PROMETHEUS: an observational, cross-sectional, retrospective study of hypertriglyceridemia in Russia

Abstract

Background: Data regarding the prevalence of hypertriglyceridemia in the Russian population are lacking, despite triglyceride (TG)-mediated pathways being causal in cardiovascular disease. The prevalence of mixed dyslipidemia and severe hypertriglyceridemia in the Russian population (PROMETHEUS) was undertaken to address this gap.

Methods: This was an observational, cross-sectional retrospective study. Data from adults with a full/partial lipoprotein record who had blood analyses done at an INVITRO laboratory in Russia between January 1, 2011 and December 31, 2013 were analyzed. The primary endpoint was the prevalence of hypertriglyceridemia (TG ≥ 1.7 mmol/L); secondary endpoints included prevalence of borderline high, high, and very high TG and severe hypertriglyceridemia, defined as a TG level of 1.7 to <2.3, 2.3 to <5.6, ≥5.6, and ≥10.0 mmol/L, respectively. Statistical analyses involved the Wilcoxon and the Chi square tests. Correlations between log-transformed TG and low- and high-density lipoprotein cholesterol (LDL-C and HDL-C) and total cholesterol (TC) were assessed. The correlation between glycated hemoglobin (HbA1c) and TG levels in a nested sample of subjects with HbA1c and TG data was also assessed using a log-linear model.

Results: The full dataset and nested sample comprised 357,072 and 54,602 individuals, respectively. Prevalence of hypertriglyceridemia, borderline high TG, high TG, very high TG, and severe hypertriglyceridemia in the full dataset was 29.2, 16.2, 12.9, 0.11, and 0.011%, respectively; corresponding rates in the nested sample were 19.0, 17.2, 0.25, and 0.016%, respectively. TG levels were 16.4% higher in males versus females; males had a greater risk of hypertriglyceridemia (risk ratio 1.25; 95% CI 1.24, 1.26; P < 0.0001). Prevalence of hypertriglyceridemia increased with age, peaking at 40-49 years in males (42.8%) and 60-69 years in females (34.4%); a 0.61% increase in TG levels for each year of life was predicted. Hypertriglyceridemia prevalence increased over time. Correlations between TG and LDL-C, HDL-C, TC, and HbA1c (nested sample only) were observed.

Conclusions: Almost one-third of Russians have hypertriglyceridemia, but severe disease (TG ≥ 10.0 mmol/L) is rare. Although the risk of hypertriglyceridemia was greater in males versus females, its prevalence increased with age, regardless of sex. TG was associated with HbA1c, LDL-C, HDL-C, and TC.

Fig. 1

Extraction and analysis of data from the INVITRO database. HbA1c glycated hemoglobin.

Fig. 2

Histogram for TG distribution, males. TG triglycerides.

Fig. 3

Histogram for TG distribution, females. TG triglycerides.

Fig. 4

Prevalence of hypertriglyceridemia according to age and sex (full dataset). Full dataset (n = 357,072). Data shown as percentage (95 % confidence interval).

Fig. 5

Prevalence of borderline high TG, high TG, very high TG, and severe hypertriglyceridemia by year. Full dataset (n = 357,072). The overall prevalence of hypertriglyceridemia (TG level ≥1.7 mmol/L) is shown to the right of each bar. The prevalence of very high TG in 2011, 2012, and 2013 was 0.03 % (n = 25), 0.08 % (n = 84), and 0.16 % (n = 294), respectively. The prevalence of severe hypertriglyceridemia in 2011, 2012, and 2013 was 0.0042 % (n = 3), 0.0066 % (n = 7), and 0.016 % (n = 29), respectively. Increases were significant (P < 0.0001 for hypertriglyceridemia, borderline high TG, and very high TG; P < 0.01 for high TG; P < 0.05 for severe hypertriglyceridemia). TG triglycerides.

Fig. 6

Glycated hemoglobin (HbA1c) distribution prior to log transformation. HbA1c distribution did not improve its shape after log transformation.

Fig. 7

Visualization of the model: log(TG) = β₀ + β₁*GH. Nested sample (n = 54,602). TG triglycerides, GH glycated hemoglobin. The model is a good fit with the real data.

Fig. 8

Visualization of the model: log(TG) = β₀ + β₁*log(TC). Full dataset (n = 357,072). The model is a good fit with the real data. TG triglycerides, TC total cholesterol.

Fig. 9

Visualization of the model: log(TG) = β₀ + β₁*log(LDL-C). Full dataset (n = 357,072). The model is a good fit with the real data. TG triglycerides, LDL-C low-density lipoprotein cholesterol.

Fig. 10

Visualization of the model: log(TG) = β₀ + β₁*log(HDL-C). Full dataset (n = 357,072). The model is a good fit with the real data. TG triglycerides, HDL-C high-density lipoprotein cholesterol.