Triglycerides and cardiovascular disease: meta-analysis of individual data on 600 000 participants in 60 studies

Lead Research Organisation: University of Cambridge
Department Name: Institute of Public Health

Abstract

Triglycerides are specific fats that are increased in the blood of people who smoke, eat fatty foods and have high blood pressure. Widely available tests that can measure blood triglycerides concentrations are frequently used to help predict heart attack risk. Although dozens of long-term studies of triglycerides and heart attack risk have been conducted over the past 50 years, it is still uncertain whether measurement of these blood fats is actually worthwhile or whether they are likely to be causative of heart attacks. Individual studies have tended to be too small, and previous reviews of such studies have been insufficiently detailed to give clear results. To help provide much more reliable evidence about the relevance of triglycerides to heart disease, we will conduct detailed combined analyses of the available studies of triglycerides and future heart attack risk in a total of about 600 000 individuals from about 60 long-term studies. Previously, this approach helped clarify the evidence about other predictors of heart attack (such as blood pressure) and it should also do so for triglycerides.

Technical Summary

Despite almost fifty years of epidemiological research, there is uncertainty about the relevance of triglycerides to coronary heart disease (CHD) in general populations. Individual studies have been too limited and previous reviews of such studies have been insufficiently detailed. We will conduct a meta-analysis of individual data on 600 000 participants from 60 studies, which have recorded a total of 25 000 incident cases of non-fatal myocardial infarction or coronary death. Such an analysis will reliably characterize several features of the association between triglycerides and CHD (and other major vascular and non-vascular outcomes) in appropriate detail and with precision, such as the magnitude of associations in different circumstances (e.g., in women and men, at different levels of triglycerides, at different ages, at different levels of known risk factors, at different levels of markers of insulin sensitivity [notably HDL]) after making appropriate allowances for within-person variability in triglycerides values and for possible confounding factors. These findings will contribute compelling evidence that will help to determine the potential usefulness of: (i) measurement of triglycerides in the prediction of CHD and (ii) strategies that lower triglycerides in cardiovascular disease prevention.

Publications

10 25 50
 
Description ERFC - major lipids
Geographic Reach Multiple continents/international 
Policy Influence Type Influenced training of practitioners or researchers
Impact The ERFC paper on major lipids has been cited in the 2011 ESC / EAS Guidelines for the management of dyslipidaemias, in the 2012 ESC Guidelines, the 2011 American Association of Clinical Endocrinologists Medical Guidelines, and the 2011 AHA Statement on Triglycerides and cardiovascular disease. The ERFC publication on the causal relevance of triglyceride-related pathways to coronary disease has been cited in the following guidelines to support the rationale for diagnosis and treatment of hypertriglyceridaemia: the 2012 Endocrine Society Clinical Practice Guideline, the 2011 ESC / EAS Guidelines for the management of dyslipidaemias, and the 2011 AHA Statement on Triglycerides and cardiovascular disease.
 
Description Biomedical Research Centre grant - Cardiovascular Theme
Amount £463,767 (GBP)
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 04/2012 
End 03/2017
 
Description Biomedical Research Centre grant - Population Science Theme
Amount £1,365,496 (GBP)
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 04/2012 
End 03/2017
 
Title Emerging Risk Factors Collaboration database 
Description A database has been created of harmonised individual participant data records from over 2 million individuals 
Type Of Material Improvements to research infrastructure 
Provided To Others? No  
Impact Published article PMID: 19903920 
URL http://europepmc.org/abstract/MED/19903920
 
Title Emerging Risk Factors Collaboration statistical methods 
Description Several novel statistical methods have been developed to enable maximal exploitation of the Emerging Risk Factors Collaboration database. 
Type Of Material Improvements to research infrastructure 
Provided To Others? No  
Impact Publication of article PMID: 19903920 
URL http://europepmc.org/abstract/MED/19903920
 
Description Media interviews 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact Interviews with representatives of the media to discuss potential implications of findings from the most comprehensive scientific study to date investigating lipid measurements and cardiovascular risk.

Profiling of research by the BBC, Heart.org, Times of India, worldnews.com and several national newspapers.
Year(s) Of Engagement Activity 2009