One-fourth of US adults overall, including nearly a third of those on statin therapy, have suboptimal triglyceride (TG) levels, a recent study found. Researchers examined the prevalence of elevated TG levels in adults with and without statin use and the associated 10-year predicted atherosclerotic cardiovascular disease (ASCVD) risk. They studied 9,593 US adults aged ≥20 years in the US National Health and Nutrition Examination Surveys (2007‒2014). They found:
- Among those not taking statin therapy, the prevalence of TG <150 mg/dL, 150‒199 mg/dL, and ≥200 mg/dL was 75.3%, 12.8%, and 11.9%; among statin users, these proportions were 68.4%, 16.2%, and 15.4%, respectively.
- Among persons with LDL-C <100 mg/dL, despite statin use, 27.7% had TG ≥150 mg/dL.
- The odds of TG ≥150 mg/dL in statin users was associated with greater age, higher body mass index, lower HDL-C, higher LDL-C, and diabetes.
- >3 million ASCVD events are expected to occur over the next 10 years in those with TG ≥150 mg/dL.
Fan W, Philip S, Granowitz C, Toth PP, Wong ND. Hypertriglyceridemia in statin-treated US adults: The National Health and Nutrition Examination Survey. [Published online ahead of print December 1, 2018]. J Clin Lipidol. doi:10.1016/j.jacl.2018.11.008.
LDL cholesterol is the primary target for therapy to reduce cardiovascular risk. Despite statin therapy, however, many patients continue to experience cardiovascular events. Elevated triglyceride levels, despite optimal LDL reduction, identify a cohort of patients with residual risk. Excess triglycerides are associated with the more atherogenic small dense LDL particles. This survey of the American population using NHANES data found that over 27% of patients on statin therapy with a treated LDL cholesterol below 100 mg/dL had elevated triglyceride levels. Elevated triglycerides were associated with low HDL cholesterol, obesity and diabetes. Patients with elevated triglyceride levels may identify a cohort of patients that will benefit from further risk reduction therapy. The recent REDUCE-IT trial, using a purified form of EPA fish oil to target triglycerides, showed a significant cardiovascular risk reduction when added to statin therapy in high risk individuals. —Matthew Sorrentino, MD