Consensus document on the role of plasma triglycerides in cardiovascular disease from the Italian Society for the Study of Atherosclerosis (SISA)

Aims: Hypertriglyceridaemia is a common clinical condition. Triglycerides (TGs) have long been recognised as a risk factor for atherosclerotic cardiovascular disease (ASCVD). Genetics, epidemiological studies and clinical trials have demonstrated a causal relationship between plasma triglycerides and ASCVD. In the bloodstream, TGs are mainly transported by lipoproteins such as VLDL and their remnants, the so-called TG-rich lipoproteins (TRL). A better understanding of the pathological consequences of elevated plasma TG levels is essential, especially in the context of addressing residual cardiovascular risk, when other major risk factors, in particular low-density lipoprotein cholesterol (LDL-C), are optimally controlled. Data synthesis: This consensus paper highlights the available evidence on the physiology, metabolism and association with atherosclerosis of TRL and their remnants. We update the current knowledge in a multidisciplinary approach and highlight targeted therapeutic approaches including: i) diet and lifestyle, ii) established treatments such as fibrates and omega-3 fatty acid supplements, iii) novel pharmacological strategies to lower serum TG levels to reduce residual cardiovascular risk in patients on maximal LDL-C-lowering treatment, and iv) new therapeutic options in patients with severe hypertriglyceridaemia. Conclusions: Managing TRL plasma concentration with a comprehensive approach that includes lifestyle changes and targeted pharmacological strategies is a key clinical approach for addressing cardiovascular (residual) risk and improving patient outcomes, especially in individuals with well-controlled primary target lipid levels such as LDL-C. In case of severe TG elevation, an intensive TG-lowering approach is of paramount importance for reducing the risk of acute pancreatitis.