Risk of cardiovascular events in patients with hypertriglyceridaemia: A review of real-world evidence

Aims: To describe the real-world prevalence and consequences of hypertriglyceridaemia. Materials and methods: We searched two large patient databases, the National Health and Nutrition Examination Survey (NHANES) database (2007–2014) and the Optum Research Database, as well as electronic medical records from two Kaiser Permanente regions. Results: The NHANES data showed that ~26% of US adults, including nearly one-third of statin users, had at least borderline hypertriglyceridaemia (triglycerides [TGs] ≥1.69 mmol/L), and ~40% of adults with diabetes had levels of ≥150 mg/dL despite statin use. The Optum analyses demonstrated that those with TG levels ≥1.69 mmol/L who were on statins had a significantly increased risk of composite initial major cardiovascular (CV) events (hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.19–1.34; P < 0.001 vs. patients with TGs <150 mg/dL). This was accompanied by increased healthcare utilization and direct healthcare costs (HR 1.12, 95% CI 1.08–1.16; P < 0.001). In the analyses of the Kaiser Permanente records, patients with diabetes and TG levels 2.26–5.64 mmol/L had significantly higher adjusted incidence rates of non-fatal myocardial infarction (rate ratio 1.30, 95% CI 1.08–1.58; P = 0.006), non-fatal stroke (rate ratio 1.23; 95% CI 1.01–1.49; P = 0.037) and coronary revascularization (rate ratio 1.21; 95% CI 1.02–1.43; P = 0.027), but not unstable angina (rate ratio 1.33; 95% CI 0.87–2.03; P = 0.185) compared with patients with TG levels <1.69 mmol/L. Conclusions: Real-world analyses suggest that elevated TGs are prevalent and commonly associated with increased CV risk. CV outcomes trials in patients with established hypertriglyceridaemia will clarify whether strategies to reduce TG levels can ameliorate residual CV risk in patients taking statins.