Abstract 14161: Increased Cardiovascular Risk in Patients With Statin-Controlled LDL Cholesterol and Residual Hypertriglyceridemia
Introduction: The value of treating high triglycerides (TG) despite statin therapy for cardiovascular (CV) risk reduction is being studied. We evaluated patients at high risk for CV events who had statin-controlled LDL cholesterol (LDL-C) to determine whether the presence of high TG levels influence CV risk.
Methods: We combined data from the Southern California and Northwest regions of Kaiser Permanente to identify adults on statin therapy with LDL-C 40-100 mg/dL, no other lipid therapies, and with a diagnosis of atherosclerotic CV disease (ASCVD: myocardial infarction [MI], ischemic stroke, and peripheral artery disease). Patients were grouped into high (200-499 mg/dL, n=2,361) or low (<150 mg/dL, n=14,454) TG levels in 2010. We used follow-up data through September 2015 to compare the adjusted incidence rates per 1,000 person-years (p-y) between the high and low TG groups of first non-fatal MI, coronary revascularization, all-cause mortality, and a composite outcome. After testing covariates including HDL-C, LDL-C, and interaction terms, the final parsimonious models controlled for age, sex, non-white race, BMI, smoking, systolic blood pressure, creatinine, and use of insulin or sulfonylureas using generalized linear models with Poisson errors.
Results: Over mean follow-up of 4.2 years, ASCVD patients with high TG were at increased risk of CV outcomes as follows: 30% for MI (95% CI 1.05-1.61), 30% for coronary revascularization (95% CI 1.08-1.57), and 13% for the composite outcome (95% CI 1.02-1.26) compared with the low TG group after multivariable adjustment (Table). Risk of all-cause mortality was similar between TG groups.
Conclusions: Despite statin-controlled LDL-C levels, CV events were greater among high-risk ASCVD patients with high vs. low TG levels. The ongoing CV outcome trial, REDUCE-IT, will determine if high dose pure prescription eicosapentaenoic acid reduces residual CV risk among statin users with persistently high TG levels.
Author Disclosures: G.A. Nichols: Research Grant; Modest; Amarin Pharma, Boehringer-Ingelheim, Sanofi Pharmaceuticals. S. Philip: Employment; Significant; Amarin Pharma. C.B. Granowitz: Employment; Significant; Amarin Pharma. K. Reynolds: Research Grant; Modest; Amarin Pharma, Amgen, Regeneron. S. Fazio: Research Grant; Modest; Amarin Pharma, Amgen, Pfizer, Kowa, Merck & Co.
- © 2017 by American Heart Association, Inc.