Jennifer S. Lee, M.D., from the Stanford University Medical Center in California, and colleagues studied 3,216 American Indians (41 percent with diabetes) who were free from cardiovascular disease at baseline in a prospective cohort (median follow-up 17.7 years). The authors estimated hazard ratios (HRs) for incident ischemic stroke and coronary heart disease in relation to combined TG and HDL-C status (fasting TG level ≥150 mg/dL was high; fasting HDL-C level <40 mg/dL [for men] was low).
The researchers found that, compared to those with normal TG and HDL levels, participants with high TG and low HDL levels had a 1.32-fold elevated HR for CHD. In participants with, but not those without, diabetes, high TG plus low HDL levels correlated with a 1.54- and 2.13-fold increased HR for CHD and stroke, respectively (P value for interaction = 0.003 and 0.060, respectively). In participants with LDL-C levels of ≥130 mg/dL, high TG and low HDL correlated with CHD risk; this was not seen in participants with lower LDL-C levels. The correlations were not modified by sex.
"Adults with both high TG and low HDL-C, particularly those with diabetes, have increased risks of incident CHD and stroke," the authors write. "Recognition of these patterns may help to enhance lipid-targeted strategies to prevent CHD and ischemic stroke."