Severe hypertriglyceridemia is associated with a markedly increased risk for coronary heart disease (CHD) and stroke mortality, even in the absence of diabetes, a UK study shows.
The finding highlights the importance of identifying people with very high triglycerides, say the researchers who recommend using high-intensity statins in addition to triglyceride-lowering therapy to reduce the risk for cardiovascular disease.
A team led by Andrew Neil (University of Oxford) studied the prognostic significance of hypertriglyceridemia among patients in the Simon Broome Register of Familial Hyperlipidemia.
The analysis included 337 patients aged less than 80 years with marked or severe hypertriglyceridemia (based on fasting triglyceride levels >5.0 mmol/l on at least two occasions). Just 47 of the patients had diabetes mellitus and 75 were women, Neil et al report in the journal Atherosclerosis.
During 13 years (4353 person-years) of follow-up there were 70 deaths, including 35 from CHD and seven from stroke.
Mortality from CHD was approximately three times higher than that in the general population, at a standardized mortality ratio (SMR) of 327. CHD mortality remained elevated even after excluding patients with diabetes at baseline, at an SMR of 287, and those without CHD at baseline, at an SMR of 259.
Further analysis revealed that the excess CHD mortality was most marked in men aged 40–59 years, at an SMR of 544. Mortality from stroke and all-cause mortality were also elevated in the cohort, at SMRs of 262 and 164, respectively.
Neil and co-authors say their long-term, prospective study demonstrates that patients with marked or severe hypertriglyceridemia are at substantially increased risk for CHD mortality and stroke mortality compared with the general population.
They note that there are few data on the association between severe hypertriglyceridemia and coronary disease, and admit that epidemiologic studies cannot determine whether triglycerides are involved causally in coronary disease or are markers of other underlying metabolic abnormalities.
Nevertheless, they conclude: “The results of our prospective observational study suggest that early identification of patients with marked or severe hypertriglyceridemia is important and, in the absence of randomized controlled trials of treatment, they should also be considered for high-intensity statin treatment in addition to triglyceride-lowering therapy to reduce their risk of cardiovascular disease.”