reaffirms that triglyceride is not directly atherogenic but represents an important biomarker of CVD risk because of its association with atherogenic remnant particles and apo CIII.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Elimination of trans fats, restriction of saturated fatty acids, and increasing consumption of marine-based omega-3 products, coupled with aerobic activity, will further optimize triglyceride-lowering efforts.

    “Elimination of trans fats, restriction of SFA, 524 -527 and increasing consumption of marine-based omega-3 products, coupled with aerobic activity, will further optimize triglyceride-lowering efforts.”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [524] 524. Watts GF, Lewis B, Brunt JN, Lewis ES, Coltart DJ, Smith LD, Mann JI, Swan AV. Effects on coronary artery disease of lipid-lowering diet, or diet plus cholestyramine, in the St Thomas' Atherosclerosis Regression Study (STARS). Lancet. 1992;339:563-569.

      Not checked in the free run.

    • cites [525] 525. Miller M. Hold the patty, not the lettuce: processing foods for over a quarter century in the Nurses' Health Study. Circulation. 2010;122: 859 -860. Letter.

      Not checked in the free run.

    • cites [526] 526. Bernstein AM SQ, Hu FB, Stampfer MJ, Manson JE, Willet WC. Major dietary protein sources and risk of coronary heart disease in women. Circulation. 2010;122:876 -883.

      Not checked in the free run.

    • cites [527] 527. Mozaffarian D, Micha R, Wallace S. Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials. PLoS Med. 2010;7:e1000252. 528. 123. Hauenschild A, Bretzel RG, Schnell-Kretschmer H, Kloer HU, Hardt PD, Ewald N. Successful treatment of severe hypertriglyceridemia with a formula diet rich in omega-3 fatty acids and medium-chain triglycer- ides. Ann Nutr Metab. 2010;56:170 -175. 124. KEY WORDS: AHA Scientific Statements Ⅲ triglycerides Ⅲ atherosclerosis Ⅲ diabetes mellitus Ⅲ epidemiology

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The ACCORD trial did not find that fibrate therapy added to statin reduced cardiovascular events in DM patients (median triglyceride level 162 mg/dL) except in the subgroup in the upper triglyceride tertile and lowest HDL-C tertile (P=0.06).

    “As noted above, the ACCORD trial 498 did not find that fibrate therapy added to statin reduced cardiovascular events in DM patients (median triglyceride level of 162 mg/dL) except in the subgroup in the upper triglyceride tertile and lowest HDL-C tertile (Pϭ0.06).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [498] 498. Ginsberg HN, Elam MB, Lovato LC, Crouse JR 3rd, Leiter LA, Linz P, Friedewald WT, Buse JB, Gerstein HC, Probstfield J, Grimm RH, Ismail-Beigi F, Bigger JT, Goff DC Jr, Cushman WC, Simons-Morton DG, Byington RP; ACCORD Study Group. Effects of combination lipid therapy in type 2 diabetes mellitus [published correction appears in N Engl J Med. 2010;362:1748]. 121. N Engl J Med. 2010;362:1563-1574.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Prototypical pilot studies demonstrate a greater understanding of healthy food choices, which in turn may also improve academic performance.

    “Prototypical pilot studies demonstrate a greater understanding of healthy food choices, which in turn may also improve academic performance.518,519”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [518] 518. DeVault N, Kennedy T, Hermann J, Mwavita M, Rask P, Jaworsky A. It's all about kids: preventing overweight in elementary school children in Tulsa, OK. J Am Diet Assoc. 2009;109:680 -687.

      Not checked in the free run.

    • cites [519] 519. Shilts MK, Lamp C, Horowitz M, Townsend MS. Pilot study: EatFit impacts sixth graders' academic performance on achievement of math- ematics and English education standards. J Nutr Educ Behav. 2009;41: 127-131.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The principal objectives of Healthy People 2010 are to improve the quality of healthy living and eliminate health disparities through interventions aimed at heart disease and stroke prevention.

    “The principal objectives are to improve the quality of healthy living and eliminate health disparities through interventions aimed at heart disease and stroke prevention.515,516”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [515] 515. Labarthe DR. Heart-healthy and stroke-free, 2008. Prev Chronic Dis. 2008;5:A32. source

      Not checked in the free run.

    • cites [516] 516. Veazie MA, Galloway JM, Matson-Koffman D, LaBarthe DR, Brownstein JN, Emr M, Bolton E, Freund E Jr, Fulwood R, Guyton- Krishnan J, Hong Y, Lebowitz M, Ochiai E, Schoeberl M, Robertson RM. Taking the initiative: implementing the American Heart Asso- ciation Guide for Improving Cardiovascular Health at the Community Level: Healthy People 2010 Heart Disease and Stroke Partnership Community Guideline Implementation and Best Practices Workgroup. Circulation. 2005;112:2538 -2554. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Healthy People 2010 was established by the Centers for Disease Control and Prevention in 1998 for health promotion and disease prevention.

    “Among the most comprehensive national programs has been Healthy People 2010, the initiative established by the Centers for Disease Control and Prevention in 1998 for health promotion and disease prevention.515”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [515] 515. Labarthe DR. Heart-healthy and stroke-free, 2008. Prev Chronic Dis. 2008;5:A32. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Trials that used statin plus niacin (or in some cases bile acid resin) combination therapy have shown a reduction in coronary arteriographic progression and regression, as well as regression of carotid artery intima-media thickness.

    “Trials that used statin plus niacin (or in some cases bile acid resin) combination therapy have shown a reduction in coronary arteriographic progression and regression, as well as regression of carotid artery intima-media thickness.504,505”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [504] 504. Brown B, Canner PL, McGovern ME, Guyton JR, Carlson LA. Nicotinic acid. In: Ballantyne C, ed. Clinical Lipidology, A Companion to Braun- wald's Heart Disease. Philadelphia, PA: Saunders; 2009:298 -314.

      Not checked in the free run.

    • cites [505] 505. Taylor AJ, Villines TC, Stanek EJ, Devine PJ, Griffen L, Miller M, Weissman NJ, Turco M. Extended-release niacin or ezetimibe and carotid intima-media thickness. N Engl J Med. 2009;361:2113-2122.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In LIPID, the lipid-related parameters most strongly associated with CVD risk were apo B, LDL-C, and the ratio of TC to HDL-C.

    “However, the lipid-related parameters most strongly associated with CVD risk in LIPID were apo B, LDL-C, and the ratio of TC to HDL-C.500”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [500] 500. Simes RJ, Marschner IC, Hunt D, Colquhoun D, Sullivan D, Stewart RA, Hague W, Keech A, Thompson P, White H, Shaw J, Tonkin A; LIPID Study Investigators. Relationship between lipid levels and clinical outcomes in the Long-term Intervention with Pravastatin in Ischemic Disease (LIPID) Trial: to what extent is the reduction in coronary events with pravastatin explained by on-study lipid levels? Circulation. 2002;105:1162-1169. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Nutrition education beginning in elementary school may yield considerable dividends toward reducing obesity rates, because dietary behaviors are often established in childhood.

    “In addition to community-based outreach programs, nutrition education beginning in elementary school may yield considerable dividends toward reducing obesity rates, because dietary behaviors are often established in childhood.517”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [517] 517. Strauss R. Childhood obesity. Curr Probl Pediatr. 1999;29:1-29.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    IR, obesity, and sedentary lifestyle can all lead to or aggravate metabolic syndrome risk factors.

    “Moreover, IR, obesity, and sedentary lifestyle can all lead to or aggravate metabolic syndrome risk factors”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Additional adjustment for HDL-C and the ratio of apo B to apo AI decreased the predictive ability of on-treatment triglyceride levels, and further adjustment for baseline glucose, BMI, hypertension, T2DM, and smoking eliminated the association.

