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25 reviewsSummaryThe Lancet RegionalHealth - WesternBackground Current international guidelines on dyslipidemia were formulated based on the research performedPacific 2025;63:mostly in White populations. However, whether the association of triglycerides (TGs) with cardiovascular disease101689(CVD) differs between Chinese and White populations is unknown.Published Online xxxMethods 3,789,025 participants from the China Health Evaluation And risk Reduction through nationwide Team (ChinaHEART) were evaluated for the association between TGs and all-cause and CVD mortality with Cox101689regression models. The findings were tested for sex-specific differences and contrasted with another comparisoncohort of 434,919 UK Biobank participants.Findings 92,888 Chinese adults died during a median follow-up of 4.6 years. All-cause and CVD mortality initiallyincreased with TG elevation abruptly and plateaued in Chinese men, while U-shaped associations were seen inChinese women. In contrast, CVD risk increased incrementally with TGs in White people. Hazard ratios (95%confidence intervals) were 1.02 (0.97–1.07), 1.05 (1.00–1.11), 1.07 (1.02–1.22), and 1.19 (1.13–1.24) from TGquintile 2 to 5 for White men, and 1.14 (1.08–1.21), 1.17 (1.11–1.24), 1.26 (1.18–1.33), and 1.41 (1.33–1.50) forWhite women, respectively. The association with CVD mortality was stronger in Chinese men who were lean,normotensive, and smoking but in Chinese women with diabetes.Interpretation The association of TGs with CVD was different for the White and the Chinese populations. Thatmortality risk elevated in conventionally low-to-moderate TG range implicates that more aggressive interventionmay be merited for Chinese and other East Asian populations.Funding The National High Level Hospital Clinical Research Funding (2023-GSP-ZD-2, 2023-GSP-RC-01), theMinistry of Finance, and the National Health Commission of China.Copyright ©