Schuitema Pauline C E, Visseren Frank L J, Nordestgaard Børge G, Teraa Martin, van der Meer Manon G, Ruigrok Ynte M, Onland-Moret N Charlotte, Koopal Charlotte
Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Atherosclerosis. 2025 Sep;408:120411. doi: 10.1016/j.atherosclerosis.2025.120411. Epub 2025 Jun 14.
Despite optimal management of low-density lipoprotein cholesterol (LDL-C), substantial residual cardiovascular risk persists in patients with cardiovascular disease (CVD), which may be attributed to other atherogenic lipoproteins. We tested the hypotheses that elevated triglycerides (TGs) are related to higher residual CVD and mortality risk in patients with established CVD, and that such relationships depend on guideline-recommended lipid target achievement, high-density lipoprotein cholesterol (HDL-C) levels, and intensity of lipid-lowering therapy (LLT).
In a prospective cohort study of 9436 patients with manifest CVD, the relationships between log-transformed TG levels and recurrent cardiovascular events and all-cause mortality were analyzed overall using Cox regression models. Subsequently, analyses were stratified by achievement of low-density lipoprotein cholesterol (LDL-C) and non-HDL-C treatment goals, HDL-C levels, and LLT intensity.
During a median follow-up of 9.0 years (IQR 4.5-14.1), 2075 recurrent cardiovascular events, 736 myocardial infarctions, 586 strokes, 1231 cardiovascular deaths, and 2729 all-cause deaths occurred. Per 1-unit higher log-TG level, the hazard ratio was 1.17 (95 % CI: 1.07-1.28) for recurrent cardiovascular events, 1.34 (1.16-1.56) for myocardial infarction, 1.10 (0.92-1.30) for stroke, 1.23 (1.09-1.38) for cardiovascular mortality, and 1.12 (1.03-1.21) for all-cause mortality. These hazard ratios did not depend on achievement of LDL-C and non-HDL-C treatment goals, HDL-C levels, or LLT intensity (all p for interaction ≥0.05).
Elevated TGs are related to higher residual CVD and mortality risk in patients with established CVD. These relationships were unrelated to guideline-recommended lipid target achievement, HDL-C levels, and LLT intensity.
尽管对低密度脂蛋白胆固醇（LDL-C）进行了优化管理，但心血管疾病（CVD）患者仍存在大量残余心血管风险，这可能归因于其他致动脉粥样硬化脂蛋白。我们检验了以下假设：甘油三酯（TG）升高与已确诊CVD患者更高的残余CVD及死亡风险相关，且这种关系取决于指南推荐的血脂目标达成情况、高密度脂蛋白胆固醇（HDL-C）水平以及降脂治疗（LLT）强度。
在一项对9436例显性CVD患者的前瞻性队列研究中，总体上使用Cox回归模型分析对数转换后的TG水平与复发性心血管事件及全因死亡率之间的关系。随后，按低密度脂蛋白胆固醇（LDL-C）和非HDL-C治疗目标的达成情况、HDL-C水平以及LLT强度进行分层分析。
在中位随访9.0年（四分位间距4.5 - 14.1年）期间，发生了2075例复发性心血管事件、736例心肌梗死、586例中风、1231例心血管死亡以及2729例全因死亡。对数TG水平每升高1个单位，复发性心血管事件的风险比为1.17（95%置信区间：1.07 - 1.28），心肌梗死为1.34（1.16 - 1.56），中风为1.10（0.92 - 1.30），心血管死亡为1.23（1.09 - 1.38），全因死亡为1.12（1.03 - 1.21）。这些风险比不取决于LDL-C和非HDL-C治疗目标的达成情况、HDL-C水平或LLT强度（所有交互作用p值≥0.05）。
TG升高与已确诊CVD患者更高的残余CVD及死亡风险相关。这些关系与指南推荐的血脂目标达成情况、HDL-C水平及LLT强度无关。
