Differentiating the effects of raising low levels of high-density lipoprotein cholesterol versus lowering normal triglycerides: further insights from the veterans affairs high-density lipoprotein intervention trial

In the Veterans Affairs High-Density Lipoprotein Intervention Trial (VA-HIT), a 6% increase in high-density lipoprotein cholesterol (HDL-C) was associated with a 22% reduction in the incidence of fatal and nonfatal myocardial infarction and death from coronary artery disease. A curvilinear correlation was demonstrated between incremental changes in HDL-C and outcome. However, triglyceride levels, which decreased by 31%, were not predictive of clinical events. Some design limitations may be implicated in this lack of statistical correlation between triglycerides and outcome. Evidence from other studies, notably the Framingham Heart Study, the Prospective Cardiovascular Münster Heart Study (PROCAM), and the Baltimore Coronary Observational Long-Term Study (COLTS) suggest that the triglyceride cutpoint of 200 mg/dL is too high. The Bezafibrate Infarction Prevention (BIP) trial found a significant correlation between reduction in death from coronary artery disease and nonfatal MI and reduced triglycerides in a subset of patients with baseline triglycerides >200 mg/dL.