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Risk of cardiovascular events in patients with hypertriglyceridaemia: A review of real‐world evidence
Author(s) -
Toth Peter P.,
Fazio Sergio,
Wong Nathan D.,
Hull Michael,
Nichols Gregory A.
Publication year - 2020
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.13921
Subject(s) - medicine , hazard ratio , confidence interval , national health and nutrition examination survey , diabetes mellitus , rate ratio , myocardial infarction , unstable angina , incidence (geometry) , statin , medical record , type 2 diabetes , angina , endocrinology , population , physics , environmental health , optics
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.