Do Triglyceride Tests Really Help Predict Heart Disease?

From the WebMD Archives

July 9, 2000 -- It's one of the most common blood tests that your doctor orders -- but experts still argue over its value. And now a new study suggests that in men, results from tests for triglycerides -- one type of fat molecules in the blood -- doesn't give your doctor any new information about your risk of heart disease.

"The current state of evidence does not justify routine screening of adults for [high triglyceride levels to predict heart disease]," the study's lead author, Andrew L. Avins, MD, MPH, tells WebMD. "It adds little to the information we get from other sources. Our study shows there is relatively little value in obtaining triglyceride levels to assess [heart disease] risk." He adds, however, that the study does not answer whether treating high triglyceride levels will reduce the incidence of heart disease.

Avins and colleague John M. Neuhaus, PhD, both from the University of California, San Francisco, analyzed data from three large studies looking at heart attack risk factors in healthy people. They found that for men, measuring triglyceride levels in the blood did not help them predict who would go on to develop heart disease. For women, the test did seem to predict heart disease -- but there were so few women in the studies that Avins says the finding must be confirmed before he'll fully believe it.

"What we specifically looked at are the routine things measured [by doctors]," Avins says. "The fact is that we as doctors already look at the traditional risk factors -- age, gender, diabetes, cholesterol, smoking -- and in men we couldn't find additional value in looking at triglycerides."

Doctors aren't going to stop measuring triglycerides, because the information is used to calculate levels of LDL cholesterol -- the bad kind of cholesterol, which does predict risk of future heart disease. For 20 years, researchers have tried to establish a value for the test itself, but the results of this effort remain highly controversial.

In an editorial accompanying the study, noted heart-disease specialist Hanna Bloomfield Rubins, MD, MPH, notes that high triglyceride levels should not be ignored. She concludes, however, that there is no compelling reason to routinely measure them.

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"This article is just one more shot in a controversial area," Rubins tells WebMD. "We've been trying to get to the bottom of this triglyceride issue for many years. I wouldn't want to have an elevated level of triglycerides myself, but there is not a lot we can do about it. We just haven't been able to get our arms around triglyceride measurements, and that suggests to me that it is not really a good test." Rubins is chief of general internal medicine at the Minneapolis VA Medical Center.

Another noted specialist -- Scott M. Grundy, MD, PhD, of the University of Texas Southwestern Medical Center in Dallas -- takes the opposite point of view. Grundy says that the study is just another in a series of analyses that miss the point.

"They might have the right answer but the wrong conclusion," Grundy tells WebMD. "Triglycerides are a marker for multiple risk factors for heart disease." He adds that they are a marker for heart disease, not necessarily a cause of the disease. "If they are a marker [for future heart disease], it doesn't mean you don't have trouble when the [level's] high. If you live in a tornado area and the siren goes off, you don't go out and treat the siren for going off. To say they are not a meaningful clinical marker is not correct."

Avins says that regardless of the predictive value of triglyceride tests, patients with higher-than-normal cholesterol levels or other risks of heart disease should take action. These include:

Although they are not conclusively proven to reduce heart disease, other important actions include moderate exercise and stress reduction.

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