Open AccessHigh Triglycerides Are Associated With Increased Cardiovascular Events, Medical Costs, and Resource Use: A Real‐World Administrative Claims Analysis of Statin‐Treated Patients With High Residual Cardiovascular Risk
Author(s) -
Toth Peter P.,
Granowitz Craig,
Hull Michael,
Liassou Djibril,
Anderson Amy,
Philip Sephy
Publication year - 2018
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.118.008740
Subject(s) - medicine , hazard ratio , statin , cohort , myocardial infarction , stroke (engine) , diabetes mellitus , confidence interval , proportional hazards model , unstable angina , risk factor , retrospective cohort study , cardiology , endocrinology , mechanical engineering , engineering
Background The American Heart Association recognizes high triglycerides as a cardiovascular risk factor. Methods and Results This retrospective observational administrative claims analysis (Optum Research Database) included statin‐treated patients ≥45 years old with diabetes mellitus and/or atherosclerotic cardiovascular disease, triglycerides 2.26 to 5.64 mmol/L, and a propensity‐matched comparator cohort with triglycerides <1.69 mmol/L and high‐density lipoprotein cholesterol >1.04 mmol/L. In the high‐triglycerides cohort versus comparators (both n=10 990, 49% women), mean age was 61.7 versus 62.2 years and follow‐up was 41.3 versus 42.1 months, respectively. Multivariate analysis of composite major cardiovascular events demonstrated significantly increased risk in the high‐triglycerides (n=13 411 patients) versus comparator (n=32 506 patients) cohorts (hazard ratio [ HR ], 1.35; 95% confidence interval [ CI ], 1.225–1.485; P <0.001), with significantly higher risk for nonfatal myocardial infarction ( HR , 1.35; 95% CI , 1.19–1.52; P <0.001), nonfatal stroke ( HR , 1.27; 95% CI , 1.14–1.42; P <0.001), and need for coronary revascularization ( HR , 1.51; 95% CI , 1.34–1.69; P <0.001), but not unstable angina or cardiovascular death. Increased cardiovascular risk in the high‐triglycerides versus comparator cohort was maintained, even with addition of non–high‐density lipoprotein cholesterol to the multivariate model and when analyzing high and low high‐density lipoprotein cholesterol subgroups. Average total healthcare cost per patient per month (cost ratio, 1.15; 95% CI , 1.084–1.210; P <0.001) and rate of occurrence of inpatient hospital stay ( HR , 1.17; 95% CI , 1.113–1.223; P <0.001) were also significantly greater in the high‐triglycerides cohort. Conclusions In this real‐world analysis, patients with high cardiovascular risk and high triglycerides had worse composite cardiovascular and health economic outcomes than patients with well‐managed triglycerides and high‐density lipoprotein cholesterol >1.04 mmol/L.