TY - JOUR
T1 - Elevated triglycerides are related to higher residual cardiovascular disease and mortality risk independent of lipid targets and intensity of lipid-lowering therapy in patients with established cardiovascular disease
AU - Schuitema, Pauline C E
AU - Visseren, Frank L J
AU - Nordestgaard, Børge G
AU - Teraa, Martin
AU - van der Meer, Manon G
AU - Ruigrok, Ynte M
AU - Onland-Moret, N Charlotte
AU - Koopal, Charlotte
AU - UCC-SMART Study Group
N1 - Copyright © 2025 The Authors. Published by Elsevier B.V. All rights reserved.
PY - 2025/9
Y1 - 2025/9
N2 - BACKGROUND AND AIMS: Despite optimal management of low-density lipoprotein cholesterol (LDL-C), substantial residual cardiovascular risk persists in patients with cardiovascular disease (CVD), which may be attributed to other atherogenic lipoproteins. We tested the hypotheses that elevated triglycerides (TGs) are related to higher residual CVD and mortality risk in patients with established CVD, and that such relationships depend on guideline-recommended lipid target achievement, high-density lipoprotein cholesterol (HDL-C) levels, and intensity of lipid-lowering therapy (LLT).METHODS: In a prospective cohort study of 9436 patients with manifest CVD, the relationships between log-transformed TG levels and recurrent cardiovascular events and all-cause mortality were analyzed overall using Cox regression models. Subsequently, analyses were stratified by achievement of low-density lipoprotein cholesterol (LDL-C) and non-HDL-C treatment goals, HDL-C levels, and LLT intensity.RESULTS: During a median follow-up of 9.0 years (IQR 4.5-14.1), 2075 recurrent cardiovascular events, 736 myocardial infarctions, 586 strokes, 1231 cardiovascular deaths, and 2729 all-cause deaths occurred. Per 1-unit higher log-TG level, the hazard ratio was 1.17 (95 % CI: 1.07-1.28) for recurrent cardiovascular events, 1.34 (1.16-1.56) for myocardial infarction, 1.10 (0.92-1.30) for stroke, 1.23 (1.09-1.38) for cardiovascular mortality, and 1.12 (1.03-1.21) for all-cause mortality. These hazard ratios did not depend on achievement of LDL-C and non-HDL-C treatment goals, HDL-C levels, or LLT intensity (all p for interaction ≥0.05).CONCLUSIONS: Elevated TGs are related to higher residual CVD and mortality risk in patients with established CVD. These relationships were unrelated to guideline-recommended lipid target achievement, HDL-C levels, and LLT intensity.
AB - BACKGROUND AND AIMS: Despite optimal management of low-density lipoprotein cholesterol (LDL-C), substantial residual cardiovascular risk persists in patients with cardiovascular disease (CVD), which may be attributed to other atherogenic lipoproteins. We tested the hypotheses that elevated triglycerides (TGs) are related to higher residual CVD and mortality risk in patients with established CVD, and that such relationships depend on guideline-recommended lipid target achievement, high-density lipoprotein cholesterol (HDL-C) levels, and intensity of lipid-lowering therapy (LLT).METHODS: In a prospective cohort study of 9436 patients with manifest CVD, the relationships between log-transformed TG levels and recurrent cardiovascular events and all-cause mortality were analyzed overall using Cox regression models. Subsequently, analyses were stratified by achievement of low-density lipoprotein cholesterol (LDL-C) and non-HDL-C treatment goals, HDL-C levels, and LLT intensity.RESULTS: During a median follow-up of 9.0 years (IQR 4.5-14.1), 2075 recurrent cardiovascular events, 736 myocardial infarctions, 586 strokes, 1231 cardiovascular deaths, and 2729 all-cause deaths occurred. Per 1-unit higher log-TG level, the hazard ratio was 1.17 (95 % CI: 1.07-1.28) for recurrent cardiovascular events, 1.34 (1.16-1.56) for myocardial infarction, 1.10 (0.92-1.30) for stroke, 1.23 (1.09-1.38) for cardiovascular mortality, and 1.12 (1.03-1.21) for all-cause mortality. These hazard ratios did not depend on achievement of LDL-C and non-HDL-C treatment goals, HDL-C levels, or LLT intensity (all p for interaction ≥0.05).CONCLUSIONS: Elevated TGs are related to higher residual CVD and mortality risk in patients with established CVD. These relationships were unrelated to guideline-recommended lipid target achievement, HDL-C levels, and LLT intensity.
KW - Aged
KW - Biomarkers/blood
KW - Cardiovascular Diseases/mortality
KW - Cholesterol, HDL/blood
KW - Cholesterol, LDL/blood
KW - Female
KW - Humans
KW - Hypertriglyceridemia/blood
KW - Hypolipidemic Agents/therapeutic use
KW - Male
KW - Middle Aged
KW - Prospective Studies
KW - Risk Assessment
KW - Risk Factors
KW - Time Factors
KW - Treatment Outcome
KW - Triglycerides/blood
KW - Up-Regulation
UR - https://www.scopus.com/pages/publications/105009325875
U2 - 10.1016/j.atherosclerosis.2025.120411
DO - 10.1016/j.atherosclerosis.2025.120411
M3 - Journal article
C2 - 40579281
SN - 0021-9150
VL - 408
SP - 120411
JO - Atherosclerosis
JF - Atherosclerosis
M1 - 120411
ER -