Abstract 13397: Determining the Optimal Cutpoint Value for the Diagnosis of Hypertriglyceridemia in the Nonfasting Population
Background: Nonfasting triglycerides may be superior to fasting triglycerides at predicting CVD. However, guideline cutpoints are based on fasting triglycerides. We aimed to determine the optimal clinical cutpoint for nonfasting triglycerides.
Methods: Among 26,509 apparently healthy women, nonfasting blood samples (<8 hours since last meal) were obtained from 6,391 participants who were prospectively followed for up to 17 years for incident CVD (MI, ischemic stroke, CABG/PTCA, CVD death). The optimal diagnostic threshold for nonfasting triglycerides was determined by univariate logistic regression model using c-statistics for triglycerides between 100-300 mg/dL, with 10-fold cross-validation and bootstrapping in multivariable models. In addition, we tested the proposed nonfasting cutpoints of 175 mg/dL (European Atherosclerosis Society), 180 mg/dL (Athens Expert Panel), and 200 mg/dL (AHA).
Results: The optimal threshold was identified as 175 mg/dL (Table). Performance of this optimal threshold was evaluated using 10-fold cross validation and bootstrapping in multivariable models that included age, smoking, blood pressure, hormone use, menopausal status, lipids, diabetes, BMI, and CRP. The adjusted hazard ratio (HR) for nonfasting triglycerides ≥ vs <175 mg/dL predicting incident CVD events was 1.69 (95% CI, 1.34-2.13, p<0.001). Adjusted HRs for triglycerides ≥ vs <175 mg/dL measured 0-4 and 4-8 hours since last meal were 1.73 (1.27-2.36, p<0.001) and 1.63 (1.15-2.32, p=0.006), respectively.
Conclusion: This is the first study to identify a diagnostic threshold for nonfasting hypertriglyceridemia, finding an optimal cutpoint of 175 mg/dL. Of note, the currently recommended AHA cutpoint for nonfasting triglycerides of 200 mg/dL had substantially lower sensitivity and could under-diagnose hypertriglyceridemia among nonfasting individuals.
Author Disclosures: K.T. White: None. M. Moorthy: None. A.O. Akinkuolie: None. O. Demler: None. P.M. Ridker: Research Grant; Significant; NHLBI, NCI, AHA, Doris Duke Charitable Foundation, Leducq Foundation, Donald W Reynolds Foundation, James and Polly Annenberg La Vea Charitable Trusts. Other Research Support; Significant; Astra-Zeneca, Novartis, Pfizer, Amgen. Consultant/Advisory Board; Modest; Isis, Vascular Biogenics, Genzyme, Boston Heart, Aegerion, Johnson & Johnson. N.R. Cook: None. S. Mora: Research Grant; Significant; AstraZeneca, Atherotech Diagnostics. Consultant/Advisory Board; Modest; Cerenis, Sanofi-Genzyme, Lilly, Quest Diagnostics.
- © 2014 by American Heart Association, Inc.