Unmet need for primary prevention in individuals with hypertriglyceridaemia not eligible for statin therapy according to European Society of Cardiology/European Atherosclerosis Society guidelines: a contemporary population-based study
Abstract
Aims: To identify individuals at high risk of atherosclerotic cardiovascular disease (ASCVD), who are not definite statin eligible according to the 2016 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines, based on high concentrations of plasma triglycerides. Methods and results: From the Copenhagen General Population Study (2003-2015) 58 547 individuals aged 40-65 and free of ASCVD, diabetes, and statin use at baseline were included. Of these, 14% were definite statin eligible, 7% were not eligible and had triglycerides ≥3.0 mmol/L (264 mg/dL), and 79% were not statin eligible and had triglycerides <3.0 mmol/L (264 mg/dL). During 456 057 person-years of follow-up, 1770 individuals experienced a major adverse cardiovascular event (MACE) and 734 experienced a myocardial infarction (MI). The cumulative incidences of MACE at age 70 were 8.1% (95% confidence interval 7.3-8.9%) and 14.6% (12.6-16.8%) in statin non-eligible individuals with triglycerides <3.0 mmol/L (264 mg/dL) and ≥3.0 mmol/L (264 mg/dL), and 16.5% (14.0-19.3%) in statin eligible individuals. Corresponding cumulative incidences of MI were 3.0% (2.7-3.3%), 7.8% (6.4-9.5%), and 7.1% (5.9-8.4%), respectively. The estimated 10-year risks of MACE were 2.8% (2.6-3.0%) and 5.7% (4.9-6.6%) in statin non-eligible individuals with triglycerides <3.0 mmol/L (264 mg/dL) and ≥3.0 mmol/L (264 mg/dL), and 7.6% (6.9-8.3%) in statin eligible individuals; the median age in these three groups were 51, 51, and 60 years, respectively. Corresponding risks of MI were 1.0% (0.9-1.1%), 3.0% (2.4-3.7%), and 3.3% (2.8-3.7%), respectively. Conclusion: Statin non-eligible individuals with triglycerides ≥3.0 mmol/L (264 mg/dL) had risk of ASCVD similar to statin eligible individuals, defined according to the 2016 ESC/EAS guidelines. This illustrates an unmet need for primary prevention, calling for expansion of guidelines on statin eligibility, and the potential for placebo-controlled randomized clinical trials in individuals with hypertriglyceridaemia.
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In large cohort studies from Copenhagen, non-fasting TG of 6.6 vs. 0.8 mmol/L was associated with a five-, three-, and two-fold increased adjusted risk for myocardial infarction, ischaemic stroke, and all-cause mortality, respectively.
“For example, in large cohort studies from Copenhagen, non-fasting TG of 6.6 vs. 0.8 mmol/L was associated with a five-, three-, and two-fold increased adjusted risk for myocardial infarction, ischaemic stroke, and all-cause mortality, respectively.18,19”
From Clinical review on triglycerides (2020) · cites this paper as [19]
Cites
European Guidelines on cardiovascular disease prevention in clinical practice (version 2012)
Authors/Task Force Members:, Perk, J., De Backer, G., Gohlke, H., Graham, I., Reiner, Ž., Verschuren, M., Albus, C., Benlian, P., Boysen, G., et al. (2012) · European Heart Journal · doi:10.1093/eurheartj/ehs092 · Cited by 8,490 · see citing works
Stone, N. J., Robinson, J. G., Lichtenstein, A. H., Bairey Merz, C. N., Blum, C. B., Eckel, R. H., Goldberg, A. C., Gordon, D., Levy, D., Lloyd-Jones, D. M., et al. (2014) · Circulation · doi:10.1161/01.cir.0000437738.63853.7a · Cited by 7,081 · see citing works
Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein
Ridker, P. M., Danielson, E., Fonseca, F. A. H., Genest, J., Gotto, A. M., Kastelein, J. J. P., Koenig, W., Libby, P., Lorenzatti, A. J., MacFadyen, J. G., et al. (2008) · New England Journal of Medicine · doi:10.1056/nejmoa0807646 · Cited by 6,674 · see citing works
