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COMMENT

Accumulating data support a role for elevated TG, a marker for TG-rich lipoproteins and their remnants, in the causal pathway for ASCVD.  The strongest evidence is from Mendelian randomization studies and genetic analyses, which support for a causal association between TG and ASCVD (1) 

This study adds new information indicating that elevated TG are also associated with an increased risk for non-Alzheimer’s dementia and ischaemic stroke. These associations are anticipated given that ASCVD underlies both conditions. The lack of association with Alzheimer’s disease may relate to lack of statistical power, given the low incidence of cases in the study populations, possibly due to the age range represented (45 to 67 years). The conclusions are strengthened by methodological features including well-defined study populations with long follow-up and rigorous identification of cases.  It is, however, recognised that the study populations – white, Danish individuals – may limit wider generalisability. 

In conclusion, these findings have important implications given the burden of care associated with both conditions (2); indeed, stroke is the leading cause of disability in adults in developed countries, the second major cause of dementia and the third commonest cause of death (3). Therapeutic targeting of hypertriglyceridaemia not only impacts ASCVD but has benefit in vascular dementia. Further study of a potential role of elevated TG in Alzheimer’s disease is merited, given evidence from mechanistic studies that the vast majority of plasma amyloid, implicated in the pathogenesis of the disease, is lipoprotein-bound, principally to TG-rich lipoproteins (2).