The role of
triglycerides in
cardiovascular disease is a controversial subject. Despite differences of opinion, present data allow a certain number of conclusions to be drawn. Hyperchylomicronemia is not associated with
atherosclerosis, whereas type III
hyperlipidemia is very atherogenic. These two abnormalities are, however, rare, and the majority of
hypertriglyceridemias are, in practice, associated with increased
very low density lipoproteins. Many epidemiological trials do not identify
hypertriglyceridemia as an independent risk factor when the
cholesterol and, in particular, the
HDL cholesterol levels, are taken into consideration. Nevertheless, these results must be interpreted with caution as
hypertriglyceridemia represents a very heterogeneous entity which is closely related to many factors which affect coronary risk (
hypertension,
insulin resistance, sedentarity, and even tobacco consumption). Therefore,
hypertriglyceridemia and hypo-HDL-emia may be the result of the same primary abnormality; as the
HDL-cholesterol level is more stable, it is the parameter which will be identified as a protective factor in epidemiological trials. The available data is insufficient to affirm that therapeutic lowering of
triglycerides is accompanied by a reduced coronary risk because none of the large scale trials were designed to analyse this problem. Despite these epidemiological data, the measurement of serum
triglyceride levels remains important in patients with
hyperlipidemia.