    “However, additional adjustment for HDL-C and the ratio of apo B to apo AI decreased the predictive ability of on-treatment triglyceride levels, and further adjustment for baseline glucose, BMI, hypertension, T2DM, and smoking eliminated the association.501”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [501] 501. Faergeman O, Holme I, Fayyad R, Bhatia S, Grundy SM, Kastelein JJ, LaRosa JC, Larsen ML, Lindahl C, Olsson AG, Tikkanen MJ, Waters DD, Pedersen TR; Steering Committees of IDEAL and TNT Trials. Plasma triglycerides and cardiovascular events in the Treating to New Targets and Incremental Decrease in End-Points through Aggressive Lipid Lowering trials of statins in patients with coronary artery disease. Am J Cardiol. 2009;104:459 -463. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Resolutions have been adopted in all 50 states targeting obesity, including elimination of high caloric sugared sodas and trans fatty acid products from public school vending machines and increasing the number of walking and bicycle paths.

    “For example, resolutions have now been adopted in all 50 states targeting obesity, including the elimination of high caloric sugared sodas and trans fatty acid products from public school vending machines and increasing the number of walking and bicycle paths.512,513”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [512] 512. Boehmer TK, Brownson RC, Haire-Joshu D, Dreisinger ML. Patterns of childhood obesity prevention legislation in the United States. Prev Chronic Dis. 2007;4:A56.

      Not checked in the free run.

    • cites [513] 513. Greves HM, Rivara FP. Report card on school snack food policies among the United States' largest school districts in 2004 -2005: room for improvement. Int J Behav Nutr Phys Act. 2006;3:1. 514. 122. Fox MK, Dodd AH, Wilson A, Gleason PM. Association between school food environment and practices and body mass index of US public school children. J Am Diet Assoc. 2009;109(suppl):S108 -S117.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Initiatives such as reducing access to low-nutrient, energy-dense foods in school cafeterias serve as adjunctive measures for controlling high triglyceride and obesity rates.

    “Initiatives such as reducing access to low-nutrient, energy-dense foods in school cafeterias serve as other adjunctive measures for controlling high triglyceride and obesity rates.514”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [514] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In JELIS, combination therapy with statin plus EPA in the high-risk subgroup reduced CVD risk by 53% compared with statin monotherapy, even though the dose of EPA (up to 1.8 g/d) translated into minimal triglyceride reduction (5% between groups).

    “Moreover, combination therapy with statin plus EPA in this high-risk subgroup reduced CVD risk by 53% compared with statin monotherapy, 503 even though the dose of EPA (up to 1.8 g/d) translated into minimal triglyceride reduction (5% between groups).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [503] 503. Saito Y, Yokoyama M, Origasa H, Matsuzaki M, Matsuzawa Y, Ishikawa Y, Oikawa S, Sasaki J, Hishida H, Itakura H, Kita T, Kita- batake A, Nakaya N, Sakata T, Shimada K, Shirato K; JELIS Investi- gators, Japan. Effects of EPA on coronary artery disease in hypercho- lesterolemic patients with multiple risk factors: sub-analysis of primary prevention cases from the Japan EPA Lipid Intervention Study (JELIS) [published correction appears in Atherosclerosis. 2009;204:233]. Atherosclerosis. 2008;200:135-140. source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Some familial disorders of triglyceride metabolism are associated with increased risk for pancreatitis when fasting triglyceride level exceeds 1000 mg/dL, while others are associated with increased atherosclerotic risk.

    “Although some familial disorders of triglyceride metabolism are associated with increased risk for pancreatitis when fasting triglyceride level exceeds 1000 mg/dL, others are associated with increased atherosclerotic risk.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Strategies to attenuate hypertriglyceridemia and its associated metabolic complications include increasing physical activity during school and afterschool sessions, incentivizing schools committed to fostering nutrition education, and offering a variety of fresh fruits and vegetables daily to school cafeterias.

    “Strategies to attenuate hypertriglyceridemia and its associated metabolic complications include increasing physical activity during school and afterschool sessions, 520,521 incentivizing schools committed to fostering nutrition education, 522 and offering a variety of fresh fruits and vegetables daily to school cafeterias.523”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [520] 520. Kelder SH, Springer AS, Barroso CS, Smith CL, Sanchez E, Ranjit N, Hoelscher DM. Implementation of Texas Senate Bill 19 to increase physical activity in elementary schools. J Public Health Policy. 2009; 30(suppl 1):S221-S247.

