The Relationship Between Triglycerides and Coronary Artery Disease Stratified by Sex and High‐Density Lipoprotein Cholesterol in Men and Women

Aims The potential impact of high‐density lipoprotein cholesterol (HDL‐C) on the relationship between triglycerides (TGs) and coronary artery disease (CAD) remains uncertain. We investigated the association between untreated fasting TG levels and CAD risk stratified by HDL‐C and sex. Materials and Methods This retrospective study analysed data from a JMDC Inc. claims based database from April 2008 to April 2022, which included information on administrative claims and annual health checkups. Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between TG levels and CAD. CAD was defined by validated methods using both disease and procedure codes. Results During a mean follow‐up of 5.55 ± 2.39 years among 1,268,651 participants, 5490 men and 665 women experienced CAD events. For participants with HDL‐C ≥ 1.8 mmol/L, no increase was observed in CAD risk associated with TG levels in either men or women. However, in those with HDL‐C < 1.8 mmol/L, CAD risk increased in men with TG > 1.5 mmol/L (HR, 1.45; 95% CI, 1.08–1.93) and in women with TG > 1.00 mmol/L (HR, 2.62; 95% CI, 1.26–5.46) compared to TG < 0.50 mmol/L. Conclusions Triglyceride levels were associated with an increased risk of CAD in both men and women, particularly in patients with HDL‐C < 1.8 mmol/L, among primary prevention participants not on lipid‐lowering drugs. Optimal cutoff or target therapeutic values based on patient characteristics need to be established to prevent CAD from an early stage.