High Triglycerides Are Associated With Increased Cardiovascular Events, Medical Costs, and Resource Use: A Real‐World Administrative Claims Analysis of Statin‐Treated Patients With High Residual Cardiovascular Risk
Open accessAbstract
Background: The American Heart Association recognizes high triglycerides as a cardiovascular risk factor. Methods and Results: This retrospective observational administrative claims analysis (Optum Research Database) included statin‐treated patients ≥45 years old with diabetes mellitus and/or atherosclerotic cardiovascular disease, triglycerides 2.26 to 5.64 mmol/L, and a propensity‐matched comparator cohort with triglycerides <1.69 mmol/L and high‐density lipoprotein cholesterol >1.04 mmol/L. In the high‐triglycerides cohort versus comparators (both n=10 990, 49% women), mean age was 61.7 versus 62.2 years and follow‐up was 41.3 versus 42.1 months, respectively. Multivariate analysis of composite major cardiovascular events demonstrated significantly increased risk in the high‐triglycerides (n=13 411 patients) versus comparator (n=32 506 patients) cohorts (hazard ratio [ HR ], 1.35; 95% confidence interval [ CI ], 1.225–1.485; P <0.001), with significantly higher risk for nonfatal myocardial infarction ( HR , 1.35; 95% CI , 1.19–1.52; P <0.001), nonfatal stroke ( HR , 1.27; 95% CI , 1.14–1.42; P <0.001), and need for coronary revascularization ( HR , 1.51; 95% CI , 1.34–1.69; P <0.001), but not unstable angina or cardiovascular death. Increased cardiovascular risk in the high‐triglycerides versus comparator cohort was maintained, even with addition of non–high‐density lipoprotein cholesterol to the multivariate model and when analyzing high and low high‐density lipoprotein cholesterol subgroups. Average total healthcare cost per patient per month (cost ratio, 1.15; 95% CI , 1.084–1.210; P <0.001) and rate of occurrence of inpatient hospital stay ( HR , 1.17; 95% CI , 1.113–1.223; P <0.001) were also significantly greater in the high‐triglycerides cohort. Conclusions: In this real‐world analysis, patients with high cardiovascular risk and high triglycerides had worse composite cardiovascular and health economic outcomes than patients with well‐managed triglycerides and high‐density lipoprotein cholesterol >1.04 mmol/L.
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Despite having a well-controlled low-density lipoprotein cholesterol on statin therapy, patients with elevated triglycerides have significant residual risk for coronary events.
“Despite having a well-controlled low-density lipoprotein cholesterol on statin therapy, patients with elevated triglycerides have significant residual risk for coronary events.”
From Benefits of Icosapent Ethyl Across the Range of Kidney Function in Patients With Established Cardiovascular Disease or Diabetes: REDUCE-IT RENAL (2021) · cites this paper as [8]
The Methods (Study Populations; page unavailable) describe statin-treated patients with elevated triglycerides, and the Abstract (Methods and Results; page unavailable) reports significantly higher risks of nonfatal myocardial infarction and coronary revascularization than in comparators. However, well-controlled LDL-C was not an inclusion criterion for that outcome analysis. The Discussion describes a separate group with LDL-C ≤100 mg/dL and elevated triglycerides, but does not report its coronary-event risk. (LLM, conf=0.86)
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- Authors
- Toth, P. P., Granowitz, C., Hull, M., Liassou, D., Anderson, A., & Philip, S.
- Affiliations
- Johns Hopkins University (US)
- Amarin (United States) (US)
- Optum (United States) (US)
- Amarin Pharma Inc Bedminster NJ
- Corresponding author
- Toth, Peter P.
- Venue
- Journal of the American Heart Association
- Published
- 2018-08-07
- Volume
- 7
- Issue
- 15
- Pages
- e008740-e008740
- ISSN
- 2047-9980 (ISSN-L)
- PMC
- PMC6201477
- OpenAlex
- W2885602607
- Cited by
- 117
- References
- 38
- Citations by year
- 2026: 12 · 2025: 8 · 2024: 15 · 2023: 13 · 2022: 13 · 2021: 16 · 2020: 16 · 2019: 19 · 2018: 5
- FWCI
- 14.55
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Journal of the American Heart Association (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- 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
- triglyceride elevation, residual cardiovascular risk, statin therapy, cardiovascular events, myocardial infarction, stroke, coronary revascularization, health care costs, hospitalization, resource utilization (health care), diabetes mellitus, atherosclerotic cardiovascular disease, non-HDL cholesterol, HDL cholesterol, hypertriglyceridemia, cardiovascular risk stratification
- MeSH terms
- Administrative Claims, Healthcare, Aged, Angina, Unstable, Cardiovascular Diseases, Diabetes Mellitus, Female, Health Resources, Health Services, Humans, Cholesterol, HDL, Male, Middle Aged, Myocardial Infarction, Myocardial Revascularization, Hypertriglyceridemia, Proportional Hazards Models, Health Care Costs, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Stroke, Atherosclerosis
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