If triglycerides matter, why do they matter?

While there is no dispute that hypercholesterolemia increases the risk of cardiovascular disease, controversy as the importance of hypertriglyceridemia persists. Much of this relates to the fact that hypertriglyceridemia is not a single disorder but rather is a collection of disorders in which elevation of plasma triglycerides is due to the accumulation of different triglyceride-rich lipoproteins, some of which, such as remnant lipoprotein particles are ferociously atherogenic whereas others, such as intact chylomicrons, are not but do increase the risk of pancreatitis. Based on just the major lipoprotein lipids-cholesterol and triglycerides-the 6 major apoB dsylipoproteinemias cannot be separated and each identified. The apoB algorithm, which is based on total cholesterol, triglycerides and apoB, all three of which can be measured inexpensively in standard clinical laboratories, for the first time, allows all the specific apoB dyslipoproteinemias to be easily and accurately identified. By incorporating apoB into clinical care, we move from the lipid to the lipoprotein era with more precise identification of those who require pharmacological therapy and more rational and precise use of pharmacological agents to reduce their risk of cardiovascular disease.