Department of Cardiology Kaiser Permanente San Francisco Medical Center San Francisco CA.
Division of Research Kaiser Permanente Northern California Oakland CA.
J Am Heart Assoc. 2021 Oct 19;10(20):e020377. doi: 10.1161/JAHA.120.020377. Epub 2021 Oct 8.
Background Patients with risk factors or established atherosclerotic cardiovascular disease remain at high-risk for ischemic events. Triglyceride levels may play a causal role. Methods and Results We performed a retrospective study of adults aged ≥45 years receiving statin therapy, with a low-density lipoprotein cholesterol of 41 to 100 mg/dL, and ≥1 risk factor or established atherosclerotic cardiovascular disease between 2010 and 2017. Outcomes included death, all-cause hospitalization, and major adverse cardiovascular events (myocardial infarction, stroke, or peripheral artery disease). The study sample included 373 389 primary prevention patients and 97 832 secondary prevention patients. The primary prevention cohort had a mean age of 65±10 years, with 51% women and 44% people of color, whereas the secondary prevention cohort had a mean age of 71±11 years, with 37% women and 32% people of color. Median triglyceride levels for the primary and secondary prevention cohorts were 122 mg/dL (interquartile range, 88-172 mg/dL) and 116 mg/dL (interquartile range, 84-164 mg/dL), respectively. In multivariable analyses, primary prevention patients with triglyceride levels ≥150 mg/dL were at lower adjusted risk of death (hazard ratio [HR], 0.91; 95% CI, 0.89-0.94) and higher risk of major adverse cardiovascular events (HR, 1.14; 95% CI, 1.05-1.24). In the secondary prevention cohort, patients with triglyceride levels ≥150 mg/dL were at lower adjusted risk of death (HR, 0.95; 95% CI, 0.92-0.97) and higher risk of all-cause hospitalization (HR, 1.03; 95% CI, 1.01-1.05) and major adverse cardiovascular events (HR, 1.04; 95% CI, 1.05-1.24). Conclusions In a contemporary cohort receiving statin therapy, elevated triglyceride levels were associated with a greater risk of atherosclerotic cardiovascular disease events and lower risk of death.
患有危险因素或已确诊动脉粥样硬化性心血管疾病的患者仍然存在发生缺血事件的高风险。甘油三酯水平可能发挥因果作用。
我们对 2010 年至 2017 年间接受他汀类药物治疗、低密度脂蛋白胆固醇水平在 41 至 100mg/dL 之间且患有≥1 种危险因素或已确诊动脉粥样硬化性心血管疾病的年龄≥45 岁的成年人进行了回顾性研究。研究结果包括死亡、全因住院和主要不良心血管事件（心肌梗死、卒中和外周动脉疾病）。研究样本包括 373389 例一级预防患者和 97832 例二级预防患者。一级预防队列的平均年龄为 65±10 岁，其中 51%为女性，44%为有色人种；而二级预防队列的平均年龄为 71±11 岁，其中 37%为女性，32%为有色人种。一级和二级预防队列的中位甘油三酯水平分别为 122mg/dL（四分位距，88-172mg/dL）和 116mg/dL（四分位距，84-164mg/dL）。多变量分析显示，甘油三酯水平≥150mg/dL 的一级预防患者的死亡风险（危险比[HR]，0.91；95%置信区间，0.89-0.94）较低，主要不良心血管事件（HR，1.14；95%置信区间，1.05-1.24）风险较高。在二级预防队列中，甘油三酯水平≥150mg/dL 的患者死亡风险（HR，0.95；95%置信区间，0.92-0.97）较低，全因住院（HR，1.03；95%置信区间，1.01-1.05）和主要不良心血管事件（HR，1.04；95%置信区间，1.05-1.24）风险较高。
在接受他汀类药物治疗的当代队列中，升高的甘油三酯水平与动脉粥样硬化性心血管疾病事件风险增加和死亡风险降低相关。
