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. 2020 Oct 20;9(19):e015801.
doi: 10.1161/JAHA.119.015801. Epub 2020 Sep 21.

Association of Hypertriglyceridemia with All-Cause Mortality and Atherosclerotic Cardiovascular Events in a Low-Risk Italian Population: The TG-REAL Retrospective Cohort Analysis

Marcello Arca  1 , Chiara Veronesi  2 , Laura D'Erasmo  1 , Claudio Borghi  3 , Furio Colivicchi  4 , Gaetano Maria De Ferrari  5 , Giovambattista Desideri  6 , Roberto Pontremoli  7 , Pier Luigi Temporelli  8 , Valentina Perrone  2 , Luca Degli Esposti  2 ; Local Health Units Group †
Collaborators, Affiliations

Association of Hypertriglyceridemia with All-Cause Mortality and Atherosclerotic Cardiovascular Events in a Low-Risk Italian Population: The TG-REAL Retrospective Cohort Analysis

Marcello Arca et al. J Am Heart Assoc. .

Abstract

Background Evidence regarding the relationships among high plasma triglycerides (TG), all-cause mortality, and atherosclerotic cardiovascular disease (ASCVD) events in low-to-moderate risk individuals is limited. The aim of this study was to determine whether the presence of high TG levels influences the risk of all-cause mortality and ASCVD events in a population cohort followed in the real-world clinical setting. Methods and Results A retrospective longitudinal cohort analysis using administrative databases of 3 Italian Local Health Units was performed. All individuals with at least one TG measurement between January 1, 2010 and December 31, 2015 were followed through December 2016. Outcome measures included incident ASCVD events and all-cause mortality. Individuals with normal TG levels (<150 mg/dL) were compared with those with high (150-500 mg/dL) and very high TG (>500 mg/dL). 158 042 individuals (142 289 with normal, 15 558 with high, and 195 with very high TG) were considered. In the whole cohort, the overall incidence rates of ASCVD and all-cause mortality were 7.2 and 17.1 per 1000 person-years, respectively. After multivariate adjustment for potential confounders, individuals with high and very high TG showed a significantly increased risk of all-cause mortality (hazard ratio [HR]=1.49 [95% confidence interval (CI) 1.36-1.63], P<0.001, and HR=3.08 [95% CI 1.46-6.50], P<0.01, respectively) and incident ASCVD events (HR=1.61 [95% CI 1.43-1.82], P<0.001, and HR=2.30 [95% CI 1.02-5.18], P<0.05, respectively) as compared to those with normal TG. Conclusions Moderate-to-severe elevation of TG is associated with a significantly increased risk of all-cause mortality and ASCVD events in a large cohort of low-to-moderate cardiovascular risk individuals in a real-world clinical setting.

Keywords: all‐cause mortality; atherosclerotic cardiovascular disease; hypertriglyceridemia; real‐world; triglycerides.

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Conflict of interest statement

Arca has received research grant support from Aegerion, Amgen, IONIS, Akcea Therapeutics, Pfizer, Regeneron, and Sanofi; has served as a consultant for Amgen, Aegerion, Akcea Therapeutics, Regeneron, Sanofi, and Alfasigma; and received lecturing fees from Amgen, Aegerion, Merck, Pfizer, Sanofi, and Alfasigma. Borghi has received research grant support from Menarini Corporate and Novartis Pharma; has served as a consultant for Novartis Pharma, Alfasigma, Grunenthal, Menarini Corporate, and Laboratoires Servier; and received lecturing fees from Laboratoires Servier, Takeda, Astellas, Teijin, Novartis Pharma, Berlin Chemie, and Sanofi. Pontremoli has served as a consultant for and has received lecturing fees from Novartis, MSD, AstraZeneca, Boehringer‐Ingelheim, Lilly, Teijin, Astellas, and Alfasigma. De Ferrari has received research grant support from Amgen, Merck, and Novartis; has served as a consultant for Amgen, Boston Scientific, Livanova, Merck, and Sigma‐Tau; and received lecturing fees from Amgen, Merck, and Sigma‐Tau. Colivicchi has been consultant per Sigma‐Tau, MSD, AstraZeneca, and Boehringer‐Ingelheim. Desideri has received research grant support from AstraZeneca and Menarini; has served as a consultant for Servier, Menarini, FIRMA, and Sigma‐Tau; and received lecturing fees from Servier, Bayer, Guidotti, Bristol Myers Squibb, DOC, and Sigma‐Tau. Temporelli has received lecturing and consulting fees from Alfasigma; consulting fees from Bayer; lecturing fees from Menarini, MSD, and Servier. D'Erasmo has received research grant support from Aegerion, Amryt, Akcea Therapeutics. The agreement signed by CliCon Srl and Alfasigma does not create any entityship, joint venture, or any similar relationship between parties. CliCon Srl is an independent company. Neither CliCon Srl nor any of their representatives are employees of Alfasigma for any purpose. The remaining authors have no disclosures to report.

Figures

Figure 1
Figure 1. Study population flowchart.
AMI indicates acute myocardial infarction; and TG, total plasma triglycerides.
Figure 2
Figure 2. Distribution of triglyceride levels among the study population (last measurement before index date, mg/dL).
See this image and copyright information in PMC

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