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Increased residual cardiovascular risk in U.S. veterans with moderately-elevated baseline triglycerides and
Sarah Leatherman1,2, Ryan Ferguson1,3, Cynthia Hau1
1VA Boston Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, Boston, MA, United States.
Insights
Elevated triglycerides (TG) in patients with controlled LDL-C on statins showed a modest increase in cardiovascular events, particularly in those with diabetes or prior cardiovascular disease. This highlights residual risk in high-risk populations.
Area of Science:
- Cardiology
- Metabolic Health
- Epidemiology
Background:
- Recent studies indicate elevated triglycerides (TG) play a causal role in incident cardiovascular (CV) events.
- This risk is particularly pronounced in patients with diabetes and established coronary heart disease (CHD).
Purpose of the Study:
- To explore residual CV risk in U.S. veterans with statin-controlled LDL-C but elevated baseline TG levels.
- To compare composite CV event rates between elevated TG and normal TG groups stratified by CV risk.
Main Methods:
- A cohort of 396,189 U.S. veterans on statins but not TG-lowering agents was analyzed (2010-2015).
- Composite CV event rates were compared between elevated (150-499 mg/dL) and normal (<150 mg/dL) TG groups.
- Analysis was stratified by diabetes status and prior CV events.
Main Results:
- 28% of the cohort had elevated TG levels.
- Overall, elevated TG was associated with a modest increase in CV events (adjusted rate ratio 1.05).
- This association was significant in patients with diabetes (1.05) and prior CV events (1.07), but not in those without diabetes or prior events (0.99).
Conclusions:
- Elevated TG levels in patients with well-controlled LDL-C on statins are associated with a modest increase in residual CV events.
- The risk is more pronounced in patients with diabetes or established CV disease.
- Elevated TG contributes to residual CV risk in both high-risk primary and secondary prevention settings.
Background:
Recent studies have demonstrated a causal role for elevated triglycerides (TG) in incident cardiovascular (CV) events in patients with established coronary heart disease (CHD) and those with CV risk factors alone, particularly diabetes.
Objective:
Using a large cohort of U.S. veterans with statin-controlled LDL-C levels (40-100 mg/dL), we explored residual CV risk among patients with elevated baseline TG levels (150-499 mg/dL) vs. those with normal TG levels (<150 mg/dL).
Methods:
We identified veterans receiving a statin but not a TG-lowering agent from the VA electronic health records database, from 2010 to 2015. We compared composite CV event rates (MI, stroke, unstable angina, coronary revascularization, and CV death) between the elevated TG and normal TG groups. We stratified the study cohort according to 3 CV risk groups: (1) no diabetes and no prior CV event, (2) diabetes and no prior CV event, and (3) prior CV event. We calculated crude event rates, rate ratios, and event rate ratios adjusted for age, sex, systolic blood pressure, estimated glomerular filtration rate, and weight.
Results:
The cohort included 396,189 veterans (predominantly male and white) of whom 109,195 (28%) had elevated TG levels. Those with elevated TG were younger (age 73 vs. 77 years) and had a higher body mass index (31.3 vs. 28.3 Kg/M2). The overall composite crude and adjusted rate ratios comparing the elevated and normal TG groups were 1.10 (1.09, 1.12) and 1.05 (1.03, 1.06), respectively. For CV risk groups 1, 2 and 3, the adjusted rate ratios comparing the elevated and normal TG groups were 0.99 (0.96, 1.02), 1.05 (1.02, 1.08), and 1.07 (1.04, 1.10), respectively. An association of increased rate ratios did not hold for fatal events.
Conclusion:
Those with elevated TG levels and well-controlled LDL-C on statins showed a modest increase in CV events compared to those with normal TG. Elevated TG levels were associated with increased CV events in patients with established CV disease and with diabetes only, suggesting that elevated TG levels are associated with a similar degree of residual risk in high-risk primary prevention and secondary prevention settings.
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