Clinical Effectiveness & Safety, GlaxoSmithKline, 5 Moore Drive, B.3116, Durham, NC 27709-3398, USA.
J Clin Lipidol. 2012 Sep-Oct;6(5):450-61. doi: 10.1016/j.jacl.2012.08.007. Epub 2012 Aug 30.
Increased levels of triglycerides are associated with an increased risk of cardiovascular disease and pancreatitis. In this study we investigated the association between patients with severely increased triglycerides whose follow-up triglyceride levels were <500 mg/dL and reduction of important clinical events and associated health care costs.
By using two large U.S. health care claims databases, we identified an initial cohort of 41,210 patients with severe hypertriglyceridemia between June 2001 and September 2010 who had a follow-up laboratory test result 6 to <24 weeks after the initial severe hypertriglyceridemia laboratory value. Of these, 8493 patients' follow-up triglyceride levels remained elevated (≥500 mg/dL) whereas 32,717 were <500 mg/dL. After their qualifying follow-up triglyceride level, patients' cardiovascular events, diabetes-related events, pancreatitis episodes, kidney disease, and related costs were identified. Adjusted incidence rate ratios with the use of Cox proportional hazards models were developed for each outcome.
Patients whose triglycerides remained ≥500 mg/dL had a greater rate of pancreatitis episodes (hazard ratio [HR]1.79; 95% confidence interval [CI] 1.47-2.18), cardiovascular events (HR1.19; 95% CI 1.10-1.28), diabetes-related events (HR1.42; 95% CI 1.27-1.59), and kidney disease (HR1.13; 95% CI 1.04-1.22) compared with patients whose follow-up triglycerides were <500 mg/dL, after we adjusted for important confounders. Adjusted all-cause total and cardiovascular-related costs were significantly lower in the first 3 years in patients whose follow-up triglyceride levels were <500 mg/dL compared with those whose triglyceride levels remained increased.
When follow-up triglyceride levels were <500 mg/dL, we observed an associated reduction in the risk of clinical events and decrease in health care resource use and costs.
甘油三酯水平升高与心血管疾病和胰腺炎风险增加有关。在这项研究中，我们调查了随访甘油三酯水平<500mg/dL 的严重高甘油三酯血症患者与重要临床事件减少和相关医疗保健费用降低之间的关联。
通过使用两个大型美国医疗保健索赔数据库，我们确定了一个初始队列，其中包括 2001 年 6 月至 2010 年 9 月期间患有严重高甘油三酯血症的 41210 名患者，他们在最初的严重高甘油三酯血症实验室值后 6 至<24 周进行了随访实验室检测结果。其中，8493 名患者的随访甘油三酯水平仍然升高（≥500mg/dL），而 32717 名患者<500mg/dL。在符合条件的随访甘油三酯水平后，确定了患者的心血管事件、糖尿病相关事件、胰腺炎发作、肾脏疾病和相关费用。使用 Cox 比例风险模型开发了每种结局的调整发病率比。
甘油三酯仍≥500mg/dL 的患者发生胰腺炎发作的比率较高（危险比[HR]1.79；95%置信区间[CI]1.47-2.18）、心血管事件（HR1.19；95% CI 1.10-1.28）、糖尿病相关事件（HR1.42；95% CI 1.27-1.59）和肾脏疾病（HR1.13；95% CI 1.04-1.22）与随访甘油三酯<500mg/dL 的患者相比，在调整了重要混杂因素后。与甘油三酯水平持续升高的患者相比，随访甘油三酯水平<500mg/dL 的患者在前 3 年内的全因和心血管相关总成本以及医疗资源使用和成本显著降低。
当随访甘油三酯水平<500mg/dL 时，我们观察到临床事件风险降低，医疗保健资源使用和成本降低。
