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In Reply: In response to Dr Yancy and colleagues, our results raise the question whether a low-fat, high-carbohydrate diet that results in increased triglyceride levels despite reduced cholesterol levels is beneficial for heart disease prevention. We agree that widespread dietary recommendations on how best to reduce triglyceride levels should be avoided unless it is documented in randomized trials that such dietary changes reduce not only triglyceride levels but also the incidence of heart disease. In our study, higher levels of nonfasting triglyceride levels were associated with higher risk of myocardial infarction, ischemic heart disease, and all-cause death. However, we did not have information on dietary intake in these individuals and therefore do not know whether high- or low-carbohydrate diets were associated with the risk of heart disease.

The explanation for our findings may be straightforward—elevated levels of nonfasting triglycerides indicate the presence of elevated levels of remnant lipoproteins that directly . . . [Full Text of this Article]

Børge G. Nordestgaard, MD, DMSc
brno@heh.regionh.dk

Marianne Benn, MD, PhD
Department of Clinical Biochemistry
Herlev University Hospital
University of Copenhagen
Herlev, Denmark

Anne Tybjærg-Hansen, MD, DMSc
Department of Clinical Biochemistry
Rigshospitalet
Copenhagen University Hospital
University of Copenhagen

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