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Clinical Chemistry 55: 1274-1276, 2009. First published May 14, 2009; 10.1373/clinchem.2009.124669
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(Clinical Chemistry. 2009;55:1274-1276.)
© 2009 American Association for Clinical Chemistry, Inc.

Perspectives

APOC3 Mutation, Serum Triglyceride Concentrations, and Coronary Heart Disease

Michael Y. Tsai1,a and José M. Ordovas2

1 Department of Laboratory Medicine & Pathology, University of Minnesota, Minneapolis, MN;2 Department of Agriculture, Human Nutrition Research Center on Aging at Tufts University, Boston, MA.

aAddress correspondence to this author at: 420 Delaware St. SE, Mayo Mail Code 609, Minneapolis, MN 55455-0392. Fax 612-625-1121; e-mail tsaix001@tc.umn.edu.

The first 20% of the full text of this article appears below.

Recent decades have witnessed an increasing awareness of the importance of lowering triglyceride concentrations in conjunction with lowering LDL cholesterol (LDL-C)1 to achieve optimal reduction of the risk for coronary heart disease (CHD). Historically, LDL-C was the only target of pharmacologic therapy in CHD prevention. Thus the first Adult Treatment Panel (ATP I) of the National Cholesterol Education Program published in 1988 used only LDL-C cutoffs as guidelines. Since then, there have been incremental changes with regard to the importance of lowering triglyceride concentrations in addition to LDL-C. In ATP II, triglyceride was still not recognized as an independent risk factor, but the upper limit considered healthy for triglycerides was lowered from 250 to 200 mg/dL. ATP II also discussed triglycerides as a risk factor and the treatment of patients with increased triglycerides with either nonpharmacologic or pharmacologic therapies. ATP III, published in 2001, further lowered the normal range of triglycerides to <150 mg/dL. Whereas ATP III maintains that lowering of LDL-C should be the primary target of therapy, it also recommended that non-HDL cholesterol (LDL + VLDL) be used as the secondary target of therapy.

In part, the increased recognition of the importance of lowering triglycerides has been a result of increased recognition of the metabolic syndrome (MS). Although the diagnosis of MS is based on meeting at least 3 of the 5 criteria (increased triglycerides, low HDL-C, abdominal obesity, high blood pressure, and increased fasting glucose concentrations), by far the majority of individuals with MS have increased triglycerides. ATP III also contained explicit guidelines on the management of MS, by treating the underlying cause through diet and exercise, through specific pharmacological therapies which lower triglycerides and hypertension, or both.

The fact that increased serum triglyceride concentrations are positively associated with . . . [Full Text of this Article]






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