Self-citation2016 European Guidelines on cardiovascular disease prevention in clinical practice
Piepoli, M. F., Hoes, A. W., Agewall, S., Albus, C., Brotons, C., Catapano, A. L., Cooney, M.-T., Corrà, U., Cosyns, B., Deaton, C., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw106 · Cited by 6,457 · see citing works
Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project
Conroy, R. (2003) · European Heart Journal · doi:10.1016/s0195-668x(03)00114-3 · Cited by 5,290 · see citing works
Stone, N. J., Robinson, J. G., Lichtenstein, A. H., Bairey Merz, C. N., Blum, C. B., Eckel, R. H., Goldberg, A. C., Gordon, D., Levy, D., Lloyd-Jones, D. M., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2013.11.002 · Cited by 3,845 · see citing works
Rosuvastatin to Prevent Vascular Events in Men and Women With Elevated C-Reactive Protein
Ridker, P. M., Danielson, E., Fonseca, F. A. H., Genest, J. J., Gotto, A. M., Kastelein, J. J. P., Köenig, W., Libby, P., Lorenzatti, A. J., MacFadyen, J. G., et al. (2009) · Obstetrical & Gynecological Survey · doi:10.1097/01.ogx.0000344393.60303.0a · Cited by 3,641 · see citing works
Self-citation2016 ESC/EAS Guidelines for the Management of Dyslipidaemias
Catapano, A. L., Graham, I., De Backer, G., Wiklund, O., Chapman, M. J., Drexel, H., Hoes, A. W., Jennings, C. S., Landmesser, U., Pedersen, T. R., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw272 · Cited by 3,162 · see citing works
Nordestgaard, B. G., Benn, M., Schnohr, P., & Tybjærg-Hansen, A. (2007) · JAMA · doi:10.1001/jama.298.3.299 · Cited by 2,058 · see citing works
Self-citationTriglycerides and cardiovascular disease
Nordestgaard, B. G., & Varbo, A. (2014) · The Lancet · doi:10.1016/s0140-6736(14)61177-6 · Cited by 1,419 · see citing works
Self-citationSarwar, N., Danesh, J., Eiriksdottir, G., Sigurdsson, G., Wareham, N., Bingham, S., Boekholdt, S. M., Khaw, K.-T., & Gudnason, V. (2007) · Circulation · doi:10.1161/circulationaha.106.637793 · Cited by 1,408 · see citing works
Demographic and epidemiologic drivers of global cardiovascular mortality
Roth, G. A., Forouzanfar, M. H., Moran, A. E., Barber, R., Nguyen, G., Feigin, V. L., Naghavi, M., Mensah, G. A., & Murray, C. J. L. (2015) · New England Journal of Medicine · doi:10.1056/nejmoa1406656 · Cited by 1,188 · see citing works
Nordestgaard, B. G. (2016) · Circulation Research · doi:10.1161/circresaha.115.306249 · Cited by 1,116 · see citing works
Self-citationRemnant Cholesterol as a Causal Risk Factor for Ischemic Heart Disease
Varbo, A., Benn, M., Tybjærg-Hansen, A., Jørgensen, A. B., Frikke-Schmidt, R., & Nordestgaard, B. G. (2013) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2012.08.1026 · Cited by 1,115 · see citing works
Self-citationEffects of fibrates on cardiovascular outcomes: a systematic review and meta-analysis
Jun, M., Foote, C., Lv, J., Neal, B., Patel, A., Nicholls, S. J., Grobbee, D. E., Cass, A., Chalmers, J., & Perkovic, V. (2010) · The Lancet · doi:10.1016/s0140-6736(10)60656-3 · Cited by 933 · see citing works
Loss-of-Function Mutations in <i>APOC3</i> and Risk of Ischemic Vascular Disease
Jørgensen, A. B., Frikke-Schmidt, R., Nordestgaard, B. G., & Tybjærg-Hansen, A. (2014) · New England Journal of Medicine · doi:10.1056/nejmoa1308027 · Cited by 919 · see citing works
Self-citationNordestgaard, B. G., Langsted, A., Mora, S., Kolovou, G., Baum, H., Bruckert, E., Watts, G. F., Sypniewska, G., Wiklund, O., Borén, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw152 · Cited by 847 · see citing works
Self-citationStatin Use for the Primary Prevention of Cardiovascular Disease in Adults
