Increased cardiovascular risk in hypertriglyceridemic patients with statin-controlled LDL cholesterol

Gregory A. Nichols, Sephy Philip, Kristi Reynolds, Craig B. Granowitz, Sergio Fazio

    Research output: Contribution to journalArticle

    17 Citations (Scopus)

    Abstract

    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.

    Original languageEnglish (US)
    Pages (from-to)3019-3027
    Number of pages9
    JournalJournal of Clinical Endocrinology and Metabolism
    Volume103
    Issue number8
    DOIs
    StatePublished - Jan 1 2018

    Fingerprint

    Hydroxymethylglutaryl-CoA Reductase Inhibitors
    LDL Cholesterol
    Triglycerides
    Composite materials
    Myocardial Infarction
    Integrated Delivery of Health Care
    Mortality
    Incidence
    Unstable Angina
    Repair
    Observational Studies
    Aneurysm
    Cohort Studies
    Cardiovascular Diseases
    Stroke
    Outcome Assessment (Health Care)

    ASJC Scopus subject areas

    • Endocrinology, Diabetes and Metabolism
    • Biochemistry
    • Endocrinology
    • Clinical Biochemistry
    • Biochemistry, medical

    Cite this

    Increased cardiovascular risk in hypertriglyceridemic patients with statin-controlled LDL cholesterol. / Nichols, Gregory A.; Philip, Sephy; Reynolds, Kristi; Granowitz, Craig B.; Fazio, Sergio.

    In: Journal of Clinical Endocrinology and Metabolism, Vol. 103, No. 8, 01.01.2018, p. 3019-3027.

    Research output: Contribution to journalArticle

    Nichols, Gregory A. ; Philip, Sephy ; Reynolds, Kristi ; Granowitz, Craig B. ; Fazio, Sergio. / Increased cardiovascular risk in hypertriglyceridemic patients with statin-controlled LDL cholesterol. In: Journal of Clinical Endocrinology and Metabolism. 2018 ; Vol. 103, No. 8. pp. 3019-3027.
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    abstract = "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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    T1 - Increased cardiovascular risk in hypertriglyceridemic patients with statin-controlled LDL cholesterol

    AU - Nichols, Gregory A.

    AU - Philip, Sephy

    AU - Reynolds, Kristi

    AU - Granowitz, Craig B.

    AU - Fazio, Sergio

    PY - 2018/1/1

    Y1 - 2018/1/1

    N2 - 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.

    AB - 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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