Duke Clinical Research Institute, Duke University, Durham, North Carolina.
Amarin Pharma Inc., Bridgewater, New Jersey.
Am J Cardiol. 2020 Oct 1;132:36-43. doi: 10.1016/j.amjcard.2020.07.005. Epub 2020 Jul 12.
Triglyceride (TG) levels encompass several lipoproteins that have been implicated in atherogenic pathways. Whether TG levels independently associate with cardiovascular disease both overall and, in particular among patients with established coronary artery disease (CAD) and type 2 diabetes (T2DM), remains controversial. Data from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial was used to evaluate patients with T2DM and CAD. Cox proportional hazards models were used to determine the association between TG levels and outcomes. Stepwise adjustment was performed for demographics, clinical factors, lipid profile and statin treatment. The primary composite outcome was time to CV death, myocardial infarction (MI), or stroke and secondary outcome was CV death. Among 2,307 patients with T2DM and CAD, the mean (±SD) TG levels were 181 (±136) with a median (Q1-Q3) 148mg/dL (104-219). Overall, 51% of patients had TG <150 mg/dL, 18% 150-199 mg/dL, 28% 200-499 mg/dL and 3% ≥500 mg/dL. Participants with elevated TG levels (≥150 mg/dL) were younger (61 vs 63 years, p <0.001), had higher BMI (32 vs 30 kg/m, p <0.001), more likely to have had prior MI (34.2 vs 30.1%, p = 0.033) and revascularization (25.8 vs 21.4%, p = 0.013), had lower HDL-C (34 vs 39 mg/dL, p <0.001) and higher HbA1c (8 vs 7%, p <0.001). In unadjusted analyses, baseline TG levels were linearly associated with both the primary composite and secondary outcomes. In fully adjusted analyses, every 50 mg/dL increase in TG level was associated with a 3.8% (HR 1.038, 95%CI 1.004-1.072, p <0.001) increase in the primary composite outcome and a 6.4% (HR 1.064 95%CI 1.018-1.113, p <0.001) increase in the secondary outcome. There was no interaction between TG and outcomes within key subgroups including female sex, additional non-coronary atherosclerotic disease, CKD or low LDL (<100 mg/dL). In conclusion, among patients with T2DM and CAD, elevated TG were independently associated with adverse cardiovascular outcomes, even after adjustment for clinical and simple biochemical covariates.
甘油三酯（TG）水平包含几种脂蛋白，这些脂蛋白与动脉粥样硬化途径有关。无论 TG 水平是否与心血管疾病独立相关，包括总体心血管疾病以及在已确诊的冠状动脉疾病（CAD）和 2 型糖尿病（T2DM）患者中，这仍然存在争议。来自旁路血管成形术再血管化研究 2 型糖尿病（BARI 2D）试验的数据用于评估 T2DM 和 CAD 患者。使用 Cox 比例风险模型确定 TG 水平与结局之间的关联。逐步进行调整，以调整人口统计学、临床因素、血脂谱和他汀类药物治疗。主要复合结局是心血管死亡、心肌梗死（MI）或中风的时间，次要结局是心血管死亡。在 2307 名患有 T2DM 和 CAD 的患者中，平均（±SD）TG 水平为 181（±136）mg/dL，中位数（Q1-Q3）为 148mg/dL（104-219）。总体而言，51%的患者 TG<150mg/dL，18%为 150-199mg/dL，28%为 200-499mg/dL，3%为≥500mg/dL。TG 水平升高（≥150mg/dL）的参与者更年轻（61 岁 vs 63 岁，p<0.001），BMI 更高（32 vs 30kg/m，p<0.001），更有可能发生既往心肌梗死（34.2% vs 30.1%，p=0.033）和血运重建（25.8% vs 21.4%，p=0.013），HDL-C 更低（34 vs 39mg/dL，p<0.001），HbA1c 更高（8% vs 7%，p<0.001）。在未调整的分析中，基线 TG 水平与主要复合结局和次要结局呈线性相关。在完全调整的分析中，TG 水平每增加 50mg/dL，主要复合结局的风险增加 3.8%（HR 1.038，95%CI 1.004-1.072，p<0.001），次要结局的风险增加 6.4%（HR 1.064，95%CI 1.018-1.113，p<0.001）。在女性、额外的非冠状动脉粥样硬化性疾病、CKD 或 LDL 低（<100mg/dL）等关键亚组中，TG 与结局之间没有交互作用。总之，在患有 T2DM 和 CAD 的患者中，即使在调整了临床和简单生化指标后，升高的 TG 水平仍与不良心血管结局独立相关。
