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All-cause and cardiovascular mortality in treated patients with severe hypertriglyceridaemia: A long-term prospective
H A W Neil1, J Cooper, D J Betteridge
1NIHR School of Primary Care Research, Division Public Health & Primary Health Care, University of Oxford, Old Road, Headington, Oxford OX3 7LF, United Kingdom. andrew.neil@wolfson.ox.ac.uk
Insights
Severe hypertriglyceridaemia significantly increases cardiovascular disease mortality, even without diabetes. Management should focus on lowering triglycerides to prevent pancreatitis and reduce overall cardiovascular risk.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Severe hypertriglyceridaemia (triglycerides >5.0 mmol/l) is a condition characterized by significantly elevated triglyceride levels.
- This condition is associated with an increased risk of pancreatitis and potentially cardiovascular disease.
Purpose of the Study:
- To investigate the association between severe hypertriglyceridaemia and all-cause and cardiovascular mortality.
- To determine if this association persists independently of diabetes and pre-existing coronary heart disease.
Main Methods:
- A prospective study of 337 patients with severe hypertriglyceridaemia, recruited from 21 UK lipid clinics.
- Patients were followed for 4353 person-years between 1980 and 2008.
- Standardised Mortality Ratios (SMR) were calculated by comparing mortality rates to the general population.
Main Results:
- A significantly elevated SMR for coronary heart disease (CHD) was observed (327), persisting after excluding patients with diabetes (287) or prior CHD (259).
- The highest SMR for CHD was noted in younger men aged 40-59 (544).
- Elevated SMRs were also found for stroke (262) and all-cause mortality (164).
Conclusions:
- Severe hypertriglyceridaemia is linked to substantially increased cardiovascular disease mortality, independent of diabetes.
- Treatment strategies should prioritize triglyceride reduction to mitigate pancreatitis risk and manage overall cardiovascular risk.
Objective:
To examine all-cause and cardiovascular mortality in patients with severe hypertriglyceridaemia.
Methods:
337 patients aged less than 80 years (47 with diabetes, 75 women) with a fasting triglyceride concentration on at least two occasions of >5.0mmol/l were registered by 21 lipid clinics in the United Kingdom and followed prospectively between 1980 and 2008 for 4353 person-years. The standardised mortality ratio (SMR) was calculated by comparison with the general population.
Results:
The mean untreated total cholesterol concentration was 9.8 (SD 3.6)mmol/l for men and 11.9 (7.2)mmol/l for women and the corresponding geometric mean triglyceride concentration was 12.6 (inter-quartile range 7.3, 21.6) and 15.7 (8.2, 29.2)mmol/l. There were 70 deaths, including 35 from CHD and 7 from stroke. The SMR for CHD was raised at 327 (95% confidence intervals 228, 455; p<0.0001) and remained elevated after excluding patients with diabetes at registration (SMR=287, 95% CI 190, 419; p<0.0001), and after excluding patients with CHD at registration (SMR=259, 95% CI 158, 400; p=0.0003). The increased SMR was most marked in younger men aged 40-59 years (SMR=544, 95% CI 304, 897; p<0.0001). The SMR for stroke for patients aged 20-79 years was raised at 262 (95% CI 105, 540; p=0.04), as was all-cause mortality at 164 (95% CI 129, 208; p<0.001).
Conclusion:
Severe hypertriglyceridaemia is associated with a substantially increased mortality from cardiovascular disease, even in the absence of diabetes. In addition to lowering triglyceride concentrations to reduce the risk of pancreatitis, treatment should aim to reduce the overall cardiovascular risk.
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