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Abstract: PO2067

Increased Residual Cardiovascular Risk in US Veterans with Moderately Elevated Baseline Triglycerides, Well-Controlled LDL Cholesterol Levels on Statins, and Decreased Renal Function

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

  • Leatherman, Sarah, VA Boston Healthcare System, Boston, Massachusetts, United States
  • Ferguson, Ryan E., VA Boston Healthcare System, Boston, Massachusetts, United States
  • Hau, Cynthia, VA Boston Healthcare System, Boston, Massachusetts, United States
  • Granowitz, Craig B., Amarin Corp, Bridgewater, New Jersey, United States
  • Harrington, Kelly M., VA Boston Healthcare System, Boston, Massachusetts, United States
  • Philip, Sephy, Amarin Corp, Bridgewater, New Jersey, United States
  • Toth, Peter Paul, CGH Medical Center, Sterling, Illinois, United States
  • Bhatt, Deepak L., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Boden, William E., VA Boston Healthcare System, Boston, Massachusetts, United States
Background

Recent studies have suggested a causal role for elevated triglycerides (TG) in incident cardiovascular (CV) events. Using a large cohort of U.S. veterans with statin-controlled LDL-C levels (40-100mg/dL), we explored whether increased residual CV risk existed in patients with elevated baseline TG levels versus those with normal TG levels in the subset who had reduced eGFR (<60 ml/min).

Methods

We identified veterans receiving a statin but not a TG-lowering agent from the VA Corporate Data Warehouse, a database of the VA electronic health record, from 2010-2015. We compared CV event rates (nonfatal MI, stroke, unstable angina, or coronary revascularization) between the elevated TG (150-499 mg/dL) and normal TG (<150 mg/dL) groups. We calculated crude event rates, rate ratios, and 95% CI for both groups, and adjusted event rate ratios for age, sex, baseline blood pressure, glomerular filtration rate, and weight.

Results

We included 152,266 veterans (predominantly male and white) in the analysis cohort of whom 43,670 (29%) had elevated TG levels. These subjects were younger and had higher BMIs. Table 1 details the crude and adjusted CV event rates. The overall crude and adjusted CV event rate ratios were 1.28 (95% CI 1.23,1.33) and 1.12 (95% CI 1.07, 1.16), respectively.

Conclusion

In this large cohort of veterans, those with elevated TG levels and moderately decreased renal function showed a significant increase in CV events despite well-controlled LDL-C on statins compared to veterans whose baseline TG was in a normal range.

Crude prevalence, crude and adjusted rate ratios of cardiovascular outcomes
 Elevated TG
(n=43,670)
Normal TG
(n=108,596)
Unadjusted Rate Ratio (95% CI)Adjusted Rate Ratio (95% CI)
Composite CV outcome3,977 (9.1%)1,129 (2.6%)1.28 (1.23, 1.33)1.12 (1.07, 1.16)
Individual CV outcomes    
Non-fatal MI2,459 (5.6%)4,656 (4.3%)1.29 (1.23, 1.35)1.13 (1.08. 1.19)
Non-fatal stroke924 (2.1%)4,656 (4.3%)1.15 (1.06, 1.24)1.04 (0.96, 1.12)
Coronary revascularization428 (1.0%)623 (0.6%)1.67 (1.48, 1.89)1.27 (1.12, 1.44)
Unstable angina1,129 (2.6%)1,891 (1.7%)1.46 (1.35, 1.57)1.24 (1.15, 1.34)

Rate ratio for each outcome based on generalized linear model with Poisson errors. Composite CV outcome was the 1st occurrence of all individual CV endpoints. Analysis based on 150,151 subjects with complete data.

Funding

  • Commercial Support