Just Read: Increased Cardiovascular Risk in Hypertriglyceridemic Patients With Statin-Controlled LDL Cholesterol – Impact of Nutrition? (not discussed)

This is a study done using data from Kaiser Permanente, performed by the Kaiser Permanente Center for Health Research (@KPCHR), looking at the relationship between triglyceride levels and cardiovascular disease in a group of patients who had their LDL’s controlled (values of 40 to 100 mg/dl). H/T @MacroFour for the link.

I believe the paper was brought to my attention because of the ongoing discussion about the value of LDL-C as the sole determinant of CVD risk. A previous study performed at Kaiser Permanente also suggests that we may need to rethink this idea: Just Read: Challenging the role of LDL vs Insulin Resistance in predicting heart disease, via Kaiser Permanente data.

The researchers found a significant association between higher triglyceride levels and CVD events, even with LDL’s controlled.

I had some additional questions/comments based on the study:

Impressive insulin resistance patterns in the study group

This was touched on a little

Patients in the high TG group (n = 2702) were significantly different from patients in the normal TG group
(n = 14,481); they were younger and more likely to be white or Hispanic, to smoke, to have lower HDL-C levels, and to have a higher prevalence of diabetes and
CKD (Table 1).

Indeed, the average HDL in the high TG group was 40 mg/dl, average TG 243 mg/dl. In single human, that would be a ratio of 6.1, very (very) indicative of insulin resistance.


It must be noted that 50% of the high TG group had a diagnosis of diabetes at baseline (vs. 38% in the nor-mal TG group), a variable we controlled for in our multivariate analysis.

No mention of nutrition

The authors mention currently underway drug trials to manipulate triglyceride levels, but do not mention how triglyceride levels are modulated by diet. This makes parts of the analysis very difficult to understand for me, because of established patterns of TG/HDL that occur with different dietary patterns.

Indeed, in studies where people move away from the Standard American Diet (SAD), both markers improve together (example: Just Read: An Online Intervention Comparing a Very Low-Carbohydrate Ketogenic Diet and Lifestyle Recommendations Versus a Plate Method Diet in Overweight Individuals With Type 2 Diabetes: Watch the Triglycerides).

In another study, the DIETFITS study, the arm of the study that went higher carbohydrate experienced a worsening of this pattern compared to the arm that went lower carbohydrate (see: Just Read: DIETFITS and Effect of Low-Fat vs Low-Carbohydrate Diet, real food is better, is the low fat diet worse for metabolic health?).

The paper contributes to the idea that lipids are much more relevant as a pattern than as a single matter. The question I have is whether each marker should be treated reductionistically as something to be reduced by single interventions.

Comments welcome as usual.


Ted Eytan, MD