Discipline of Life Science, School of Science, Psychology and Sport, Federation University Australia, University Drive, Mt Helen, Ballarat, VIC, 3350, Australia.
Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
Cardiovasc Res. 2023 May 2;119(3):826-834. doi: 10.1093/cvr/cvac124.
We investigated the association of fasting triglycerides with cardiovascular disease (CVD) mortality.
This cohort study included US adults from the National Health and Nutrition Examination Surveys from 1988 to 2014. CVD mortality outcomes were ascertained by linkage to the National Death Index records. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of triglycerides for CVD mortality. The cohort included 26 570 adult participants, among which 3978 had diabetes. People with higher triglycerides had a higher prevalence of diabetes at baseline. The cohort was followed up for a mean of 12.0 years with 1492 CVD deaths recorded. A 1-natural-log-unit higher triglyceride was associated with a 30% higher multivariate-adjusted risk of CVD mortality in participants with diabetes (HR, 1.30; 95% CI, 1.08-1.56) but not in those without diabetes (HR, 0.95; 95% CI, 0.83-1.07). In participants with diabetes, people with high triglycerides (200-499 mg/dL) had a 44% (HR, 1.44; 95% CI, 1.12-1.85) higher multivariate-adjusted risk of CVD mortality compared with those with normal triglycerides (<150 mg/dL). The findings remained significant when diabetes was defined by fasting glucose levels alone, or after further adjustment for the use of lipid-lowering medications, or after the exclusion of those who took lipid-lowering medications.
This study demonstrates that fasting triglycerides of ≥200 mg/dL are associated with an increased risk of CVD mortality in patients with diabetes but not in those without diabetes. Future clinical trials of new treatments to lower triglycerides should focus on patients with diabetes.
我们研究了空腹甘油三酯与心血管疾病（CVD）死亡率之间的关系。
本队列研究纳入了 1988 年至 2014 年期间来自美国国家健康和营养调查的成年人。通过与国家死亡索引记录的关联来确定 CVD 死亡率的结果。使用 Cox 比例风险模型来估计甘油三酯与 CVD 死亡率的风险比（HR）和 95%置信区间（CI）。该队列包括 26570 名成年参与者，其中 3978 人患有糖尿病。基线时，甘油三酯较高的人更有可能患有糖尿病。该队列的平均随访时间为 12.0 年，记录了 1492 例 CVD 死亡。在患有糖尿病的参与者中，与糖尿病患者（HR，1.30；95%CI，1.08-1.56）相比，空腹甘油三酯每增加 1 个自然对数单位，多变量调整后的 CVD 死亡率风险增加 30%，但在无糖尿病患者中（HR，0.95；95%CI，0.83-1.07）并非如此。在患有糖尿病的参与者中，与正常甘油三酯（<150mg/dL）相比，甘油三酯高（200-499mg/dL）的患者 CVD 死亡率的多变量调整后风险增加了 44%（HR，1.44；95%CI，1.12-1.85）。当仅根据空腹血糖水平定义糖尿病时，或在进一步调整降脂药物的使用后，或在排除使用降脂药物的患者后，这些发现仍然具有统计学意义。
本研究表明，空腹甘油三酯≥200mg/dL 与糖尿病患者的 CVD 死亡率增加相关，但与非糖尿病患者无关。未来降低甘油三酯的新治疗方法的临床试验应集中在糖尿病患者身上。
