Triglyceride-lowering therapy for the prevention of cardiovascular events, stroke, and mortality in patients with diabetes: A meta-analysis of randomized controlled trials

Yang, Xiu Hong; Tu, Qian; Li, Li; Guo, Yong; Wang, Nian Song; Jin, Hui

doi:10.1016/j.atherosclerosis.2023.117187

Cited by 5 publications

(2 citation statements)

References 40 publications

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“…However, conflicting reports exist, with some studies failing to establish such a positive correlation [23,[62][63][64]. Nonetheless, a meta-analysis of 19 studies involving 91,285 diabetic patients revealed that triglyceride-lowering therapy was associated with reduced CVD events and mortality [65]. Consequently, hypertriglyceridemia has been recognized as a "risk-enhancing factor" by the American Heart Association and American College of Cardiology [66].…”

Section: Discussionmentioning

confidence: 99%

Fasting Triglycerides in the Upper Normal Range Are Independently Associated with an Increased Risk of Diabetes Mortality in a Large Representative US Population

Wang

2024

JCDD

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The association between normal-range triglyceride levels and diabetes mortality remains unclear. This cohort study aimed to elucidate this relationship by examining 19,010 US adult participants with fasting serum triglycerides below 150 mg/dL. Cox proportional hazards models were employed to estimate mortality hazard ratios (HRs) and 95% confidence intervals (CIs). Participants were followed up for a mean of 15.3 years, during which 342 diabetes deaths were recorded. A 1 natural log unit increase in triglycerides was associated with a 57% higher risk of diabetes mortality (adjusted HR, 1.57; 95% CI, 1.04–2.38). Comparable results were obtained when triglycerides were analyzed in quartiles. Receiver operating characteristic curve analysis identified an optimal triglyceride cutoff of 94.5 mg/dL for diabetes mortality; individuals with triglyceride levels above this threshold faced a greater risk of diabetes mortality (adjusted HR, 1.43; 95% CI, 1.12–1.83). Further investigation revealed a positive association between normal triglyceride levels and all-cause mortality, though no association was observed between normal triglycerides and mortality from hypertension or cardiovascular disease. In conclusion, elevated triglyceride levels within the normal range were associated with an increased risk of diabetes mortality. Individuals with triglyceride levels of 95 mg/dL or higher may require vigilant monitoring for diabetes and its associated complications.

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Section: Discussionmentioning

confidence: 99%

Fasting Triglycerides in the Upper Normal Range Are Independently Associated with an Increased Risk of Diabetes Mortality in a Large Representative US Population

Wang

2024

JCDD

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“…Yet, conflicting reports exist, with some studies failing to establish such a positive correlation [21,[59][60][61]. Nonetheless, a meta-analysis of 19 studies involving 91,285 diabetic patients revealed that triglyceride-lowering therapy was associated with reduced CVD events and mortality [62]. Consequently, hypertriglyceridemia has been recognized as a "risk-enhancing factor" by the American Heart Association and American College of Cardiology [63].…”

Section: Discussionmentioning

confidence: 99%

Fasting Triglycerides in the Upper Normal Range Are Independently Associated with an Increased Risk of Diabetes Mortality

Wang

2024

Preprint

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The association between normal-range triglycerides and diabetes mortality remains unclear. This cohort study aimed to elucidate this relationship by examining 19,010 US adult participants with fasting serum triglycerides below 150 mg/dL. Cox proportional hazards models were employed to estimate mortality hazard ratios (HRs) and 95% confidence intervals (CIs). Participants were followed up for a mean of 15.3 years, during which 342 diabetes deaths were recorded. A 1-natural-log-unit increase in triglycerides was associated with a 57% higher risk of diabetes mortality (adjusted HR, 1.57; 95% CI, 1.04–2.38). Comparable results were obtained when triglycerides were analyzed in quartiles. Receiver operating characteristic curve analysis identified an optimal triglyceride cutoff of 94.5 mg/dL for diabetes mortality; individuals with triglyceride levels above this threshold faced a greater risk of diabetes mortality (adjusted HR, 1.43; 95% CI, 1.12–1.83). Further investigation revealed a positive association between normal triglyceride levels and all-cause mortality, though no association was observed between normal triglycerides and mortality from hypertension or cardiovascular disease. In conclusion, elevated triglycerides within the normal range were associated with an increased risk of diabetes mortality. Individuals with triglyceride levels of 95 mg/dL or higher may require vigilant monitoring for diabetes and its associated complications.

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Managing hypertriglyceridemia for cardiovascular disease prevention: Lessons from the PROMINENT trial

Yamashita,

Hirano,

Shimano

et al. 2024

Eur J Clin Investigation

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BackgroundNumerous epidemiological studies have shown that hypertriglyceridemia is a significant risk factor for cardiovascular diseases (CVD). However, large clinical studies on triglyceride‐lowering therapy have yielded inconsistent results. In the current review, we reassess the importance of triglyceride‐lowering therapy in preventing CVD based on previous literature and the recently published findings of the PROMINENT trial.MethodsThis narrative review is based on literature and public documents published up to November 2023.ResultsMeta‐analyses of trials on peroxisome proliferator‐activated receptor α agonists and triglyceride‐lowering therapy, including the PROMINENT trial, have indicated that triglyceride‐lowering therapy can reduce CVD events. Mendelian randomization studies have also indicated that triglyceride is indeed a true risk factor for coronary artery disease, leaving no doubt about its relationship to CVD. Meanwhile, the negative results from the PROMINENT trial were likely due to the insufficient triglyceride‐lowering effect, slight increases in low‐density lipoprotein cholesterol and apolipoprotein B, and the inclusion of mostly high‐intensity statin users as target patients. It is unlikely that adverse events counteracted the effectiveness of pemafibrate on outcomes. Additionally, pemafibrate has shown positive effects on non‐alcoholic fatty liver disease and peripheral artery disease.ConclusionAlthough the PROMINENT trial did not demonstrate the significance of pemafibrate as a triglyceride‐lowering therapy in a specific population, it does not necessarily negate the potential benefits of treating hypertriglyceridemia in reducing CVD events. It is necessary to explore appropriate populations that could benefit from this therapy, utilize data from the PROMINENT trial and other databases, and validate findings in real‐world settings.

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Triglyceride-lowering therapy for the prevention of cardiovascular events, stroke, and mortality in patients with diabetes: A meta-analysis of randomized controlled trials

Cited by 5 publications

References 40 publications

Fasting Triglycerides in the Upper Normal Range Are Independently Associated with an Increased Risk of Diabetes Mortality in a Large Representative US Population

Fasting Triglycerides in the Upper Normal Range Are Independently Associated with an Increased Risk of Diabetes Mortality in a Large Representative US Population

Fasting Triglycerides in the Upper Normal Range Are Independently Associated with an Increased Risk of Diabetes Mortality

Managing hypertriglyceridemia for cardiovascular disease prevention: Lessons from the PROMINENT trial

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