      Not checked in the free run.

    • cites [521] 521. Topp R, Jacks DE, Wedig RT, Newman JL, Tobe L, Hollingsworth A. Reducing risk factors for childhood obesity: the Tommie Smith Youth Athletic Initiative. West J Nurs Res. 2009;31:715-730.

      Not checked in the free run.

    • cites [522] 522. He M, Callaghan C, Evans A, Mandich G. Healthy eating champions award for elementary schools. Can J Diet Pract Res. 2009;70:101-104.

      Not checked in the free run.

    • cites [523] 523. Davis EM, Cullen KW, Watson KB, Konarik M, Radcliffe J. A Fresh Fruit and Vegetable Program improves high school students' con- sumption of fresh produce. J Am Diet Assoc. 2009;109:1227-1231.

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationnone given

    Measurements of non-HDL-C, apo B, or both may be especially useful in those with prominent triglyceride/HDL abnormalities in which LDL-C measurements may underestimate true atherosclerotic vascular risk.

    “Measurements of non-HDL-C, apo B, or both may be especially useful in those with prominent triglyceride/ HDL abnormalities in which LDL-C measurements may underestimate true atherosclerotic vascular risk.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    High-risk statin-treated patients who continue to have elevated triglyceride levels display an increased risk for CVD, but these patients also have other metabolic abnormalities, and adjustment for measures of these associated abnormalities, such as non-HDL-C and apo B, decreases the predictive effect of triglycerides.

    “Thus, high-risk statin-treated patients who continue to have elevated triglyceride levels display an increased risk for CVD, but these patients also have other metabolic abnormalities, and adjustment for measures of these associated abnormalities, such non-HDL-C and apo B, decreases the predictive effect of triglycerides.”
    Quote in the paperSubstantial claim
180 of 180

  • The paper relies on this without support.

    NHANES surveys provide representative estimates of the US adult population's triglyceride levels.

    “In the United States, the National Health and Nutrition Examination Survey (NHANES) has monitored biomarkers of CVD risk for Ͼ3 decades.”
    “Overall, 31% of the adult US population has a triglyceride level Ն150 mg/dL, with no appreciable change between NHANES 1988 -1994 and 1999 -2008.”

  • The paper relies on this without support.

    The molecular basis underlying FCHL is largely unknown.

    “The molecular basis underlying FCHL is largely unknown; genetic variants in the APOA1/C3/A4/A5 cluster and the upstream stimulatory factor 1 (USF1) gene may play a role.140 -142”

  • The paper relies on this without support.

    The joint occurrence of high triglyceride level and low HDL-C characterizes the dyslipidemia of MetS.

    “The joint occurrence of high triglyceride level and low HDL-C characterizes the dyslipidemia of MetS.”

  • The authors state this as an assumption.

    The increase in triglyceride levels induced by oral estrogens is enhanced among women with preexisting hypertriglyceridemia.

    “It is assumed, but not well documented, that the increase in triglyceride levels induced by oral estrogens is enhanced among women with preexisting hypertriglyceridemia”

  • The paper relies on this without support.

    In South Asians and other minorities, MetS is uniformly accompanied by an increase in atherogenic TRLs, thereby contributing to increased CVD risk in these populations.

    “In South Asians and other minorities (eg, Mexican Americans, Native Hawaiians, and American Indians), MetS is uniformly accompanied by an increase in atherogenic TRLs, thereby contributing to increased CVD risk in these populations.”

  • The paper relies on this without support.

    Reducing elevated triglyceride levels reduces cardiovascular risk.

    “The association of elevated triglycerides with increased CVD risk and clustered metabolic abnormalities (as discussed in other sections of this scientific statement) has led to research and clinical interest in the potential protective benefit of reducing high levels of triglycerides.”
    “Although no published clinical trials have been designed specifically to examine the effect of triglyceride reduction on CVD event rate, secondary analyses from major trials of lipid-regulating therapy have assessed CVD risk in subgroups with high triglyceride levels.”

