Background and methods: We aimed to assess whether fasting plasma triglycerides independently predicted future fatal and nonfatal cardiovascular disease (CVD) in a population having a high prevalence of the metabolic syndrome. In the Turkish Adult Risk Factor Study, a population-based survey, 2682 men and women 20 years of age or over with fasting triglyceride values available and free of CVD at baseline examination in 1990, were prospectively followed up till 2003/04. Triglyceride concentrations were measured by the enzymatic dry chemistry method and stratified into sex-specific quintiles. Information on the mode of death was obtained from first-degree relatives and/or health personnel of local health office. Diagnosis of coronary heart disease and stroke among survivors was based on history, physical examination of the cardiovascular system and Minnesota coding of resting electrocardiograms. A total of 120 fatal and 221 new nonfatal CVD occurred among adults (mean age 43+/-14) during a mean 9.3 years of follow-up.
Results: CVD was significantly and independently predicted by the top versus the bottom fasting triglyceride quintile in logistic regression analyses when adjusted for age, sex, BMI, systolic blood pressure, total cholesterol, lipid-lowering medication, status of smoking and of glucose regulation (relative risk [RR] in men and all adults 2.38 and 1.79, respectively, p both <0.02). This corresponded to hazard ratios (HR) of 1.43 in men and 1.28 in men and women combined. Adjustment for HDL-cholesterol instead of total cholesterol in the same model gave also significant HRs corresponding to 1.42 in men and 1.32 in sexes combined.
Conclusions: Fasting triglycerides are predictive of future CVD among men with an HR of 1.4, independent of age, diabetes, lipid-lowering medication, traditional risk factors including total cholesterol or HDL-C, in a population in which metabolic syndrome prevails. A modest independent risk increment in women did not reach significance.