Treating patients with hypertriglyceridaemia saves lives: triglyceride revisited.

The statin trials in secondary and primary prevention have shown that lowering LDL cholesterol produces a reduction in coronary event rates of around 35%. The most common dyslipidaemia in MI survivors is mixed hyperlipidaemia rather than hypercholesterolaemia. New evidence from VA-HIT and BIPS suggests that relatively low levels of triglyceride may be associated with a significant increase in coronary risk. In patients with established coronary disease, treatment with a fibrate that lowers triglyceride and raises HDL cholesterol, but which has little effect on LDL cholesterol, slows the rate of progression of coronary lesions. In hypertriglyceridaemic patients who have survived an MI or who have angina pectoris, fibrate treatment reduced the incidence of fatal and non-fatal MI by 40% (p = 0.03) (BIPS). In patients with coronary artery disease, who have low levels of HDL, fibrate treatment reduced the incidence of fatal and non-fatal MI by 22% (p = 0.006) (VA-HIT). These patients represent around 25% of the post-MI population. Work in progress will shortly define the effect of fibrate treatment on coronary event rate in patients with peripheral vascular disease and Type 2 diabetes.