Triglycerides revisited: is hypertriglyceridaemia a necessary therapeutic target in cardiovascular disease?

Eur Heart J Cardiovasc Pharmacother. 2023 Sep 20;9(6):570-582. doi: 10.1093/ehjcvp/pvad044.

Abstract

Despite the atherosclerotic cardiovascular disease (ASCVD) risk reduction achieved by low-density lipoprotein cholesterol (LDL-C) lowering therapy, residual ASCVD risk still exists. Previous epidemiological studies have suggested high plasma triglyceride (TG) levels as a risk factor or risk marker for ASCVD independent of LDL-C levels. In this review, we highlighted the underlying pathophysiology of hypertriglyceridaemia, the mechanistic action of therapeutic agents, the interpretation of conflicting results on recent clinical trials, and the present options for primary and secondary prevention. The benefits of fibrates-induced reduction in TG and increase in high-density lipoprotein cholesterol might outweigh the disadvantages of increasing LDL-C levels in primary prevention. In secondary CVD prevention, using eicosapentaenoic acid without docosahexaenoic acid, in addition to statins, will be beneficial. This comprehensive review may prove useful for the development of novel approaches that target hypertriglyceridaemia in future.

Keywords: Atherosclerosis; Cardiovascular disease; Hypertriglyceridaemia; Lipid-lowering therapy; Lipoprotein; Statins.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Atherosclerosis* / drug therapy
  • Cardiovascular Diseases* / diagnosis
  • Cardiovascular Diseases* / epidemiology
  • Cardiovascular Diseases* / prevention & control
  • Cholesterol, LDL
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors* / therapeutic use
  • Hypertriglyceridemia* / diagnosis
  • Hypertriglyceridemia* / drug therapy
  • Hypertriglyceridemia* / epidemiology
  • Triglycerides

Substances

  • Triglycerides
  • Cholesterol, LDL
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors