Summary

The most convincing argument for the importance of elevated triglycerides comes from the fact that large trials, primarily with fibrates as their intervention, have shown selective benefits in patients with triglycerides >200 mg/dL, according to W. Virgil Brown, MD, Emory University School of Medicine, Atlanta, GA. A substudy of the Helsinki Heart Study, for example, which divided patients into groups above and below median HDL levels and then into those with triglycerides above and below 200 mg/dL revealed a “terrific” benefit (∼70% reduction) in coronary death plus MI for gemfibrozil versus placebo in patients with high triglycerides and low HDL. In those with other risk factors, the reduction was only 20% (34% for the overall study). Furthermore, the Israeli BIP study with fibrates, despite showing only borderline benefits overall in a hypercholesterolemic population, showed a 40% reduction in the fourth of patients with triglycerides >200 mg/dL.