High triglycerides linked to mortality in coronary heart disease

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Take triglycerides seriously

Klempfner and his colleagues add further support for a role of triglycerides in promoting mortality, likely via an increase in cardiovascular disease mortality. This research takes on special importance given that elevations in triglycerides are increasingly common.

Dr. Karol E. Watson

Although we search for the true significance of elevated triglycerides in cardiovascular risk and potentially the optimal method to lower triglycerides, we congratulate the researchers on an important study, which provides support for the idea that triglycerides should be considered more seriously as a future target to improve our patients’ outcomes. Be reminded, however, that we currently do not know if triglyceride elevations will hold similar predictive value in patients whose low-density lipoprotein cholesterol is optimally controlled. And we must always remember that simply because something may or may not be a cardiovascular risk factor, altering it pharmacologically does not always mean that we will lower risk.

Dr. Karol E. Watson is at the University of California, Los Angeles. Dr. Philipp Wiesner is at the University of California, San Diego. These comments were taken from their editorial. They had no disclosures.




Severe hypertriglyceridemia significantly increased the long-term risk of death among patients with established coronary heart disease, even after accounting for low-density lipoprotein cholesterol, according to a large prospective study published March 8 in Circulation: Cardiovascular Quality and Outcomes.

“This effect is graded – the higher the triglycerides concentration, the higher the independent mortality risk,” said Dr. Robert Klempfner at Sheba Medical Center in Tel-Hashomer, Israel, and his associates. Thus, patients whose triglycerides measured at least 500 mg/dL were 68% more likely to die in the next 2 decades than were patients with triglycerides levels of than 100 mg/dL (P less than .001). The relative increase in risk was 29% for patients with levels between 200-499 mg/dL and 16% for those measuring between 150-200 mg/dL.

Prior studies of hypertriglyceridemia in patients with established congenital heart disease have been small, with short follow-up periods and inconclusive results, the investigators noted. Therefore, they analyzed national registry mortality data and fasting triglyceride levels for 15,355 patients who had been screened for the Bezafibrate Infarction Prevention trial during 1990 and 1992. They grouped patients as low-normal (less than 100 mg/dL); high-normal (100-149 mg/dL); borderline hypertriglyceridemia (150-199 mg/dL); moderate hypertriglyceridemia (200-499 mg/dL); and severe hypertriglyceridemia (at least 500 mg/dL; (Circ Cardiovasc Qual Outcomes. 2016 Mar 8. doi: 10.1161/CIRCOUTCOMES.115.002104).

After researchers adjusted for age and sex, the overall survival rate during 22 years of follow-up was 41% in the low-normal triglycerides group and 37%, 36%, 35%, and 25% in the higher triglycerides cohorts, respectively (P less than .001). In the adjusted model, each 1 unit natural logarithm increase in triglycerides corresponded with a 6% rise in the 22-year risk of all-cause mortality (P = .016).

Limited follow-up data after screening prevented the researchers from controlling for a variety of confounders, but the results nonetheless support consideration for lower triglyceride targets and highlight the need for prospective studies in “appropriately selected subjects,” they added.

The researchers reported no funding sources and had no disclosures.

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