{"id":8061,"date":"2011-05-01T21:37:15","date_gmt":"2011-05-02T01:37:15","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?p=8061"},"modified":"2011-07-19T17:45:18","modified_gmt":"2011-07-19T21:45:18","slug":"screen-with-nonfastingtriglycerides","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2011\/05\/01\/screen-with-nonfastingtriglycerides\/","title":{"rendered":"Don\u2019t Miss the New AHA Recommendations on Triglycerides"},"content":{"rendered":"<p>I\u2019ve been surprised at the lack of fanfare surrounding the American Heart Association\u2019s recently published <a href=\"http:\/\/circ.ahajournals.org\/cgi\/reprint\/CIR.0b013e3182160726v1\">scientific statement on triglycerides and cardiovascular disease<\/a> (CVD).\u00a0The attention it did receive focused on the lower fasting triglyceride level that is now considered optimal: &lt;100 mg\/dL. In my opinion, the real headline was the committee\u2019s important statements in support of <em>less<\/em> drug treatment \u2014 in particular, the recommendation for a substantial increase in the triglyceride level that should trigger consideration of pharmacologic therapy.<\/p>\n<p>After a careful review of the recent literature, the committee concluded that pharmacologic therapy should not be started until a patient\u2019s fasting triglyceride level is \u2265500 mg\/dL (in contrast to the <a href=\"http:\/\/www.nhlbi.nih.gov\/guidelines\/cholesterol\/atp3full.pdf\">Adult Treatment Panel\u2019s recommendation<\/a> of \u2265200 mg\/dL). See the figure below, which also appears on page 17 of the AHA statement.<\/p>\n<p><a href=\"http:\/\/blogs.nejm.org\/cardioexchange\/wp-content\/uploads\/sites\/7\/2011\/04\/ScreenWithNonfastingTriglycerides.png\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-8062\" title=\"ScreenWithNonfastingTriglycerides\" src=\"http:\/\/blogs.nejm.org\/cardioexchange\/wp-content\/uploads\/sites\/7\/2011\/04\/ScreenWithNonfastingTriglycerides.png\" alt=\"Screen With Nonfasting Triglycerides\" width=\"519\" height=\"492\" \/><\/a><\/p>\n<p>The AHA committee also explicitly acknowledges (on page 6) that \u201cthe independence of triglyceride level as a causal factor in promoting CVD remains debatable. Rather, triglyceride levels appear to provide unique information as a biomarker of risk, especially when combined with low HDL-C and elevated LDL-C.\u201d This clear statement\u2014together with the new, higher threshold for initiating drug treatment\u2014represents a remarkable change.<\/p>\n<p>Meanwhile, on April 20, Abbott announced that\u00a0<a href=\"http:\/\/www.abbott.com\/PressRelease\/2011Apr20.htm\">sales of its flagship fenofibrate drugs increased by 28%<\/a> in the first quarter.<\/p>\n<p><strong>Two questions:<\/strong><\/p>\n<ol>\n<li>Why are doctors prescribing fibrates with growing enthusiasm when data from negative drug trials support an increasingly conservative approach to drug treatment?<\/li>\n<li>Given the new AHA recommendations, what should we do about all the people who were started on drug therapy to lower triglyceride levels that were less than 500 mg\/dL?<\/li>\n<\/ol>\n<p>I welcome your insights.<\/p>\n<p><span style=\"font-size: 11px;\"><strong><br \/>\n<\/strong><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>I\u2019ve been surprised at the lack of fanfare surrounding the American Heart Association\u2019s recently published scientific statement on triglycerides and cardiovascular disease (CVD).\u00a0The attention it did receive focused on the lower fasting triglyceride level that is now considered optimal: &lt;100 mg\/dL. In my opinion, the real headline was the committee\u2019s important statements in support of [&hellip;]<\/p>\n","protected":false},"author":211,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[476,807],"class_list":["post-8061","post","type-post","status-publish","format-standard","hentry","category-prevention","tag-aha","tag-triglycerides"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/8061","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/211"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=8061"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/8061\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=8061"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=8061"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=8061"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}