Elevated Triglyceride Level Associated With Increased All-Cause Mortality in Established CHD

Study Questions:

Is there an association between elevated triglycerides and long-term all-cause mortality among patients with established coronary heart disease (CHD)?

Methods:

The study cohort comprised 15,355 patients who were screened for the BIP (Bezafibrate Infarction Prevention) trial. Twenty-two–year mortality data were obtained from the national registry. Patients were divided into five groups according to strata of fasting serum triglycerides: 1) low-normal triglycerides (<100 mg/dl), 2) high-normal triglycerides (100-149 mg/dl), 3) borderline hypertriglyceridemia triglycerides (150-199 mg/dl), 4) moderate hypertriglyceridemia triglycerides (200-499 mg/dl), and 5) severe hypertriglyceridemia triglycerides (≥500 mg/dl). Patients with incident cancer were excluded.

Results:

Mean age was 60 years and 80% were male. Increased triglycerides were associated with lower age, smoking, hypertension, diabetes, CHD, increased heart rate and systolic blood pressure, lower high-density lipoprotein cholesterol (HDL-C), and higher glucose. Age- and sex-adjusted survival was 41% in the low-normal triglycerides group then 37%, 36%, 35%, and 25% in groups with progressively higher triglycerides, respectively (p < 0.001). In an adjusted Cox-regression for various covariates including HDL-C, each 1 unit of natural logarithm (Ln) triglyceride elevation was associated with a corresponding 6% (p = 0.016) increased risk of 22-year all-cause mortality. The 22-year mortality risk for patients with severe hypertriglyceridemia increased by 68% when compared with patients with low-normal triglycerides (p < 0.001). The fully multivariate adjusted model included adjustment for baseline glucose level >100 mg/dl.

Conclusions:

In patients with established CHD, higher triglyceride levels are independently associated with increased 22-year mortality. Even in patients with triglycerides of 100-149 mg/dl, the elevated risk for death could be detected than in patients with lower triglycerides levels, whereas severe hypertriglyceridemia denotes a population with particularly increased mortality risk.

Source: www.acc.org