Elevated LDL Triglycerides and Atherosclerotic Risk

Quick Takes

  • Increased LDL triglycerides, which may be a marker of highly atherogenic remnant lipoproteins, are associated with increased ASCVD risk.
  • Measurement of LDL triglycerides may be useful in the future as an additional cardiac risk marker in addition to the standard lipid panel.
  • Measurement of LDL triglycerides may be best done with a direct assay rather than a nuclear magnetic resonance (NMR), as it can be done on most autoanalyzers at a cost lower than NMR assay.

Study Questions:

Are elevated low-density lipoprotein (LDL) triglycerides associated with increased risk of atherosclerotic cardiovascular disease (ASCVD), and its components that include ischemic heart disease, myocardial infarction, ischemic stroke, and peripheral artery disease?


Patients were recruited from the Copenhagen General Population Study. A total of 38,081 subjects had LDL triglycerides measured using an automated assay from Denka. These subjects were enrolled from 2013–2017. In parallel, nuclear magnetic resonance (NMR) analysis of LDL triglycerides was performed on 30,208 frozen samples obtained from 2003–2015. The development of ASCVD in these cohorts over the mean follow-up periods were analyzed for their association with levels of LDL triglycerides.


Elevation of LDL triglycerides were very much associated with not only increased overall ASCVD risk but increased risk in each of the components including ischemic heart disease, myocardial infarction, ischemic stroke, and peripheral artery disease. The hazard ratio per 0.1 mmol/L (9 mg/dL) was 1.26 for both cohorts, with a range of hazard ratios from 1.22–1.41 for other subsets in both cohorts.


Measurement of LDL triglycerides may provide additional information in assessing a patient’s total ASCVD risk as well as each of the major components that make up this risk. Measurement using a direct assay that can be done on an autoanalyzer is comparable to NMR, but further study is necessary to determine which populations have the most to benefit from this additional test.


The standard ASCVD risk predictors serve us very well in identifying patients for intensive cardiovascular risk reduction including pharmacologic treatment for hyperlipidemia, as well as drug selection and target blood pressure selection for patients with hypertension. But these markers are not perfect, and additional risk stratification with modalities such as high-sensitivity C-reactive protein, coronary computed tomography, apolipoprotein B, and lipoprotein (a) are often incrementally of value. Measurement of LDL triglycerides may, in the future, give the clinician more additional data on which to make judgments regarding intensity of preventive therapy in individual patients in whom a clinical plan might be otherwise unclear.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Noninvasive Imaging, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Hypertriglyceridemia, Lipid Metabolism, Nonstatins, Magnetic Resonance Imaging

Keywords: Atherosclerosis, Cardiovascular Diseases, Cholesterol, LDL, Dyslipidemias, Ischemic Stroke, Lipids, Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy, Myocardial Infarction, Myocardial Ischemia, Peripheral Arterial Disease, Primary Prevention, Risk Factors, Triglycerides, Vascular Diseases

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