Abstract 1502: Impact of Triglycerides in PROVE-IT TIMI-22: Does TG <150 Improve CHD Risk Beyond LDL <70?
Background: The PROVE-IT TIMI-22 trial demonstrated that intensive LDL lowering (with LDL < 70 mg/dL) was associated with greater reduction in coronary heart disease (CHD) event rates compared with standard lipid lowering (with LDL < 100 mg/dL) following an acute coronary syndrome (ACS). While attainment of low LDL is a primary goal, the National Cholesterol Education Program also recommends reduction in triglycerides (TGs) as a secondary target. However, the extent to which “desirable” TGs (i.e., <150 mg/dL) may improve CHD risk beyond LDL < 70 mg/dL has not been explored.
Methods: PROVE IT-TIMI 22 evaluated 4162 patients hospitalized for ACS and randomized to atorvastatin 80 mg or pravastatin 40 mg daily. The on-treatment levels of TG and LDL cholesterol were assessed at 30 d, 4 mo and 8 mo using the composite endpoint of death, MI, recurrent ischemia or unstable angina.
Results: Compared with LDL <70 and TG<150, on-treatment LDL≥ 70 and TG ≥ 150 was associated with a 53–62% higher risk of CHD event rates (P value range: < 0.001 to 0.02) across the 3 time intervals (Table⇓). Likewise, both on-treatment LDL <70 with TG ≥150 and on-treatment LDL ≥70 with TG <150 were associated with higher CHD risk compared with having both LDL <70 and TG <150 (Table⇓).
Conclusions: The favorable impact of TG < 150 beyond LDL < 70 suggests that on-treatment low LDL in combination with low TG is associated with lower CHD risk. Confirmation in ongoing trials specifically addressing this issue may support intensive lowering of both LDL and TG as primary target goals in order to further enhance CHD secondary prevention efforts.