  • The paper relies on this without support.

    A nonfasting triglyceride level below 200 mg/dL is commensurate with a normal (below 150 mg/dL) or optimal (below 100 mg/dL) fasting triglyceride level.

    “A nonfasting level of Ͻ200 mg/dL is commensurate with a normal (Ͻ150 mg/dL) or optimal (Ͻ100 mg/dL) fasting triglyceride level and requires no further testing.”

  • The paper relies on this without support.

    A 5% to 10% reduction in body weight anticipates a triglyceride-lowering response of 20%.

    “For example, a 5% to 10% reduction in body weight anticipates a triglyceride-lowering response of 20%.”

  • The paper relies on this without support.

    Reducing added sugars and fructose while increasing unsaturated fat intake may contribute an additional 10% to 20% reduction in triglyceride levels.

    “Further offsets in CHO calories by reducing added sugars and fructose while increasing unsaturated fat intake may contribute an additional 10% to 20% reduction in triglyceride levels.”

  • The paper relies on this without support.

    For postmenopausal women with hypertriglyceridemia who require postmenopausal hormone preparations, switching to transdermal preparations may blunt the triglyceride increases observed with oral compounds.

    “For postmenopausal women with hypertriglyceridemia who require postmenopausal hormone preparations, switching to transdermal preparations may blunt the triglyceride increases observed with oral compounds.”

  • The paper relies on this without support.

    The subject of medication and triglycerides is still lacking crucial clinical trial evidence.

    “The subject of medication and triglycerides is still lacking crucial clinical trial evidence.”
11 of 11

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Alcohol consumption just before testing may elevate fasting triglyceride measurements.

    “As reviewed in the 2011 AHA statement on triglycerides and cardiovascular disease, 1 alcohol consumption just before testing may elevate fasting triglyceride measurements.118,119”

    From Omega-3 Fatty Acids for the Management of Hypertriglyceridemia: A Science Advisory From the American Heart Association (2019) · cites this paper as [1]

    Section 13.5 (Alcohol; page unavailable) reports that higher alcohol intake raises triglyceride levels. Sections 10 and 10.3 discuss factors affecting triglyceride measurements and fasting versus nonfasting tests, but do not establish that alcohol consumed just before testing elevates a fasting measurement. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • IPE reduced TG, a prominent biomarker of CVD risk.

    “IPE, a highly purified and prescription form of eicosapentaenoic acid (EPA), reduced TG, a prominent biomarker of CVD risk [13]”

    From Icosapent ethyl reduces CVD risk in cardiovascular-kidney-metabolic syndrome: REDUCE-IT CKM (2026) · cites this paper as [13]

    Section 3.4 (page unavailable) describes triglycerides as a biomarker of cardiovascular risk, and Section 13.6 says EPA may reduce triglyceride levels. The paper does not establish that the specific prescription formulation IPE reduced triglycerides; its EPA discussion is broader and more qualified. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Statins provide a 10% to 30% dose-dependent reduction in triglycerides in patients with elevated triglyceride levels.

    “Although commonly recognized for their impact on LDL-C, statins also provide a 10% to 30% dose-dependent reduction in triglycerides in patients with elevated triglyceride levels (45).”

    From 2021 ACC Expert Consensus Decision Pathway on the Management of ASCVD Risk Reduction in Patients With Persistent Hypertriglyceridemia (2021) · cites this paper as [45]

    Table 12 in the “Elevated Triglyceride Levels” section (page unavailable) lists a 10%–30% triglyceride reduction for statins. It does not establish that the reduction is dose-dependent; that part of the claim is unsupported by the cited passage. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Moderate triglyceride elevation is often associated with increased atherosclerotic cardiovascular disease risk.

    “The 2011 statement cited epidemiological evidence that a moderate elevation in triglycerides is often associated with increased atherosclerotic cardiovascular disease (ASCVD) risk.”

    From Omega-3 Fatty Acids for the Management of Hypertriglyceridemia: A Science Advisory From the American Heart Association (2019) · cites this paper as [1]

  • Small lipid-depleted LDL subfractions contain less cholesterol than larger ones.

