Clinical Effectiveness and Safety, GlaxoSmithKline, Durham, NC.
US Health Outcomes, GlaxoSmithKline, Philadelphia, Pa.
Am J Med. 2014 Jan;127(1):36-44.e1. doi: 10.1016/j.amjmed.2013.09.018. Epub 2013 Oct 8.
Patients with severe hypertriglyceridemia have an increased risk of cardiovascular disease and pancreatitis. Target triglyceride levels associated with clinical benefit for patients with severe hypertriglyceridemia are not currently known. This study evaluates the association between lower follow-up triglyceride levels and incidence of clinical events for patients with severe hypertriglyceridemia.
By using claims data from 2 large US healthcare databases, we conducted a retrospective cohort study and identified 41,210 adults with severe hypertriglyceridemia (triglycerides ≥ 500 mg/dL) between June 2001 and September 2010. The date of the first severe hypertriglyceridemia laboratory result was the index date. Patients were categorized into 1 of 5 triglyceride ranges (<200 mg/dL, 200-299 mg/dL, 300-399 mg/dL, 400-499 mg/dL, and ≥ 500 mg/dL) based on a follow-up triglyceride level assessed 6 to 24 weeks after initial triglyceride levels were measured. Adjusted Cox regression models were developed to evaluate the impact of follow-up triglyceride levels on rates of pancreatitis episodes and cardiovascular events.
The mean age of patients was 50 years, 72% were male, and the mean follow-up was 825 days. Patients with severe hypertriglyceridemia with follow-up triglyceride levels <200 mg/dL experienced a lower rate of pancreatitis episodes (adjusted incidence rate ratio, 0.45; 95% confidence interval, 0.34-0.60) and cardiovascular events (adjusted incidence rate ratio, 0.71; 95% confidence interval, 0.64-0.78) with some clinical benefit in adults with severe hypertriglyceridemia with follow-up triglyceride levels 200 to 299 mg/dL and 300 to 399 mg/dL (P < .001 for trend).
We observed the greatest impact on clinical events among patients with severe hypertriglyceridemia with the lowest follow-up triglyceride levels.
患有严重高甘油三酯血症的患者心血管疾病和胰腺炎的风险增加。目前尚不清楚与严重高甘油三酯血症患者的临床获益相关的目标甘油三酯水平。本研究评估了严重高甘油三酯血症患者随访甘油三酯水平降低与临床事件发生率之间的关系。
利用来自 2 个美国大型医疗保健数据库的索赔数据，我们进行了一项回顾性队列研究，确定了 2001 年 6 月至 2010 年 9 月期间患有严重高甘油三酯血症（甘油三酯≥500mg/dL）的 41210 名成年人。第一次严重高甘油三酯血症实验室结果的日期为索引日期。根据初次测量甘油三酯水平后 6 至 24 周评估的随访甘油三酯水平，将患者分为以下 5 个甘油三酯范围之一：<200mg/dL、200-299mg/dL、300-399mg/dL、400-499mg/dL 和≥500mg/dL。使用调整后的 Cox 回归模型评估随访甘油三酯水平对胰腺炎发作和心血管事件发生率的影响。
患者的平均年龄为 50 岁，72%为男性，平均随访时间为 825 天。患有严重高甘油三酯血症且随访甘油三酯水平<200mg/dL 的患者胰腺炎发作（调整后的发病率比，0.45；95%置信区间，0.34-0.60）和心血管事件（调整后的发病率比，0.71；95%置信区间，0.64-0.78）的发生率较低，患有严重高甘油三酯血症且随访甘油三酯水平为 200-299mg/dL 和 300-399mg/dL 的成年患者具有一定的临床获益（趋势 P<.001）。
我们观察到严重高甘油三酯血症患者的随访甘油三酯水平最低，对临床事件的影响最大。
