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Triglycerides and the Risk of Atherosclerotic Cardiovascular Events Across Different Risk Categories
Hiroyuki Mizuta1,2, Masanobu Ishii2,3, So Ikebe2
1Tokushukai Isen Clinic.
Insights
High triglyceride levels increase major adverse cardiovascular events (MACE) risk in primary prevention but not secondary. Distinct triglyceride thresholds for MACE risk are suggested, needing further validation.
Area of Science:
- Cardiovascular Medicine
- Epidemiology
- Biochemistry
Background:
- Elevated triglyceride levels are a known risk factor for cardiovascular disease.
- Understanding the specific impact of triglyceride levels on major adverse cardiovascular events (MACE) in different patient populations is crucial for effective prevention strategies.
Purpose of the Study:
- To investigate the association between triglyceride levels and MACE.
- To compare this association in primary and secondary cardiovascular prevention cohorts.
Main Methods:
- Retrospective analysis of a nationwide Japanese health insurance claims database (approx. 3.8 million participants).
- Classification into primary (no prior CVD/stroke) and secondary (prior CVD/stroke) prevention cohorts.
- Categorization of participants based on triglyceride levels: very low (<50 mg/dL), low normal (50-99 mg/dL), high normal (100-149 mg/dL), and hypertriglyceridemia (≥150 mg/dL).
- MACE outcomes included acute myocardial infarction, unstable angina, ischemic stroke, and cardiac death.
Main Results:
- Over 3.25 years, MACE occurred in 0.3% of primary and 2.6% of secondary prevention cohorts.
- Hypertriglyceridemia (≥150 mg/dL) was associated with a higher risk of MACE in primary prevention, but not in secondary prevention.
- A significant interaction between prevention category and TG levels was observed for MACE.
- The population-attributable fraction for hypertriglyceridemia in primary prevention was 4.1% for MACE.
Conclusions:
- Distinct triglyceride thresholds for MACE risk exist between primary and secondary prevention.
- Hypertriglyceridemia poses a significant risk for MACE in primary prevention settings.
- Further prospective studies are required to validate these findings for clinical application.
Aims:
To investigate the association between triglyceride levels and major adverse cardiovascular events (MACE) in primary and secondary prevention cohorts.
Methods:
This retrospective study was conducted with a nationwide health insurance claims database, which included approximately 3.8 million participants with medical checkups between January 2005 and August 2020 in Japan. The participants were classified into primary prevention (n=3,415,522) and secondary prevention (n=29,806) cohorts based on cardiovascular or cerebrovascular disease history. Each participant was categorized as having very low (triglyceride ＜50 mg/dL), low normal (50-99), high normal (100-149), or hypertriglyceridemia (≥ 150). The primary prevention cohort was further stratified into low-, intermediate-, and high-risk groups according to atherosclerotic cardiovascular diseases risk. Outcome was MACE, including acute myocardial infarction (AMI), unstable angina, ischemic stroke, and cardiac death.
Results:
Over a mean follow-up of 3.25 years, 0.3% and 2.6% MACE occurred in primary and secondary prevention, respectively. Hypertriglyceridemia was associated with high risk of MACE in the primary prevention, but not in the secondary prevention. A significant interaction was observed between prevention categories and the association of TG levels with MACE in those with TG ＜150 mg/dL and ischemic stroke in those with TG ≥ 150 mg/dL. The population-attributable fraction for hypertriglyceridemia in primary prevention was 4.1% for MACE. In primary prevention, lower risks of AMI were observed in the lower TG category compared to the current threshold.
Conclusions:
This study suggests distinct triglyceride thresholds for MACE risk in primary and secondary prevention cohorts, requiring further prospective validation for clinical implementation.
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