Real-world risk of cardiovascular outcomes associated with hypertriglyceridaemia among individuals with atherosclerotic cardiovascular disease and potential eligibility for emerging therapies
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Aims: Hypertriglyceridaemia in patients with atherosclerotic cardiovascular disease (ASCVD) has been in focus following the REDUCE-IT trial showing benefit with icosapent ethyl. Among individuals with prevalent ASCVD, we sought to quantify the contemporary, real-world risk of ASCVD events associated with hypertriglyceridaemia, as well as estimate icosapent ethyl eligibility and compare trial participants with REDUCE-IT-like individuals in the population. Methods and results: We examined data from 2 424 865 adults with lipid panels in the Ontario population. Among those with prevalent ASCVD, we examined adjusted associations between triglyceride (TG) and ASCVD events (first occurrence of myocardial infarction, unstable angina, stroke or transient ischaemic attack, coronary revascularization, or cardiovascular death). The proportion of patients with ASCVD potentially eligible for icosapent ethyl was estimated as those with TG 135–499 mg/dL (1.52–5.63 mmol/L) and low-density lipoprotein cholesterol (LDLc) 41–100 mg/dL (1.06–2.59 mmol/L), similar to the lipid cut-offs in REDUCE-IT, and their demographics and event rates examined. Among 196 717 individuals with ASCVD, median age was 69 years and 30% were female. A total of 24 097 composite ASCVD events occurred over a mean (standard deviation) 2.9 (0.5) years of follow-up. Increasing TG was associated with a graded, progressively higher hazard of ASCVD events. Twenty-five percent (49 886) of individuals with ASCVD had hypertriglyceridaemia and controlled LDLc; these patients were demographically similar to those in REDUCE-IT with comparable event rates. Conclusions: Among patients with ASCVD, hypertriglyceridaemia is common, and is associated with higher ASCVD risk across a range of TG. It is possible that as many as one in four patients with ASCVD may be candidates for emerging therapies.
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Fasting triglyceride levels from as low as approximately 1.2 mmol/L can be associated with a cluster of metabolic abnormalities that include accumulation of triglyceride-rich lipoproteins and remnants, as well as increased cardiovascular disease events.
“it is less widely appreciated that fasting levels from as low as ∼1.2 mmol/L (∼100 mg/dL) can be associated with a cluster of metabolic abnormalities that include accumulation of TRL and remnants,14 as well as increased cardiovascular disease events15,16 (Figure 1).”
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- Authors
- Lawler, P. R., Kotrri, G., Koh, M., Goodman, S. G., Farkouh, M. E., Lee, D. S., Austin, P. C., Udell, J. A., & Ko, D. T.
- Affiliations
- University Health Network (CA)
- University of Toronto (CA)
- Institute for Clinical Evaluative Sciences (CA)
- St. Michael's Hospital (CA)
- Corresponding author
- Lawler, Patrick R
- ORCID
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2019-11-16
- Volume
- 41
- Issue
- 1
- Pages
- 86-94
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2987868385
- Cited by
- 113
- References
- 26
- Citations by year
- 2026: 7 · 2025: 15 · 2024: 18 · 2023: 13 · 2022: 23 · 2021: 16 · 2020: 20 · 2019: 1
- FWCI
- 14.33
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Funders
- FDN (143313, 154333)
- Canadian Institutes of Health Research
- Heart and Stroke Foundation
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Keywords
- hypertriglyceridemia, atherosclerotic cardiovascular disease, icosapent ethyl, REDUCE-IT trial, triglyceride levels, cardiovascular risk, LDL cholesterol, myocardial infarction, stroke, coronary revascularization, cardiovascular mortality
- MeSH terms
- Aged, Cardiovascular Diseases, Female, Humans, Male, Ontario, Risk Factors, Triglycerides, Hypertriglyceridemia, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Atherosclerosis
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