Risk of cardiovascular events in patients with hypertriglyceridaemia: A review of real‐world evidence

Abstract

Aims To describe the real‐world prevalence and consequences of hypertriglyceridaemia. Materials and methods We searched two large patient databases, the National Health and Nutrition Examination Survey (NHANES) database (2007–2014) and the Optum Research Database, as well as electronic medical records from two Kaiser Permanente regions. Results The NHANES data showed that ~26% of US adults, including nearly one‐third of statin users, had at least borderline hypertriglyceridaemia (triglycerides [TGs] ≥1.69 mmol/L), and ~40% of adults with diabetes had levels of ≥150 mg/dL despite statin use. The Optum analyses demonstrated that those with TG levels ≥1.69 mmol/L who were on statins had a significantly increased risk of composite initial major cardiovascular (CV) events (hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.19–1.34; P < 0.001 vs. patients with TGs <150 mg/dL). This was accompanied by increased healthcare utilization and direct healthcare costs (HR 1.12, 95% CI 1.08–1.16; P < 0.001). In the analyses of the Kaiser Permanente records, patients with diabetes and TG levels 2.26–5.64 mmol/L had significantly higher adjusted incidence rates of non‐fatal myocardial infarction (rate ratio 1.30, 95% CI 1.08–1.58; P = 0.006), non‐fatal stroke (rate ratio 1.23; 95% CI 1.01–1.49; P = 0.037) and coronary revascularization (rate ratio 1.21; 95% CI 1.02–1.43; P = 0.027), but not unstable angina (rate ratio 1.33; 95% CI 0.87–2.03; P = 0.185) compared with patients with TG levels <1.69 mmol/L. Conclusions Real‐world analyses suggest that elevated TGs are prevalent and commonly associated with increased CV risk. CV outcomes trials in patients with established hypertriglyceridaemia will clarify whether strategies to reduce TG levels can ameliorate residual CV risk in patients taking statins.

The role of postprandial very-low-density lipoprotein in the development of atrial remodeling in metabolic syndrome

“…The importance of postprandial hyperlipidemia in the context of atherosclerosis was suggested early in 1979 [ 38 ] and was later increasingly explored in recent years [ 10 , 16 , 17 ]. In 2016, experts reached a consensus regarding the complementary value of nonfasting measurements of lipid profiles for clinical and laboratory medicine [ 39 ].…”

“…Elevated triglycerides are common in MetS and correlate with elevated cardiovascular risk [ 10 ]. Triglycerides are primarily carried by very low density lipoprotein (VLDL) in circulation [ 11 ].…”

Prevalence of dyslipidemia and associated risk factors among adults aged ≥ 35 years in northern China: a cross-sectional study

“…However, compared with several regional studies [18][19][20] , the prevalence of decreased HDL-C and elevated TG in our study were at higher levels. The epidemiological data showed that HDL-C levels were negatively correlated with the risk of atherosclerotic cardiovascular disease (ASCVD) [21] , and elevated TG was commonly associated with increased CVD risk [22] . Therefore, monitoring of HDL-C and TG should be strengthened to prevent the incidence of CVD among adults in northern China.…”

Postprandial Negatively Charged Very-Low-Density Lipoprotein ­Is a Novel Biomarker for Atrial Remodeling in Metabolic Syndrome

“…The importance of postprandial hyperlipidemia in the context of atherosclerosis was suggested early in 1979 [38] and was later increasingly explored in recent years [10,16,17]. In 2016, experts reached a consensus regarding the complementary value of nonfasting measurements of lipid pro les for clinical and laboratory medicine [39].…”