Elevated triglyceride conveys increased atherosclerotic CV events but lower death risks

Among patients on statin therapy, high triglyceride levels appear to confer a higher risk of atherosclerotic cardiovascular disease events and protection against death at the same time, according to data from the KP REACH* study.

The retrospective analysis included 373,389 primary prevention patients (mean age 65 years, 51 percent women, 44 percent people of colour) and 97,832 secondary prevention patients (mean age 71 years, 37 percent women, 32 percent people of colour).

All patients had a low‐density lipoprotein cholesterol of 41–100 mg/dL, had at least one risk factor or established atherosclerotic cardiovascular disease, and were receiving statin therapy. The median triglyceride levels in the primary and secondary prevention cohorts were 122 and 116 mg/dL, respectively. Triglyceride levels decreased with age and were generally lower in non‐Hispanic Black patients and higher in Hispanic and Asian/Pacific Islander patients relative to non‐Hispanic White patients.

Multivariable Cox analyses in the primary prevention cohort revealed that patients with triglyceride levels ≥150 mg/dL were at lower risk of death (hazard ratio [HR], 0.91, 95 percent confidence interval [CI], 0.89–0.94) but higher risk of major adverse cardiovascular events (HR, 1.14, 95 percent CI, 1.05–1.24) compared with patients who had lower triglyceride levels.

Likewise, in the secondary prevention cohort, triglyceride levels ≥150 mg/dL were associated with a reduced risk of death (HR, 0.95, 95 percent CI, 0.92–0.97) but an increased risk of all‐cause hospitalization (HR, 1.03, 95 percent CI, 1.01–1.05) and major adverse cardiovascular events (HR, 1.04, 95 percent CI, 1.05–1.24).

The findings indicate that triglycerides can function as a surrogate of atherosclerotic cardiovascular disease risk, in addition to being a marker of nutritional status, so additional risk‐reduction strategies are needed to further improve outcomes.

*Kaiser Permanente Residual Risk by Ethnicity, Sex, and Age in a Statin‐Treated Cohort