Triglyceride levels in coronary artery disease

ABSTRACT

The method of estimating Serum Triglyceride levels have been long and tedious and therefore restricted to specialized centres. Recently a relatively simple method using a miconephelometer has been described by Stone & Thorp of the I.C.I. Laboratories. This report is concerned with our experience with this method during the past six months. The method was applied to 113 patients and the results compared with the cholesterol levels taken at the same time. Seventy-seven patients were from private practice and of these 15 had myocardial infarcts, 18 had angina pectoris and 44 reported for routine checks. 36 were from clinics at U.W.I. (Dr. G. Millers), 12 were diabetics, 12 were hypertensives and 12 had myocardial infarcts. Of the 33 private patients with cardiac ischaemia 2 had high cholesterols and low triglycerides, 12 had high cholesterols and high triglycerides, 13 had low cholesterols and high triglycerides and 6 had low cholesterols and low triglycerides. Thus measuring cholesterol levels alone, as is the custom of most physicians, would have missed 13 or 39 percent of this group who had normal cholesterol but high triglycerides. Of the 44 private patients reporting for routine checks 9 had cholesterols with low triglycerides, 13 had high cholesterols and triglycerides, 9 had low cholesterols and high triglycerides and 13 had low cholesterols and triglycerides. Thus 9 or 22 percent would have been missed if cholesterol levels alone were checked. Of the 12 clinic patients with infarcts only 1 had a slightly high cholesterol level with normal triglycerides; while 3 had elevated triglycerides with normal cholesterol levels. Of the 12 hypertensives 1 had a slightly high cholesterol and 1 a high triglyceride level. Of the 12 diabetics (on treatment) only one had a very slightly elevated cholesterol level. Thus of the 36 U.W.I. clinic patients, 29 were in the normal low cholesterol-low triglyceride range. The higher incidence of abnormal lipids in the private group than in the clinic group is explained on the different income levels and consequently dietary habits of the two groups. It is suggested that this is one of the reasons that ischaemic heart disease is more commonly seen in private practice than in University practice in Jamaica. In 4 patients in whom adequate follow-up was available Atromid-S (chlor-phenoxy iso-butyric ester) was shown to be very effective in lowering elevated triglyceride levels, and as an incidental observation in one diabetic patient, retinal exudates disappeared after 2 months on Arromid-S when both cholesterol and triglycerides were lowered, though the diabetes was still not well controlled. The number are small yet the indications are that triglyceride estimation is a useful addition to cholesterol estimation since many patients have low cholesterol yet high triglyceride levels. There is no promise that correcting the lipids will definitely alter the course of established coronary artery disease but the prophylactic value in people who report for routine checks should be assessed over the years (AU)