Abstract 13175: Fasting and Postprandial Triglycerides and Cardiovascular Event in Stable Coronary Artery Disease: 4-Years Follow-Up of the Homburg Cream & Sugar Study
Background: The aim of the prospective Homburg Cream & Sugar study was to compare risk prediction by fasting and postprandial serum triglycerides (TG) in patients with coronary artery disease (CAD) on guideline-recommended medication.
Methods & Results: N=514 consecutive patients with angiographically confirmed, clinically stable CAD (median age 68 years, 83% male, 95% on a statin, median LDL-C 105mg/dl) received a sequential oral triglyceride (OTT, 75g cream fat) and glucose tolerance test (OGT, 75g glucose) to obtain standardized measurements of postprandial TG and glucose kinetics. Lipid and glucose parameters were measured at fasting, 3, 4, and 5 hours after the OTT/OGT.
Fasting TG were strongly associated with the area under the curve (AUC) of the postprandial TG increase (R=0.93, p<0.0001). Compared to the lowest tertile of fasting TG (<106mg/dl), patients in the highest tertile (>150mg/dl) were younger, more obese, more were smoking, they had a higher blood pressure, lower HDL- and higher LDL-C and more had glucose intolerance or a metabolic syndrome. A similar association was observed with the AUC tertiles.
The primary outcome was the composite endpoint of death and hospitalization for acute coronary syndrome or hospitalization for unplanned, symptom-induced coronary angiography and revascularization within 48 months. Time-to-event analyses (Kaplan-Meier curves, Cox regression) demonstrated that both fasting and postprandial TG predicted the primary outcome (fasting TG >150mg/dl vs. <106mgdl: HR 1.79, 95%-CI 1.31-2.45, p=0.0001; AUC >1120mg/dl vs. <750mg/dl: HR 1.78, 95%-CI 1.29-2.45, p=0.0003). Postprandial TG parameters did not improve risk prediction compared to fasting TG. The number of cardiovascular deaths and myocardial infarctions was higher in the upper tertile of fasting TG >150mg/dl (HR 1.79, 95%-CI 1.04-3.09, p=0.03). Risk prediction by TG was independent of traditional risk factors, medication, glucose metabolism, LDL-C and HDL-C.
Conclusions: Fasting serum triglycerides >150 mg/dl predict cardiovascular events in patients with coronary artery disease on guideline-recommended medication. Assessment of postprandial TG does not improve risk prediction compared to fasting TG in these patients.
Author Disclosures: C. Werner: None. A. Knoll: None. M. Böhm: None. U. Laufs: None.
- © 2014 by American Heart Association, Inc.