Triglyceride impact on stroke risk remains unclear
MedWire News: Baseline triglyceride levels are positively associated with stroke risk, but the impact of reducing levels through drug treatment is less certain, say the authors of a systematic review and meta-analysis.
"Despite the analysis of lipid-modifying randomized trials including >190,000 patients, the present meta-regression analysis failed to detect a positive impact of triglyceride reduction on stroke risk," say Pierre Amarenco (Bichat Hospital, Paris, France) and team.
"However, the analysis that focused on studies with drugs that are more able to reduce triglyceride levels, such as fibrates or niacin and, showed a trend toward a positive effect of triglycerides lowering and risk of stroke."
The overall analysis, which is published in the journal Atherosclerosis, included 64 randomized, controlled trials.
Among the 98,681 placebo-treated patients, there was a positive association between baseline triglyceride levels and stroke risk, such that each 10-mg/dl (0.1 mmol/l) rise in triglyceride levels conferred a 5% increase in stroke risk.
However, each 10-mg/dl decline in triglyceride levels during follow-up was associated with only a nonsignificant 0.4% reduction in stroke risk. In 12 trials of fibrates or niacin, each 10-mg/dl triglyceride reduction was associated with a 9.6% reduction in stroke risk, although this was again nonsignificant (confidence interval -20.7% to 3.1%).
Only change in low-density lipoprotein cholesterol was associated with reduced stroke risk (4.5% per 10-mg/dl [0.1 mmol/l] reduction). This was also the only lipid measure to be associated with reduced carotid intima-media thickness progression in 26 trials that reported this outcome.
"The question regarding reduction of triglyceride levels to decrease stroke risk remains of great importance," say the researchers.
They conclude that additional studies addressing this issue are needed.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
By Eleanor McDermid