Increased Cardiovascular Risk in Hypertriglyceridemic Patients With Statin-Controlled LDL Cholesterol
Open accessAbstract
Context: Real-world evidence of the relationship between high triglyceride (TG) levels and cardiovascular (CV) disease (CVD) risk among statin-treated patients with low-density lipoprotein cholesterol (LDL-C) control is lacking. Objective: We aimed to compare CVD and mortality risk between patients with high vs normal TGs. Design: Longitudinal observational cohort study. Setting: Integrated delivery system. Patients: Patients aged ≥45 years whose TG level was either <150 mg/dL (normal) or between 200 and 499 mg/dL (high) in 2010, were taking only statins, had LDL-C values 40 to 100 mg/dL, and had diagnosed CVD. Outcome Measures: Patients were followed through December 2016. Our primary outcomes were a composite of nonfatal myocardial infarction (MI), nonfatal stroke, unstable angina, coronary revascularization, and all-cause mortality and a second composite adding peripheral revascularization and aneurysm repair. We compared multivariable-adjusted incidence rates and rate ratios (RRs) of the outcomes and their components. Results: A total of 14,481 patients comprised the normal TG group, and 2702 patients were in the high TG group. Multivariable-adjusted incidence of the second composite was 10% greater in the high TG group [50.9/1000 person-years, 95% CI 47.0 to 55.2 vs 46.5, 44.8 to 48.2, RR 1.10, 95% CI 1.00 to 1.20, P = 0.041]. The difference was driven by nonfatal MI (RR 1.20, 95% CI 1.00 to 1.45, P = 0.045), coronary revascularization (RR 1.18, 95% CI 1.00 to 1.40, P = 0.045), and peripheral revascularization (RR 1.56, 95% CI 1.14 to 2.13, P = 0.006). Conclusions: CVD risk in high-risk statin-treated patients with atherosclerotic CVD was associated with high TG levels.
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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 [7]
The Abstract reports significantly more nonfatal myocardial infarctions and coronary revascularizations in the high-triglyceride group despite statin-controlled LDL cholesterol. The study was limited to patients aged 45 or older with established cardiovascular disease and triglycerides of 200–499 mg/dL; the claim does not retain those population limits. (LLM, conf=0.85)
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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
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2018-05-29
- Volume
- 103
- Issue
- 8
- Pages
- 3019-3027
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2806371375
- Cited by
- 102
- References
- 45
- Citations by year
- 2026: 2 · 2025: 10 · 2024: 14 · 2023: 12 · 2022: 20 · 2021: 12 · 2020: 11 · 2019: 14 · 2018: 7
- FWCI
- 11.51
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Amgen
- Pfizer
- Merck
- Sanofi
- Regeneron Pharmaceuticals
- Amarin Corporation
- Kowa Company
- Amarin Pharma
- Janssen Pharmaceuticals
- 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, triglycerides, cardiovascular risk, statin therapy, LDL cholesterol control, atherosclerotic cardiovascular disease, myocardial infarction, coronary revascularization, peripheral revascularization, all-cause mortality, secondary prevention, real-world evidence, integrated health system, cardiovascular risk stratification, cardiovascular risk reclassification
- MeSH terms
- Aged, Aged, 80 and over, Cardiovascular Diseases, Female, Humans, Cholesterol, LDL, Longitudinal Studies, Male, Middle Aged, Mortality, Risk Factors, Hypertriglyceridemia, Cohort Studies, Hydroxymethylglutaryl-CoA Reductase Inhibitors
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