The Relationship Between Triglycerides and Coronary Artery Disease Stratified by Sex and High-Density Lipoprotein Cholesterol in Men and Women.

Among participants with HDL-C >= 1.8 mmol/L, no increase in CAD risk associated with TG levels was observed in either men or women.

• This finding applied to both sexes when HDL-C was at or above 1.8 mmol/L.
• The study used multivariable Cox regression models to estimate hazard ratios and 95% confidence intervals.
• Participants were not on lipid-lowering drugs, representing a primary prevention population.

In men with HDL-C < 1.8 mmol/L, CAD risk increased significantly at TG > 1.5 mmol/L compared to TG < 0.50 mmol/L.

• HR of 1.45 (95% CI, 1.08–1.93) for men with TG > 1.5 mmol/L versus TG < 0.50 mmol/L.
• This association was only observed in those with HDL-C < 1.8 mmol/L.
• 5490 men experienced CAD events during the study period.

In women with HDL-C < 1.8 mmol/L, CAD risk increased at a lower TG threshold (> 1.00 mmol/L) compared to men, with a larger effect size.

• HR of 2.62 (95% CI, 1.26–5.46) for women with TG > 1.00 mmol/L versus TG < 0.50 mmol/L.
• The TG threshold associated with increased CAD risk in women (> 1.00 mmol/L) was lower than that in men (> 1.5 mmol/L).
• 665 women experienced CAD events during the study period.
• This association was only observed in those with HDL-C < 1.8 mmol/L.

The study analyzed data from 1,268,651 participants over a mean follow-up of 5.55 ± 2.39 years.

• Data were drawn from the JMDC Inc. claims-based database from April 2008 to April 2022.
• The database included information on administrative claims and annual health checkups.
• CAD was defined by validated methods using both disease and procedure codes.
• This was a retrospective study design.

The relationship between TG levels and CAD risk differed by sex, with women showing increased risk at lower TG levels than men when HDL-C was low.

• Women showed elevated CAD risk at TG > 1.00 mmol/L, while men showed elevated risk at TG > 1.5 mmol/L, both in the context of HDL-C < 1.8 mmol/L.
• The magnitude of the hazard ratio was substantially larger in women (HR 2.62) than in men (HR 1.45) at their respective TG thresholds.
• The authors concluded that optimal cutoff or target therapeutic values based on patient characteristics need to be established to prevent CAD from an early stage.