US Preventive Services Task Force, Bibbins-Domingo, K. B., Grossman, D. C., Curry, S. J., Davidson, K. W., Epling, J. W., García, F., Gillman, M. W., Kemper, A. R., Krist, A. H., et al. (2016) · JAMA · doi:10.1001/jama.2016.15450 · Cited by 590 · see citing works
Statins for Prevention of Cardiovascular Disease in Adults
Chou, R., Dana, T., Blazina, I., Daeges, M., & Jeanne, T. L. (2016) · JAMA · doi:10.1001/jama.2015.15629 · Cited by 570 · see citing works
Nonfasting triglycerides and risk of ischemic stroke in the general population
Freiberg, J. J. (2008) · JAMA · doi:10.1001/jama.2008.621 · Cited by 542 · see citing works
Keene, D., Price, C., Shun-Shin, M. J., & Francis, D. P. (2014) · BMJ · doi:10.1136/bmj.g4379 · Cited by 519 · see citing works
Cumulative Incidence Estimation in the Presence of Competing Risks
Coviello, V., & Boggess, M. M. (2004) · The Stata Journal Promoting communications on statistics and Stata · doi:10.1177/1536867x0400400201 · Cited by 463 · see citing works
Banegas, J. R., Lopez-Garcia, E., Dallongeville, J., Guallar, E., Halcox, J. P., Borghi, C., Masso-Gonzalez, E. L., Jimenez, F. J., Perk, J., Steg, P. G., et al. (2011) · European Heart Journal · doi:10.1093/eurheartj/ehr080 · Cited by 354 · see citing works
Haase, C. L., Tybjærg-Hansen, A., Ali Qayyum, A., Schou, J., Nordestgaard, B. G., & Frikke-Schmidt, R. (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-1846 · Cited by 282 · see citing works
Self-citationNordestgaard, B. G., Palmer, T., Benn, M., Zacho, J., Tybjærg‐Hansen, A., Smith, G. D., & Timpson, N. J. (2012) · PLoS Medicine · doi:10.1371/journal.pmed.1001212 · Cited by 280 · see citing works
Self-citationMortensen, M. B., Afzal, S., Nordestgaard, B. G., & Falk, E. (2015) · European Heart Journal · doi:10.1093/eurheartj/ehv251 · Cited by 64 · see citing works
Self-citationMortensen, M. B., Nordestgaard, B. G., Afzal, S., & Falk, E. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw426 · Cited by 61 · see citing works
Self-citationLangsted, A., Freiberg, J. J., & Nordestgaard, B. G. (2017) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2016.11.025 · Cited by 21 · see citing works
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Clinical review on triglycerides
Laufs, U., Parhofer, K. G., Ginsberg, H. N., & Hegele, R. A. (2020) · European Heart Journal · doi:10.1093/eurheartj/ehz785 · Cited by 544 · see citing works
Fan, W., Philip, S., Granowitz, C., Toth, P. P., & Wong, N. D. (2019) · Journal of Clinical Lipidology · doi:10.1016/j.jacl.2018.11.008 · Cited by 67 · see citing works
- Authors
- Madsen, C. M., Varbo, A., & Nordestgaard, B. G.
- Affiliations
- University of Copenhagen (DK)
- Herlev Hospital (DK)
- Corresponding author
- Nordestgaard, Børge G
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-11-22
- Volume
- 39
- Issue
- 7
- Pages
- 610-619
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2768478526
- Cited by
- 47
- References
- 29
- Citations by year
- 2024: 2 · 2023: 9 · 2022: 5 · 2021: 8 · 2020: 6 · 2019: 9 · 2018: 7 · 2017: 1
- FWCI
- 6.44
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Funders
- Gentofte Hospital
- Novo Nordisk
- Novo Nordisk Fonden (NNF16OC0020826)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- hypertriglyceridemia, primary prevention, statin eligibility, atherosclerotic cardiovascular disease, major adverse cardiovascular events, myocardial infarction, triglycerides, ESC/EAS guidelines, cardiovascular risk prediction, Copenhagen General Population Study, population-based cohort, cardiovascular risk stratification
- MeSH terms
- Adult, Cholesterol, Eligibility Determination, Humans, Middle Aged, Risk Factors, Hypertriglyceridemia, Practice Guidelines as Topic, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Atherosclerosis
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