Triglyceride levels modulate CAD vascular event risk independent of diabetes, lipids
MedWire News: Researchers have found that patients with coronary artery disease (CAD) and high plasma triglyceride (TG) levels may be at risk for recurrent vascular events, independent of the presence of Type 2 diabetes, use of lipid-lowering medications, or other lipid levels.
Previous meta-analyses have shown that plasma TG is an independent risk factor for the development of cardiovascular diseases in healthy populations. However, drugs lowering plasma TG levels have not clearly proven to be effective in preventing vascular events and it is unclear whether plasma TG levels on their own increase the risk associated with higher non-high density lipoprotein-cholesterol (nonHDL-C).
"[There] is the need for increased attention for plasma TG levels, in particular in patients with CAD. To reduce residual risk, lowering plasma low-density lipoprotein cholesterol (LDL-C) or even nonHDL-C to current targets may not be sufficient," say Frank Visseren (University Medical Center Utrecht, the Netherlands) and colleagues.
For the prospective study, the team analyzed data from 5746 patients with a history or recent diagnosis of clinically manifest arterial disease who took part in the Second Manifestations of ARTerial disease (SMART) study between 1996 and 2010. In total, 3448 patients presented with CAD, 1612 with cerebrovascular disease, and 1603 with peripheral artery disease or aneurysm of the abdominal aorta.
Over a median 4.9-year follow-up, 782 patients presented new vascular events, including myocardial infarction, ischemic stroke, and vascular death. Patients in the highest plasma TG quintile (>2.24 mmol/L) were 45% more likely to experience recurrent vascular events compared with patients in the lowest quintile (<0.97 mmol/L) after adjusting for age, gender, body mass index, smoking, lipid-lowering medication, and LDL-C.
The risk for ischemic stroke was 47% higher in the highest TG quintile compared with the lowest quintile, as was the risk for myocardial infarction (56%) and vascular death (48%).
Further analysis showed the increased risk associated with increasing plasma TG levels was independent of Type 2 diabetes. High plasma TG increased the risk for vascular events in patients without the metabolic syndrome, but not in patients with the metabolic syndrome.
In addition, the increased risk for vascular events was magnified in patients with CAD (hazard ratio=1.45), but was not modified by other lipid levels as plasma TG modified vascular risk when other lipoproteins were at target levels.
Writing in the International Journal of Cardiology, the researchers conclude: "As long as there are no TG-lowering drugs proven to be effective in reducing vascular events, focus should be on a strict nonHDL-C target. In patients with elevated plasma TG levels a strict nonHDL-C target could be defined to lower the risk associated with plasma TG."
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By Ingrid Grasmo