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Fasting triglycerides predict ACS risk
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Fasting triglyceride levels appear to be strongly predictive of residual ACS risk in patients with ACS who are receiving statins, according to recent results.
Researchers evaluated 15,817 patients enrolled in the dal-OUTCOMES trial and 1,501 patients in the atorvastatin arm of the MIRACL trial. In dal-OUTCOMES, patients with recent ACS (acute MI or unstable angina) were randomly assigned at 4 to 12 weeks after ACS to receive dalcetrapib (F. Hoffmann-La Roche) or placebo, with a median follow-up of 31 months. In the MIRACL trial, patients started treatment with atorvastatin (80 mg daily) at 1 to 4 days after ACS, with 16 weeks of follow-up. All patients in the present analysis had fasting triglyceride profiles measured at random assignment.
After initial ACS, the researchers observed a correlation between fasting triglyceride levels and long- and short-term risk for ACS. In the dal-OUTCOMES trial population, long-term risk increased from the lowest to highest quintiles of baseline triglycerides (P < .001): Compared with the lowest triglyceride quintile (≤ 80 mg/dL), the adjusted risk in the highest triglyceride quintile (> 175 mg/dL) was 1.61 (95% CI, 1.34-1.94). The researchers found no interaction between triglycerides and treatment allocation with regard to the primary outcome.
Analysis of the atorvastatin group of MIRACL revealed increased short-term risk across baseline triglyceride tertiles (P = .03), with an HR of 1.51 (95% CI, 1.05-2.15) for the highest tertile (> 195 mg/dL) vs. the lowest (≤ 135 mg/dL). In both studies, the association between triglycerides and risk was independent of LDL.
According to the researchers, additional studies are needed to evaluate the utility of triglyceride-lowering treatments in patients with ACS.
“It remains uncertain whether triglyceride-rich lipoproteins should be a target of therapy after ACS, above and beyond statin treatment,” the researchers wrote. “The question will remain open until trials specifically test the efficacy of triglyceride-lowering interventions after ACS.” – by Jennifer Byrne
Disclosure: The dal-OUTCOMES trial was funded by F. Hoffmann-La Roche, and the MIRACL trial was funded by Pfizer. Schwartz, through his institution, reports receiving research grants from Anthera, Pfizer, Resverlogix, Roche and Sanofi. Please see the full study for a list of all other authors’ relevant financial disclosures.
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