Abstract 13690: Clinical Benefits of Lowering Severely High Triglycerides on Cardiovascular Events, Pancreatitis, and Diabetes
Background: The impact on clinical outcomes when severely elevated triglycerides (TG) are lowered to below 500 mg/dL is not known. We aimed to quantify the effect of reducing severely elevated TG levels on select clinical events, including cardiovascular events, acute pancreatitis, and hospitalizations/ER visits for diabetes.
Methods and Results: Utilizing two large US healthcare claims databases, we identified 34,823 non-pregnant patients with a TG ≥ 500mg/dL between June 2001 and March 2009 who were ≥ 18 years old and maintained continuous enrollment with medical and pharmacy claims for ≥ 6 months before their first TG lab value ≥ 500 mg/dL. Of these, we identified 7,415 patients whose TGs remained elevated (≥500 mg/dL) and 27,408 patients whose TGs were lowered to below 500mg/dL within 6 to 24 weeks after their first TG ≥ 500 mg/dL. We examined patient data after their second TG level for 746 days on average and assessed the following primary outcomes: cardiovascular (CV) events, hospitalization/ER visits for diabetes, and pancreatitis. CV events included sudden death, myocardial infarctions, acute coronary syndrome, ischemic and hemorrhagic stroke, heart failure, coronary revascularization and atrial fibrillation. Crude and adjusted multivariate Cox proportional hazards models were developed for each outcome. Patients whose TGs remained elevated were 1.75 times more likely to experience acute pancreatitis (95% CI: 1.38-2.22), 1.22 times more likely to have a CV event (95% CI: 1.11-1.34), and 1.33 times more likely to have a hospitalization or ER visit for diabetes (95% CI: 1.15-1.54) compared to patients whose TGs were lowered to below 500mg/dL, after adjusting for important confounders. Sensitivity analyses based on a censored follow-up period were similar in scope and significance.
Conclusions: These findings have significant clinical implications, as they suggest that lowering TG levels below 500mg/dL reduces the risk of CV disease, pancreatitis, and hospitalizations/ER visits for diabetes. This threshold may represent a useful goal for therapy in patients with severely elevated TGs.
- © 2011 by American Heart Association, Inc.