Elevated triglycerides and treatment eligibility in patients with severe, asymptomatic carotid stenosis: CREST 2
Seemant Chaturvedi1, Tanya N Turan2, Jenifer H Voeks2
1University of Maryland, USA.
Insights
Elevated triglyceride (TG) levels are common in patients with asymptomatic carotid stenosis. High TG is linked to diabetes, hypertension, and obesity, warranting further investigation into treatment benefits.
Area of Science:
- Cardiovascular Medicine
- Metabolic Disorders
- Clinical Trials
Background:
- Elevated triglyceride (TG) levels affect roughly 25% of adults.
- Pharmacologic treatment for high TG in patients on statins may reduce vascular events, but evidence is mixed.
- The prevalence of high TG and associated conditions in asymptomatic carotid stenosis (CS) patients is not well-defined.
Purpose of the Study:
- To determine the prevalence of elevated TG levels in patients with asymptomatic carotid stenosis (CS).
- To identify medical conditions associated with high TG in this patient population.
- To assess eligibility for TG-lowering treatment based on established criteria.
Main Methods:
- Analysis of baseline lipid profiles from 2328 patients in the CREST 2 trial.
- TG treatment eligibility assessed using REDUCE-IT criteria (TG ≥150 mg/dL, LDL <100 mg/dL on statin therapy).
- Chi-square and t-tests used to evaluate associations between baseline factors and elevated TG levels.
Main Results:
- 20.5% of patients meeting REDUCE-IT criteria were eligible for TG-lowering treatment.
- Median TG level was 205 mg/dL.
- High TG levels (≥150 mg/dL) were significantly associated with hypertension, diabetes, obesity, high HbA1c, and reduced physical activity (p<0.0001).
Conclusions:
- Elevated TG levels are prevalent and strongly associated with common comorbidities in asymptomatic CS patients.
- Further research is required to determine if treating elevated TG levels benefits patients with asymptomatic carotid stenosis.
Background:
Data from the Centers for Disease Control show that approximately one-quarter of adults have elevated triglyceride (TG) levels. Some clinical trials, but not all, have demonstrated that pharmacologic treatment of high TG levels in patients already on statin therapy reduces the rate of major vascular events such as myocardial infarction and stroke. We assessed the prevalence of elevated TG levels in patients with asymptomatic carotid stenosis (CS), and medical conditions associated with high TG.
Methods:
Baseline lipid profiles from patients enrolled in the Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST 2) were analyzed. to determine treatment eligibility for high TG levels using the criteria established by the REDUCE-IT trial (triglyceride levels ≥150 mg/dL with LDL managed by a statin to <100 mg/dL). Equally assessed was the percentage of patients who were using pharmacologic treatment for high TG levels at study entry. Demographic factors and baseline medical conditions associated with high (>150 mg/dl) TG values were also analyzed. Chi-square and t=tests were used to assess baseline factors and abnormal TG values.
Results:
As of October 2023, of 2377 randomized CREST-2 patients, 2328 (98 %) (mean age 70.0 years, 63 % men) had baseline lipid profiles suitable for analysis. Among 1961 (84 %) patients who met REDUCE-IT criteria, analysis of lipid profiles revealed that 20.5 % of the patients were eligible for treatment of high triglycerides. Of the 1464 patients with fasting lipid profiles, 17.8 % were eligible for treatment. The median TG value was 205 (IQR 91) mg/dl in the total population. TG levels of 150 mg/dl or higher were strongly associated with hypertension, diabetes, obesity, high hemoglobin A1c, and reduced physical activity (all p<0.0001).
Conclusions:
Elevated TG levels are strongly associated with diabetes, hypertension, obesity, and reduced physical activity. Further research is needed on whether treatment of elevated TG levels in patients with asymptomatic carotid stenosis confers benefit.
Related Concept Videos
01:26Atherosclerosis III: Management
01:20Lipid-Lowering Drugs: Statins and Miscellaneous Agents
01:25Blood Studies for Cardiovascular System III: Serum Lipid Profile
Serum lipids are fats and fatty substances in the blood and are crucial for various bodily functions, including energy storage, cellular structure, and hormone production. Serum lipids consist of cholesterol, triglycerides, and phospholipids.
Cholesterol is a soft, fat-like substance found in all body cells. It is crucial for producing hormones, vitamin D, and substances that aid...
01:26Angina IV: Management
01:27Angina II: Classification
01:26Coronary Artery Disease IV: Medical Management