Nonfasting Triglycerides and Risk of Myocardial Infarction, Ischemic Heart Disease, and Death in Men and Women

The Copenhagen City Heart Study followed 13,981 individuals to determine whether nonfasting triglycerides — measured in the postprandial state, reflecting real-world physiological conditions — were associated with MI, ischemic heart disease, and death independently of traditional risk factors and LDL-C.

Nonfasting triglycerides were strongly and independently associated with MI and ischemic heart disease risk in both men and women. The gradient was steep: compared to those with triglycerides <89 mg/dL, those with values >443 mg/dL had hazard ratios of approximately 5 in women and 3 in men for MI. The associations persisted after adjustment for LDL-C, HDL-C, CRP, and other confounders.

The clinical implication challenges the standard recommendation to measure fasting triglycerides. Postprandial lipemia — the state most humans spend most of their waking hours in — is more prognostically relevant than the fasting measurement that laboratory reference ranges are based on. This study was foundational in establishing that nonfasting triglycerides should be considered in cardiovascular risk assessment.

For patients with metabolic syndrome, insulin resistance, or hypertriglyceridemia, the nonfasting triglyceride level may be a more meaningful risk signal than the fasting value measured at 8 AM after a 12-hour fast.

We rate the evidence strong. A large prospective cohort study establishing nonfasting triglycerides as independent cardiovascular risk predictors — clinically important for rethinking how and when we measure lipid risk.