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MELANY and Familial Combined Hyperlipidemia
Submit responseWith such a large and well-characterized study sample, is it possible to determine whether “ethnicity” contributes to either the baseline or second triglyceride level in the MELANY study? Namely, would a post-hoc analysis indicate differences among Eastern European, Central Asian, or North African Jewish subjects? Since familial combined hyperlipidemia is a prevalent, world-wide disease marked by low HDL cholesterol and hypertriglyceridemia, identifying subpopulations (and kindred) in MELANY might help unravel this nefarious disease.
Conflict of Interest:
None declared
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Most important thing to be considered with an elevated triglycerides leading to coronary artery dise
Submit responseDear Editor,
Tirosh and colleagues have done an excellent observational study on relationship between triglyceride levels and risk of coronary artery disease. (1) There are few points worth mentioning – the sample of the population are all males and military personnel which is not representative of the population that we see in our daily clinics and wards. It is also important to note that the triglyceride levels are comparatively higher in women and diabetes; both were excluded in this study.
As already well known, that mild to moderate elevation of fasting plasma triglyceride level is common in patients with diabetes. In adult onset type diabetes, the fasting triglyceride values are highly variable but the prevalence of hypertriglyceridemia is markedly increased over that in age matched control population. Basal triglyceride level is regulated by the rate of production of circulating triglycerides and by the efficiency of their removal. In type 2 diabetes, hypertriglyceridemia results from increased plasma concentrations of VLDL, with or without chylomicronemia; deficient lipoprotein lipase activity; increased cholesteryl ester transfer protein activity; and increased flux of free fatty acids to the liver.(1)
Even though the study did not include people with diabetes; patients with high triglycerides may have sub-clinical diabetes (glucose intolerance) to start with and may have developed subsequent diabetes, putting them at risk of coronary artery disease. So I need to know whether the patients who had coronary angiogram proved CAD were investigated for the presence of diabetes or glucose intolerance at all. The increased prevalence of CAD in hypertriglyceridemia group could be because of diabetes itself playing an important role than triglycerides. As an important point life style modification, diet and exercise improves glycemic control thereby reducing the risk of CAD.
1. Tirosh A, Rudich A, Shochat T, Tekes-Manova D, Israeli E, Henkin Y, Kochba I, Shai I . Changes in Triglyceride Levels and Risk for Coronary Heart Disease in Young Men. Ann Intern Med. 2007;147(6): 377-85
2.Pollex RL, Hegele RA. Genetic determinants of the metabolic syndrome. Nat Clin Pract Cardiovasc Med 2006;3:482-9.