Risk of cardiovascular events in patients with hypertriglyceridaemia: A review of real-world evidence

Abstract

Aims: To describe the real-world prevalence and consequences of hypertriglyceridaemia.

Materials and methods: We searched two large patient databases, the National Health and Nutrition Examination Survey (NHANES) database (2007-2014) and the Optum Research Database, as well as electronic medical records from two Kaiser Permanente regions.

Results: The NHANES data showed that ~26% of US adults, including nearly one-third of statin users, had at least borderline hypertriglyceridaemia (triglycerides [TGs] ≥1.69 mmol/L), and ~40% of adults with diabetes had levels of ≥150 mg/dL despite statin use. The Optum analyses demonstrated that those with TG levels ≥1.69 mmol/L who were on statins had a significantly increased risk of composite initial major cardiovascular (CV) events (hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.19-1.34; P < 0.001 vs. patients with TGs <150 mg/dL). This was accompanied by increased healthcare utilization and direct healthcare costs (HR 1.12, 95% CI 1.08-1.16; P < 0.001). In the analyses of the Kaiser Permanente records, patients with diabetes and TG levels 2.26-5.64 mmol/L had significantly higher adjusted incidence rates of non-fatal myocardial infarction (rate ratio 1.30, 95% CI 1.08-1.58; P = 0.006), non-fatal stroke (rate ratio 1.23; 95% CI 1.01-1.49; P = 0.037) and coronary revascularization (rate ratio 1.21; 95% CI 1.02-1.43; P = 0.027), but not unstable angina (rate ratio 1.33; 95% CI 0.87-2.03; P = 0.185) compared with patients with TG levels <1.69 mmol/L.

Conclusions: Real-world analyses suggest that elevated TGs are prevalent and commonly associated with increased CV risk. CV outcomes trials in patients with established hypertriglyceridaemia will clarify whether strategies to reduce TG levels can ameliorate residual CV risk in patients taking statins.

Keywords: atherosclerosis; cardiovascular disease; cost-effectiveness; database research; dyslipidaemia; hypertriglyceridaemia.

Figure 1

Effect of hypertriglyceridaemia on risk, outcomes, healthcare utilization and costs.41, 44, 45, 47, 50 A, Estimated number of atherosclerotic cardiovascular disease (ASCVD) events in 10 years among people aged 40–79 years, by triglyceride (TG) concentration, and stratified by statin use, based on the 9593 participants identified in the National Health and Nutrition Examination Survey (NHANES) database. The estimated number of events in 10 years was calculated by multiplying the estimated ASCVD risk score by the corresponding projected population (the estimated ASCVD risk score also indicated the proportion of events expected to occur in 10 years). The 10‐year risk of ASCVD was defined as non‐fatal myocardial infarction (MI) or coronary heart disease death, or fatal or non‐fatal stroke, over a 10‐year period among people free from ASCVD at the beginning of the period. B, Increase in risk in patients with TG levels ≥1.69 mmol/L and in the subcohort with TG levels 2.26–5.64 mmol/L versus comparators from the Optum Research Database. See Table 2 for analysis details. C, Increase in risk in patients from the Kaiser Permanente database with TG levels 2.26–5.64 mmol/L versus patients with TG levels <1.69 mmol/L. See Table 3 footnotes for analysis details. ^*Overall pre‐match cohort: TG ≥1.69 mmol/L (n = 25 452 patients); comparator pre‐match cohort: TG <1.69 mmol/L and HDL cholesterol >1.04 mmol/L (n = 31 805 patients); pre‐match subcohort: TG 2.26–5.64 mmol/L (n = 13 411 patients); comparator pre‐match cohort: TG <1.69 mmol/L and HDL cholesterol >1.04 mmol/L (n = 32 506 patients). ^† P < 0.001, ^‡ P < 0.01, ^§ P < 0.05, all others not significant. BMI, body mass index; CV, cardiovascular; TG, triglycerides