    “Small lipid-depleted LDL subfractions contain less cholesterol than larger ones.”

    From Quantifying atherogenic lipoproteins for lipid-lowering strategies: Consensus-based recommendations from EAS and EFLM (2020) · cites this paper as [11]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Overweight prevalence is mistaken for the rate of high triglycerides

    Major

    The table shows that about 80% of participants with triglycerides at or above 150 mg/dL were overweight or obese-not that 80% of overweight or obese participants had triglycerides that high. Using the table's counts and percentages, the latter rate is about 43%.

  • Pancreatitis-risk threshold uses conflicting units

    Minor

    One passage gives the threshold as 1000 mg/L, while another gives it as 1000 mg/dL. Those concentrations differ tenfold, making the stated risk threshold inconsistent.

2 of 2

Cites

2 retracted

Flagged first, then by citations

7 of the 557 references couldn’t be matched to a known paper.

Research works printed but not linked: 5

  1. National Cholesterol Education Program (U.S.). Working Group on Lipoprotein Measurement. Recommendations on Lipoprotein Measurement. Bethesda, Md.: National Institutes of Health, National Heart, Lung, and Blood Institute; 1995. NIH publication No. 95-3044.
  2. Putnam JJ, Allshouse JE. Food Consumption, Prices, and Expenditures, 1970–97. Washington, DC: Food and Rural Economics Division, Economic Research Service, US Department of Agriculture; 1999. Statistical Bulletin No. 965.
  3. McKenney JM, Ganz P, Wiggins BS, Saseen JS. Statins. In: , Ballantyne C, ed. Clinical Lipidology, A Companion to Braunwald's Heart Disease. Philadelphia, PA: Saunders; 2009: 253–280.
  4. Norata GD, Catapano AL. In: , Ballantyne C, ed. Clinical Lipidology, A Companion to Braunwald's Heart Disease. Philadelphia, PA: Saunders; 2009: 288–297.
  5. Brown B, Canner PL, McGovern ME, Guyton JR, Carlson LA. Nicotinic acid. In: , Ballantyne C, ed. Clinical Lipidology, A Companion to Braunwald's Heart Disease. Philadelphia, PA: Saunders; 2009: 298–314.

Cited by

Sorted by citations

Related

Authors
Miller, M., Stone, N. J., Ballantyne, C., Bittner, V., Criqui, M. H., Ginsberg, H. N., Goldberg, A. C., Howard, W. J., Jacobson, M. S., Kris-Etherton, P. M., Lennie, T. A., Levi, M., Mazzone, T., & Pennathur, S.
Affiliations
University of Maryland, College Park (US)
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2011-05-24
Volume
123
Issue
20
Pages
2292-2333
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/cir.0b013e3182160726
OpenAlex
W2036747551
Cited by
1,871
References
557
Citations by year
2026: 85 · 2025: 102 · 2024: 108 · 2023: 96 · 2022: 123 · 2021: 125 · 2020: 118 · 2019: 123 · 2018: 122 · 2017: 162 · 2016: 147 · 2015: 142 · 2014: 156 · 2013: 151 · 2012: 74
FWCI
135.07
Type
journal article
Language
en
Open access
closed
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • American Heart Association
  • Northwestern Medical Faculty Foundation
  • Bristol-Myers Squibb
  • Pfizer
  • AstraZeneca
  • GlaxoSmithKline
  • Sanofi
  • General Mills
  • Northwestern University
  • Almond Board of California
  • Archer Daniels Midland
  • Amarin Corporation
  • Canola Council of Canada
  • Peanut Institute
  • Kowa Company
  • National Institutes of Health
  • Centers for Disease Control and Prevention
  • University of California, San Diego
  • National Heart, Lung, and Blood Institute
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
triglycerides, cardiovascular disease, coronary artery disease, dyslipidemia
MeSH terms
American Heart Association, Cardiovascular Diseases, Humans, Risk Factors, Triglycerides, United States, Hypertriglyceridemia

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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