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The original article by Pedersen et al. (1) proves unequivocally that the risk for myocardial infarction increases to a highly significant degree with rising triglyceride concentrations. Compared with triglyceride measurements below 1 mmol/L (89 mg/dL), in hypertriglyceridemia the hazard ratio for myocardial infarction rises to 1.6 (triglyceride values 1.00–1.99 mmol/L), 2.2 (2.00–2.99 mmol/L), 3.2 (3.00–3.99 mmol/L, 2.8 (4.00–4.99 mmol/L) and 3.5 (≥ 5.00 mmol/L) (1). The importance of triglycerides for cardiovascular risk has been shown in numerous further studies that are cited in our article (2). In accordance with these data, the DEGAM guideline (Table 10 in the guideline) points out the increased cardiovascular risk in hypertriglyceridemia (3). The European recommendations on the treatment of dyslipidemias (4) rightly take up a great deal of space in the article because it summarizes the currently available evidence very well. In the European recommendations, as well as in our article (2), it is clearly stated that in hypertriglyceridemia, no evidence exists from RCTs that fibrates in combination with statins lower the cardiovascular risk. Similarly, we discuss (4) the problems of the comparator (mineral oil) used in the REDUCE-IT Study.

Our article (2) summarizes the current knowledge on hypertriglyceridemia. We are therefore convinced that we counteract potential overdiagnosis or overtreatment with this article.

DOI: 10.3238/arztebl.2020.0224b

Prof. Dr. med. Klaus G. Parhofer

Medizinische Klinik 4

Klinikum der Universität München

klaus.parhofer@med.uni-muenchen.de

Prof. Dr. med. Ulrich Laufs

Klinik und Poliklinik für Kardiologie

Universitätsklinikum Leipzig

Conflict of interest statement

Prof. Parhofer has received lecture fees, consulting (advisory board) fees, and fees for Data Monitoring Committee (DMC) responsibilities and/or research support from the following companies: Aegerion, Akcea, Amarin, Amgen, Amryt, Berlin-Chemie, Boehringer-Ingelheim, Daiichi Sankyo, MSD, Novartis, Pfizer, Regeneron, and Sanofi.

Prof. Laufs has received lecture or consulting fees from the following companies: Amgen, Boehringer-Ingelheim, Daiichi Sankyo, Novartis, Pfizer, Sanofi, and Servier.

1.
Pedersen SB, Langsted A, Nordestgaard BG: Nonfasting mild-to-moderate hypertriglyceridemia and risk of acute pancreatitis. JAMA Intern Med 2016; 176: 1834–42 CrossRef MEDLINE
2.
Parhofer KG, Laufs U: The diagnosis and treatment of hypertriglyceridemia. Dtsch Arztebl Int 2019; 116: 825–32 VOLLTEXT
3.
Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM): Hausärztliche Risikoberatung zur kardiovaskulären Prävention. www.awmf.org/leitlinien/ detail/ll/053–024.html​ (last accessed on 15 February 2020).
4.
Mach F, Baigent C, Catapano AL, et al.: 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020; 41: 111–88 CrossRef MEDLINE
1.Pedersen SB, Langsted A, Nordestgaard BG: Nonfasting mild-to-moderate hypertriglyceridemia and risk of acute pancreatitis. JAMA Intern Med 2016; 176: 1834–42 CrossRef MEDLINE
2.Parhofer KG, Laufs U: The diagnosis and treatment of hypertriglyceridemia. Dtsch Arztebl Int 2019; 116: 825–32 VOLLTEXT
3.Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM): Hausärztliche Risikoberatung zur kardiovaskulären Prävention. www.awmf.org/leitlinien/ detail/ll/053–024.html​ (last accessed on 15 February 2020).
4.Mach F, Baigent C, Catapano AL, et al.: 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020; 41: 111–88 CrossRef MEDLINE

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