Measuring Triglycerides Is Mostly not Necessary
The authors postulate cardiovascular risk from increased triglyceride concentrations, which would actually be a reason for measuring this parameter (1). They do not, however, provide proof for their claim—the cited reference ( in the article) refers only to an association of hypertriglyceridemia and pancreatitis. The German College of General Practitioners and Family Physicians (Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin, DEGAM) in its guideline (2) does not make any mention of an increased cardiovascular risk—contrary to what was claimed in the article—but wrote: “The relevance/importance of triglycerides for the cardiovascular risk is the subject of controversy.”
Much space is taken up by the table showing the European recommendations for the treatment of dyslipidemias. Furthermore, the close relations between the European Society of Cardiology (ESC) and the pharmaceutical industry should raise substantial skepticism. The evidence levels falsely suggest a patient-relevant benefit. For fibrates, no lowering of cardiovascular mortality has been confirmed (3).
What remains unclear is whether the benefit of high-dose fish oil in the REDUCE-IT Study was not a function of the fact that in the control arm, the comparison substance used was mineral oil (4). Articles such as this one (1) substantially contribute to overdiagnosis and overtreatment.
Dr. med. Günther Egidi
Arztpraxis für Allgemeinmedizin, Bremen
Conflict of interest statement
The author is a member of the DEGAM working group for the guideline on cardiovascular prevention.
|1.||Parhofer KG, Laufs U: The diagnosis and treatment of hypertriglyceridemia. Dtsch Arztebl Int 2019; 116: 825–32 VOLLTEXT|
|2.||Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM): www.awmf.org/uploads/tx_szleitlinien/053–024l_S3_Hausaerztliche_Risikoberat_kardiovask_Praevention_2018–09.pdf (last accessed on 17 February 2020).|
|3.||Jun M, Foote C, Lv J, et al.: Effects of fibrates on cardiovascular outcomes: a systematic review and meta-analysis. Lancet 2010; 375: 1875–84 CrossRef|
|4.||Bhatt DL, Steg PG, Miller M, et al.: Cardiovascular risk reduction with Icosapent ethyl for hypertriglyceridemia. N Engl J Med 2019; 380: 11–22 CrossRef MEDLINE|