High triglycerides raise risk for peripheral artery revascularization

Peter P. Toth

MUNICH — Among high-risk patients on statin treatment, those with elevated triglycerides were more likely to undergo peripheral artery revascularization within 5 years, researchers reported at the European Society of Cardiology Congress.

Elevated triglycerides are a known risk factor for peripheral artery disease, but little was known about their relationship with peripheral artery revascularization, Peter P. Toth, MD, PhD, FAHA, FESC, FACC, director of preventive cardiology at CGH Medical Center in Sperling, Illinois, professor of clinical family and community medicine at University of Illinois College of Medicine in Peoria and professor of medicine at Michigan State University College of Osteopathic Medicine in East Lansing, and colleagues wrote in a poster.

Toth and colleagues conducted a retrospective, longitudinal administrative claims analysis of 46,362 patients from the Optum Research Database aged 45 years or older with diabetes and/or atherosclerotic CVD (mean age, 62 years; 50% women) who had a statin prescription filled in 2010 and had data available 6 months before the claim for statin therapy.

“We’re committed to trying to understand whether there is a link between elevated triglycerides and cardiovascular events,” Toth told Cardiology Today’s Intervention. “This is a database with millions of patients, so it is fertile ground to explore.”

Patients with triglycerides of at least 1.69 mmol/L (150 mg/dL) were matched with comparators with triglycerides less than 1.69 mmol/L and HDL greater than 1.04 mmol/L (40 mg/dL). Median triglyceride levels were 2.23 mmol/L in the elevated group and 1.11 mmol/L in the comparator group.

The outcome of interest was peripheral artery revascularization. Patients were followed until death, disenrollment from insurance plan or March 31, 2016, whichever was earliest.

Over time, freedom from peripheral artery revascularization was higher in the comparator group vs. the elevated-triglycerides group (P < .001), according to the researchers.

At 5 years, the probability of peripheral artery revascularization was 6.9% in the elevated cohort and 4.9% in the comparator cohort, and in a multivariate analysis controlled for patient characteristics and comorbidities, the rate of occurrence of peripheral artery revascularization was 37% higher in the elevated cohort (HR = 1.37; 95% CI, 1.263-1.486), Toth and colleagues found.

In addition, the elevated group had higher risk for an initial major CV event (HR = 1.258; 95% CI, 1.185-1.335), higher health care costs (cost ratio = 1.118; 95% CI, 1.08-1.159) and a longer initial inpatient hospital stay (HR = 1.134; 95% CI, 1.101-1.169) vs. the comparator group.

“The triglycerides held their significance even after a comprehensive adjustment for such risk factor covariates such as HDL-C and non-HDL-C,” Toth said in an interview. “That suggests triglycerides have an association with heart events independent of all other lipid fractions.” – by Erik Swain

Reference:

Toth PP, et al. Abstract P739. Presented at: European Society of Cardiology Congress; Aug. 25-29, 2018; Munich.

Disclosure: The study was funded by Amarin. Toth reports he is a speaker and consultant for Amarin, Amgen and Kowa, is a speaker for Merck, Regeneron and Sanofi and is a consultant for Akcea.