Decrease of plasma triglycerides during the acute phase of unstable angina or non-ST elevation myocardial infarction is a marker of recurrent ischemia

Both increase and decrease of plasma triglycerides during acute coronary syndromes (ACS) are reported, however, a clinical relevance for these distinct metabolic responses is unclear. To test the association between distinct responses of lipid metabolism and cardiovascular risk, 39 subjects admitted with non-ST elevation ACS within 48 h of presentation had plasma lipids measured on the first and sixth days of hospitalization, and continuous electrocardiogram was performed during the first 2 days to quantify recurrent ischemia and heart rate variability. No lipid-lowering therapy was offered to the patients. During the first 5 days, half of them experimented a decrease in triglycerides (n = 19, median: −18 mg/dl) and the other half presented triglyceride increase (n = 20, median: +44 mg/dl). A higher incidence of recurrent ischemia (35% versus 5%, P = 0.02) and greater ischemic burden/patient (123 ± 286 mm min versus 47 ± 212 mm min, P = 0.02) were observed in subjects with triglyceride reduction, when compared with those with triglyceride increase. Individuals with heart rate variability below the median presented a median decrease in triglycerides during the 5-day period, as opposed to the counterparts (P = 0.05). In conclusion, triglyceride reduction during ACS is associated with a greater incidence of recurrent ischemia and may constitute a sign of higher sympathetic activity.