Increased residual cardiovascular risk in patients with diabetes and high versus normal triglycerides despite statin‐controlled LDL cholesterol
Open accessAbstract
AIM: To determine whether high triglycerides (TG) in the presence of statin-controlled LDL-C influence the risk of cardiovascular disease (CVD) among patients with diabetes in real-world clinical practice. MATERIALS AND METHODS: We identified adults with diabetes from the Southern California and Pacific Northwest regions of Kaiser Permanente. We included patients undergoing statin therapy with LDL-C from 40-100 mg/dL who were not undergoing other lipid-lowering therapies and had a prior diagnosis of atherosclerotic CVD or at least one other CVD risk factor. We grouped patients into high TG (200-499 mg/dL; n = 5542) or normal TG (<150 mg/dL, n = 22 411) from January 2010 through December 2016 to compare incidence rates and rate ratios of first non-fatal myocardial infarction (MI), non-fatal stroke, unstable angina and coronary revascularization. We adjusted multivariable analyses for age, sex, race/ethnicity, smoking status, blood pressure, HbA1c, serum creatinine, presence of ischaemic heart disease and study site. RESULTS: Adjusted rate ratios for the four outcomes were all statistically significantly different. The incidence rate for non-fatal MI was 30% higher in the high TG group (rate ratio, 1.30; 95% CI, 1.08-1.58; P = 0.006). The rate was 23% higher for non-fatal stroke (1.23, 1.01-1.49, P = 0.037), 21% higher for coronary revascularization (rate ratio, 1.21; 95% CI, 1.02-1.43; P = 0.027) and was, non-significantly, 33% higher for unstable angina (rate ratio, 1.33; 95% CI, 0.87-2.03; P = 0.185). CONCLUSIONS: Despite statin-controlled LDL-C levels, CV events were greater among patients with diabetes and high TG levels. Because we controlled for cardiometabolic risk factors, it is likely that the difference in TG levels contributed to the excess risk observed in patients with high TGs.
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The PROMINENT data further highlight the complexity of lipid mediators of residual risk among patients with insulin resistance who are receiving statin therapy.
“Thus, our data further highlight the complexity of lipid mediators of residual risk among patients with insulin resistance who are receiving statin therapy. 6,23-25”
From Triglyceride Lowering with Pemafibrate to Reduce Cardiovascular Risk (2022) · cites this paper as [24]
The Discussion reports that triglyceride levels were associated with residual cardiovascular events in statin-treated patients with diabetes despite controlled LDL cholesterol, supporting the background point about lipid-related residual risk. The study concerns patients with diabetes, not the broader population of patients with insulin resistance. The citing authors’ statement about what their own data highlight is not attributed to this source. (LLM, conf=0.82)
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- Authors
- Nichols, G. A., Philip, S., Reynolds, K., Granowitz, C. B., & Fazio, S.
- Affiliations
- Kaiser Permanente Center for Health Research (US)
- Amarin (United States) (US)
- Kaiser Permanente (US)
- Oregon Health & Science University (US)
- Corresponding author
- Nichols, Gregory A.
- Venue
- Diabetes, Obesity and Metabolism
- Publisher
- Wiley
- Published
- 2018-10-14
- Volume
- 21
- Issue
- 2
- Pages
- 366-371
- ISSN
- 1462-8902 (ISSN-L)
- 1463-1326
- PMC
- PMC6587847
- OpenAlex
- W2891231432
- Cited by
- 125
- References
- 16
- Citations by year
- 2026: 8 · 2025: 14 · 2024: 13 · 2023: 22 · 2022: 17 · 2021: 13 · 2020: 20 · 2019: 16 · 2018: 2
- FWCI
- 13.25
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes Obesity and Metabolism (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- Amarin Pharma, Inc.
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Keywords
- hypertriglyceridemia, diabetes mellitus, residual cardiovascular risk, statin therapy, LDL cholesterol, myocardial infarction, stroke, coronary revascularization, unstable angina, atherosclerotic cardiovascular disease, lipid-lowering therapy
- MeSH terms
- Aged, Anticholesteremic Agents, California, Cardiovascular Diseases, Diabetes Mellitus, Female, Humans, Cholesterol, LDL, Male, Middle Aged, Risk Factors, Triglycerides, Hypertriglyceridemia, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Diabetes Complications
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