Abstract 18134: Importance of Fasting And Postprandial Triglycerides for Risk Prediction in Stable Coronary Disease - 24 Months Follow-up

Abstract

Aim: Risk prediction with serum triglycerides (TG) in patients with cardiovascular disease remains uncertain. We examined the role of fasting and postprandial serum triglycerides as risk modifiers in relation to glucose metabolism and obesity in patients with coronary artery disease (CAD). Methods: A sequential oral triglyceride (OTT, 75g cream fat) and glucose tolerance test (OGT, 75g glucose) was applied to obtain standardized measurements of postprandial TG kinetics and glucose in 514 consecutive patients with stable CAD confirmed by angiography. Lipid and glucose parameters were measured at fasting, 3, 4, and 5 hours after the OTT/OGT. The primary outcome measure was the composite of cardiovascular death and cardiovascular hospitalizations. Here, the 24 months follow-up data are presented.

Results: In the total cohort, fasting and postprandial TG did not correlate with the first primary outcome (log-rank test comparing TG tertiles, p=0.070 and 0.086, respectively). The total number of outcome events was higher in the upper tertile of fasting TG (>150mg/dl; ANOVA, p=0.019), but did not correlate with postprandial TG. Both, impaired glucose tolerance / diabetes (n=388) and obesity (n=419) were associated with elevated fasting and postprandial triglycerides, but triglycerides were no independent risk predictor in these patients. In the subgroups of patients with normal waist circumference or normal glucose tolerance, both fasting TG and area under the postprandial TG curve (AUC) predicted event-free survival in time-to-event analyses. In these patients, TG remained independent predictors after adjustment for baseline characteristics, cardiovascular risk factors and metabolic parameters (cox regression analyses). In patients with the combination of normal glucose tolerance and normal waist circumference (n=83), the adjusted hazard ratio (HR) for fasting TG >150mg/dl was 8.9 (95%-CI 1.78-44.91, p=0.008, compared to fasting TG <106mg/dl) and 13.6 (95%-CI 3.42-53.68, p<0.0001) for an AUC >1120mg/dl (compared to <750mg/dl).

Conclusion: Both fasting and postprandial serum triglycerides independently predict cardiovascular events in patients with coronary artery disease in the absence of impaired glucose tolerance or obesity.