High prevalence of C-reactive protein elevation with normal triglycerides (100-149 mg/dL): Are triglyceride levels below 100 mg/dL more optimal in coronary heart disease risk assessment?

Background: The National Cholesterol Education Program defines a fasting triglyceride level below 150 mg/dL as normal. However, observational data suggest that triglyceride levels above 100 mg/dL may predict coronary heart disease (CHD) events. Methods: To determine the prevalence of systemic inflammation with a normal triglyceride level (100-149mg/dL), data obtained from the population-based cross-sectional study of 4412 men and women in the third National Health and Nutrition Examination Survey were reviewed. Measurements included fasting lipids and lipoproteins and serum C-reactive protein (CRP) level measured using a Behring Nephelometer Analyzer System. Results: High CRP level was equally prevalent whether the designated triglyceride cutpoint was greater than or equal to 100 (unadjusted OR, 2.0; 95% Cl, 1.7-2.3) or greater than or equal to 150 (unadjusted OR, 1.9, 95% Cl, 1.6-2.2). After adjustment for other covariates, the triglyceride range of 100 to 149 mg/dL remained independently associated with elevated CRP level (OR, 1.3; 95% Cl, 1.02-1.67). In addition, an approximately fivefold higher likelihood of elevated CRP level was observed with triglyceride levels between 100 and 149 mg/dL and normal body mass index (BMI; 24-24.9) compared with lower triglyceride level (< 65 mg/dL) and BMI (< 22) (P < 0.0001). Conclusions: These data indicate that "normal" triglyceride levels (100-150 mg/dL) are associated with systemic inflammation and that lower fasting triglyceride levels (eg, < 100 rather than < 150 mg/dL) may be a more optimal cutpoint in CHD risk assessment.