Hormonal
Elevated triglyceride levels and poor glycaemic control (HbA1c/T2DM) causally mediate the majority of the increased coronary heart disease (CHD) risk associated with higher body mass index (BMI).
For individuals with high BMI, simply losing weight may not be enough to protect the heart. The research indicates that high triglycerides and poor blood sugar control (HbA1c) are the main drivers of heart disease risk in this group. Therefore, secondary prevention should focus on actively managing these specific metabolic markers—through diet, medication, or lifestyle changes—rather than focusing solely on body weight or LDL cholesterol.
Increased triglyceride levels and poor glycaemic control appear to mediate much of the effect of BMI on CHD.
Why this rating
Uses large-scale Mendelian Randomization (MR) with 60,801 CHD cases, multiple sensitivity analyses (IVW, MR-Egger), and robust genetic instruments, though observational in nature.
Source
The role of glycaemic and lipid risk factors in mediating the effect of BMI on coronary heart disease: A two-step, two-sample Mendelian randomization study
Lin Xu et al. · bioRxiv (Cold Spring Harbor Laboratory) · 2017
DOI 10.1101/118133
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