Epidemiology as a guide to clinical decisions; the association between triglyceride and coronary heart disease

In the practice of preventive medicine, many physicians have accepted the hypothesis that triglyceride is a causal factor in coronary heart disease. Yet epidemiological studies, such as the Western Collaborative Group Study and others, do not provide support for this idea, especially when viewed against the strong evidence linking cholesterol to coronary heart disease. When these studies were adjusted by multivariable analysis of a set of risk variables, triglyceride was not an independent risk factor. Thus, health interventions or policies specifically aimed at reductions in triglyceride level in order to prevent coronary heart disease are unjustified. In clinical trials in which drugs were used to lower serum triglyceride, no improvement in incidence of coronary disease was observed. Medical interventions must be based on proven evidence that the intervention will be beneficial, especially when the intervention is applied to a currently healthy individual. The widespread practice of screening and treating healthy persons for hypertriglyceridemia is therefore unwarranted