Changes in Triglyceride Levels and Risk for Coronary Heart Disease in Young Men

18 September 2007 | Volume 147 Issue 6 | Pages 377-385

Background: Current triglyceride levels might be only a weak predictor of risk for coronary heart disease (CHD).

Objective: To assess the association between changes over time in fasting triglyceride levels and CHD risk in young adults.

Design: Follow-up study over 5.5 years after 2 measurements of fasting triglycerides 5 years apart.

Setting: The Staff Periodic Examination Center of the Israel Defense Forces, Zrifin, Israel.

Patients: 13 953 apparently healthy, untreated, young men (age 26 to 45 years) with triglyceride levels less than 3.39 mmol/L (<300 mg/dL).

Measurements: Two triglyceride measurements (at enrollment [time 1] and 5 years later [time 2]), lifestyle variables, and incident cases of angiography-proven CHD.

Results: Within 5.5 years, 158 new cases of CHD were identified. The multivariate model was adjusted for age; family history; fasting glucose; high-density lipoprotein cholesterol; blood pressure; body mass index; and changes between time 1 and time 2 in body mass index, physical activity, smoking status, and habit of eating breakfast. Investigators categorized triglyceride levels according to low, intermediate, and high tertiles (as measured at time 1 and time 2 [expressed as tertile at time 1/tertile at time 2]). The risk for CHD in men with high-tertile triglyceride levels at time 1 changed depending on the tertile at time 2 (hazard ratios, 8.23 [95% CI, 2.50 to 27.13] for high/high, 6.84 [CI, 1.95 to 23.98] for high/intermediate, and 4.90 [CI, 1.01 to 24.55] for high/low, compared with the stable low/low group). The risk for CHD in men with low-tertile levels at time 1 also changed depending on the tertile at time 2 (hazard ratios, 3.81 [CI, 0.96 to 15.31] for low/intermediate and 6.76 [CI, 1.34 to 33.92] for low/high, compared with the stable low/low group).

Limitations: Participants were healthy and had a low incidence rate of CHD. The study was observational.

Conclusions: Two triglyceride measurements obtained 5 years apart may assist in assessing CHD risk in young men. A decrease in initially elevated triglyceride levels is associated with a decrease in CHD risk compared with stable high triglyceride levels. However, this risk remains higher than in those with persistently low triglyceride levels.

Editors' Notes Context Whether the serum triglyceride level is an independent risk factor for coronary heart disease (CHD) is not clear. Contribution The authors measured triglyceride levels and performed stress electrocardiographies 5 years apart on 13 593 young Israeli male career soldiers and did coronary angiography if the stress test was abnormal. Triglycerides and change in triglyceride levels strongly predicted incident CHD after adjustment for known CHD risk factors and lifestyle. Decreases in triglyceride levels were associated with adoption of a healthier lifestyle and lower CHD risk. The lowest CHD risk occurred when triglyceride levels remained low. Caution The participants were healthy male soldiers. Implication In healthy young men, triglycerides and changes in triglyceride levels are an independent CHD risk factor. —The Editors

 

Author and Article Information

From Sheba Medical Center, Tel-Hashomer, Israel; The S. Daniel Abraham Center for Health and Nutrition, Soroka Medical Center, and Ben-Gurion University of the Negev, Beer-Sheva, Israel; and Israel Defense Forces Medical Corps, Zrifin, Israel.

Note: Drs. Tirosh and Rudich contributed equally to this work.

Acknowledgment: The authors thank the Israel Diabetes Research Group for valuable support and advice, and Dr. M.J. Stamper, Harvard School of Public Health, for valuable discussions during the early stages of this work.

Grant Support: By Ben-Gurion University of the Negev, Beer-Sheva, Israel, and funds from the Israel Defense Forces National Budget.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Iris Shai, RD, PhD, Department of Epidemiology and Health Systems Evaluation, The S. Daniel Abraham International Center for Health and Nutrition, Ben-Gurion University of the Negev, PO Box 653, Beer-Sheva 84105, Israel; e-mail, irish{at}bgu.ac.il.

Current Author Addresses: Dr. Tirosh: Department of Internal Medicine A, Sheba Medical Center, Tel-Hashomer, Israel.

Dr. Rudich: Department of Clinical Biochemistry, The S. Daniel Abraham International Center for Health and Nutrition, Ben-Gurion University of the Negev, PO Box 653, Beer-Sheva 84105, Israel.

Ms. Shochat and Drs. Tekes-Manova, Israeli, and Kochba: Medical Corps Headquarters, Israel Defense Forces, Zrifin, Israel.

Dr. Henkin: Soroka University Medical Center, Ben-Gurion University of the Negev, PO Box 653, Beer-Sheva 84105, Israel.

Dr. Shai: Department of Epidemiology and Health Systems Evaluation, The S. Daniel Abraham International Center for Health and Nutrition, Ben-Gurion University of the Negev, PO Box 653, Beer-Sheva 84105, Israel.

Author Contributions: Conception and design: A. Tirosh, A. Rudich, D. Tekes-Manova, E. Israeli, I. Kochba, I. Shai.

Analysis and interpretation of the data: A. Tirosh, A. Rudich, I. Shai.

Drafting of the article: A. Tirosh, A. Rudich, I. Shai.

Critical revision of the article for important intellectual content: A. Tirosh, A. Rudich, Y. Henkin, I. Shai.

Final approval of the article: A. Tirosh, I. Shai.

Provision of study materials or patients: A. Tirosh, D. Tekes-Manova, E. Israeli, I. Kochba, I. Shai.

Statistical expertise: A. Tirosh, T. Shochat, I. Shai.

Obtaining of funding: E. Israeli.

Administrative, technical, or logistic support: D. Tekes-Manova, E. Israeli, I. Kochba.

Collection and assembly of data: T. Shochat.

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