Great debate: Plasma triglycerides are an important causal factor and therapeutic target for atherosclerotic cardiovascular disease

Great debate on plasma triglyceridesFocus on plasma TG as biomarker for TRL Triglycerides Plasma TG as risk factor Plasma TG is widely measured with good standardization.Calculation of TRL-cholesterol o ers no new information.Plasma TG is a biomarker for TRL.Raised TG leads to increased remnants and changes in LDL (smaller, denser) and HDL. Plasma TG as targetEarly TG-lowering trials had positive outcomes, later studies (on top of statin) were positive for subgroups.Atherogenicity of TRL involves multiple mechanismsdue to the presence of TG-associated long chain fatty acids and other components such as apolipoproteins. Focus on remnant cholesterol not TG Remnant cholesterol as risk factorOnce trapped in the intima, remnant cholesterol is deposited and TG hydrolyzed.Genetically elevated remnants (in remnant hyperlipidaemia) like genetically elevated LDL (in FH) lead to CVD, while genetically severely elevated TG (as hyperchylomicronaemia in FCS) do not.Remnant-C can be easily measured or calculated.PIasma TG are a biomarker for risk of pancreatitis.To date the evidence that TG-lowering itself leads to CVD risk reduction is not robust.Mechanisms of bene t likely extend beyond TG reduction.TG Iowering does not lower risk if apoB is not reduced.