Triglycerides are often misunderstood. We look at new evidence on triglyceride lowering and heart disease. An overview of the value and caveats of trigliceryde levels

New trial on triglyceride lowering. triglyceridelowering drug vs placebo. participants: high triglycerides, low HDLcholesterol. LDLcholesterol was low, only triglycerides were high

fibrate reduced triglycerides. HDLcholesterol went up by 5%

no significant change in risk of cardiovascular events (heart attack, stroke or death). why wasn’t risk lower if triglycerides came down?

Lipids like triglycerides and cholesterol are carried in our bloodstream in lipoproteins like LDL and VLDL. VLDLs carry mostly triglycerides, LDLs carry mostly cholesterol. in cardiovascular research risk follows number of lipoproteins, not lipid level. so cholesterol and triglycerides are markers

usually the higher the cholesterol and triglycerides, the more lipoproteins. VLDLs and LDLs are cousins. VLDLs can turn into LDLs. both carry ApoB

the fibrate didn't reduce apoB so risk didnt go down, regardless of what happens to triglycerides or cholesterol. fibrates lower VLDLs (which carry mostly TGs). So both triglycerides and their carriers go down. But it raises large LDLs

VLDLs were reduced by being converted into LDLs. Reducing triglycerides by transforming one ApoB lipoprotein, VLDLs, into another, LDLs, is not helpful

Other trials: lowering triglycerides without lowering apoB doesnt help

genetics: triglyceride levels have little if any effect on cardiovascular risk when we account for ApoB

raising HDLcholesterol doesn´t help; triglycerides and HDLcholesterol combined play small if any role in cardiovascular risk accounting for apoB; people with good triglycerides and HDLcholesterol can still have plaque in their arteries

triglycerides associate with risk at population level; higher triglycerides associate with higher risk; lowering them doesn’t necessarily lower risk

high triglycerides reflect overweight, diabetes etc. changing triglycerides directly doesnt necessarily do much

markers vs makers. triglycerides, HDLcholesterol (tracks well with risk but changing HDLc directly makes little difference), LDLcholesterol

triglycerides/HDLcholesterol, total cholesterol/HDLcholesterol, reflect obesity, diabetes but higher HDLcholesterol genetically doesn´t affect risk

triglycerides can come down without change to apoB

high triglycerides: chances are i´m overweight or diabetic; if triglycerides come down due to weight loss, they reflect positive change

very high triglycerides can be bad news besides heart disease. pancreatitis and fatty liver.

don´t ignore high triglycerides. but don’t assume lower triglycerides mean lower heart disease risk; also can’t assume low triglycerides mean safety. could still have determinants of cardiovascular risk out of whack, like high blood pressure or high ApoB

fibrates reduce triglycerides and VLDLs yet risk wasn´t lower

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References:
1https://www.nejm.org/doi/full/10.1056...
2https://jamanetwork.com/journals/jama...
3https://jamanetwork.com/journals/jama...
4https://jamanetwork.com/journals/jama...
5https://www.nejm.org/doi/full/10.1056...
6https://pubmed.ncbi.nlm.nih.gov/33870...
7https://link.springer.com/book/10.100...
8https://elifesciences.org/articles/58...
9https://www.ahajournals.org/doi/full/...
10https://jamanetwork.com/journals/jama...
11https://journals.plos.org/plosmedicin...
12https://www.ncbi.nlm.nih.gov/pmc/arti...
13https://academic.oup.com/ije/article/...
14https://www.sciencedirect.com/science...
15https://academic.oup.com/eurheartj/ar...
16https://academic.oup.com/eurheartj/ar...

Disclaimer: The contents of this video are for informational purposes only and are not intended to be medical advice, diagnosis, or treatment, nor to replace medical care. The information presented herein is accurate and conforms to the available scientific evidence to the best of the author's knowledge as of the time of posting. Always seek the advice of your physician or other qualified health provider with any questions regarding any medical condition. Never disregard professional medical advice or delay seeking it because of information contained in Nutrition Made Simple!.

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0:00 New trial on Triglyceride lowering
1:21 Triglycerides vs Lipoproteins
3:55 Conclusion of the trial
5:24 LDL particle size
6:30 Big picture
7:50 Markers vs Makers
10:27 Ratios
11:36 Value of Triglycerides
13:02 Improving health as a whole