Association of triglyceride levels with adverse cardiovascular events in patients with ST-segment elevation
Mehmet Yildiz1, Michael D Miedema2, Avinash Murthy3
1The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, OH, USA.
Insights
Elevated triglyceride (eTG) levels in ST-segment elevation myocardial infarction (STEMI) patients were not linked to worse cardiovascular outcomes. After adjustments, eTG levels showed comparable long-term MACE risks to lower triglyceride levels.
Area of Science:
- Cardiology
- Biochemistry
- Public Health
Background:
- Elevated triglycerides (eTG, ≥175 mg/dl) are generally associated with adverse cardiovascular events.
- Some studies suggest neutral or improved outcomes in acute myocardial infarction patients with eTG, but with limitations.
- Existing research lacks robust analysis of eTG impact on major adverse cardiac events (MACE) in ST-segment elevation myocardial infarction (STEMI).
Purpose of the Study:
- To investigate the association between elevated triglyceride levels and 1-year MACE in STEMI patients.
- To address limitations of previous studies by analyzing a large, prospective cohort.
- To determine if eTG levels predict cardiovascular outcomes in STEMI patients after risk factor adjustment.
Main Methods:
- Analysis of 5347 STEMI patients from a prospective registry-based cohort (March 2003-December 2020).
- Used a cutoff of 175 mg/dl for elevated triglyceride levels.
- Compared 1-year MACE (myocardial infarction, stroke, death) between eTG and low TG groups, with and without statistical adjustments.
Main Results:
- 24.5% of STEMI patients had elevated triglyceride levels.
- Patients with eTG were younger, male, and had more cardiovascular risk factors.
- Unadjusted analysis showed lower 1-year MACE in eTG group (8.8% vs. 11%).
- Adjusted analysis revealed no significant difference in 1-year MACE between eTG and low TG groups (aHR: 1.10).
Conclusions:
- A quarter of STEMI patients present with elevated triglyceride levels.
- Elevated triglyceride levels in STEMI patients are associated with comparable long-term cardiovascular outcomes to lower levels after clinical and lipid profile adjustments.
- Findings suggest that eTG may not be an independent predictor of adverse outcomes in STEMI.
- Further research may explore the specific mechanisms and implications of eTG in STEMI populations.
Abstract:
Although there is an established association between elevated triglyceride (eTG, ≥175 mg/dl) levels and adverse cardiovascular events, some studies have suggested that eTG levels may be linked to neutral or even improved clinical outcomes, particularly among patients with acute myocardial infarction. However, these studies had certain limitations, including small sample sizes, heterogeneous study populations, and inadequate statistical adjustments. To address these limitations, we conducted an analysis of 5347 patients with ST-segment elevation myocardial infarction (STEMI) between March 2003 and December 2020, using a prospective registry-based cohort from two large, regional STEMI centers. We used a triglyceride level of 175 mg/dl as the cutoff point for eTG levels. Of the study participants, 24.5% (n = 1312) had eTG levels. These patients were more likely to be younger, male, and have a higher number of cardiovascular risk factors compared to those with low TG levels. Despite these unfavorable cardiovascular risk profiles, patients with eTG levels had lower unadjusted risks of 1-year major adverse cardiac events (MACE) -a composite of myocardial infarction, stroke, and death- than those with low TG levels (8.8% vs. 11%, p = 0.034). However, after adjusting for certain clinical factors and lipid profile, eTG levels were not associated with a lower 1-year MACE (aHR: 1.10 (0.71-1.70), p = 0.7). In conclusion, a quarter of STEMI patients had eTG levels and these patients had comparable long-term cardiovascular outcomes compared to those with low TG levels after controlling for clinical factors and lipid profile.
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