Increased residual cardiovascular risk in patients with diabetes and high versus normal triglycerides despite statin‐controlled LDL cholesterol
Aim To determine whether high triglycerides (TG) in the presence of statin‐controlled LDL‐C influence the risk of cardiovascular disease (CVD) among patients with diabetes in real‐world clinical practice. Materials and methods We identified adults with diabetes from the Southern California and Pacif...
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| Veröffentlicht in: | Diabetes, obesity & metabolism obesity & metabolism, 2019-02, Vol.21 (2), p.366-371 |
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| creator | Nichols, Gregory A. Philip, Sephy Reynolds, Kristi Granowitz, Craig B. Fazio, Sergio |
| description | Aim
To determine whether high triglycerides (TG) in the presence of statin‐controlled LDL‐C influence the risk of cardiovascular disease (CVD) among patients with diabetes in real‐world clinical practice.
Materials and methods
We identified adults with diabetes from the Southern California and Pacific Northwest regions of Kaiser Permanente. We included patients undergoing statin therapy with LDL‐C from 40‐100 mg/dL who were not undergoing other lipid‐lowering therapies and had a prior diagnosis of atherosclerotic CVD or at least one other CVD risk factor. We grouped patients into high TG (200‐499 mg/dL; n = 5542) or normal TG ( |
| doi_str_mv | 10.1111/dom.13537 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6587847</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2109327238</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4437-d4da99610b3caf8817ac0659bb6ecaf2c07e16e6e20d5834bf0542fa8229d5893</originalsourceid><addsrcrecordid>eNp1kctu1DAUhiMEoqWw4AWQJTawSOtL4iQbpKrlUmlQN7C2HPtk4uLYg51MNTseAV6RJ-G0UypAwpJl6_jT53P0F8VzRo8ZrhMbp2MmatE8KA5ZJUXJBJcPb--8bDvKD4onOV9RSivRNo-LA0E5r9uWHRY_LoJJoDNYkiA7u2hPjE7Wxa3OZvE6keTyF-IC2ejZQZgzuXbzSKzTPcyQiQ6WjG49ki2kvGQSYppQMie39jsDyVmEcG_cDCTPKAk_v303Mcwpeo__rs5XxIzRQ54BS0-LR4P2GZ7dnUfF53dvP519KFeX7y_OTlelqSrRlLayuusko70wesBZGm2orLu-l4AFbmgDTIIETm3diqofaF3xQbecd1joxFHxZu_dLP0E1uBoSXu1SW7Saaeidurvl-BGtY5bJeu2aasGBa_uBCl-XbB7NblswHsdIC5ZcUY7wRsuWkRf_oNexSUFHA8pKSli7IZ6vadMijknGO6bYVTdBK0waHUbNLIv_uz-nvydLAIne-Daedj936TOLz_ulb8AIBW3rQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2166032718</pqid></control><display><type>article</type><title>Increased residual cardiovascular risk in patients with diabetes and high versus normal triglycerides despite statin‐controlled LDL cholesterol</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><creator>Nichols, Gregory A. ; Philip, Sephy ; Reynolds, Kristi ; Granowitz, Craig B. ; Fazio, Sergio</creator><creatorcontrib>Nichols, Gregory A. ; Philip, Sephy ; Reynolds, Kristi ; Granowitz, Craig B. ; Fazio, Sergio</creatorcontrib><description>Aim
To determine whether high triglycerides (TG) in the presence of statin‐controlled LDL‐C influence the risk of cardiovascular disease (CVD) among patients with diabetes in real‐world clinical practice.
Materials and methods
We identified adults with diabetes from the Southern California and Pacific Northwest regions of Kaiser Permanente. We included patients undergoing statin therapy with LDL‐C from 40‐100 mg/dL who were not undergoing other lipid‐lowering therapies and had a prior diagnosis of atherosclerotic CVD or at least one other CVD risk factor. We grouped patients into high TG (200‐499 mg/dL; n = 5542) or normal TG (<150 mg/dL, n = 22 411) from January 2010 through December 2016 to compare incidence rates and rate ratios of first non‐fatal myocardial infarction (MI), non‐fatal stroke, unstable angina and coronary revascularization. We adjusted multivariable analyses for age, sex, race/ethnicity, smoking status, blood pressure, HbA1c, serum creatinine, presence of ischaemic heart disease and study site.
Results
Adjusted rate ratios for the four outcomes were all statistically significantly different. The incidence rate for non‐fatal MI was 30% higher in the high TG group (rate ratio, 1.30; 95% CI, 1.08‐1.58; P = 0.006). The rate was 23% higher for non‐fatal stroke (1.23, 1.01‐1.49, P = 0.037), 21% higher for coronary revascularization (rate ratio, 1.21; 95% CI, 1.02‐1.43; P = 0.027) and was, non‐significantly, 33% higher for unstable angina (rate ratio, 1.33; 95% CI, 0.87‐2.03; P = 0.185).
Conclusions
Despite statin‐controlled LDL‐C levels, CV events were greater among patients with diabetes and high TG levels. Because we controlled for cardiometabolic risk factors, it is likely that the difference in TG levels contributed to the excess risk observed in patients with high TGs.</description><identifier>ISSN: 1462-8902</identifier><identifier>EISSN: 1463-1326</identifier><identifier>DOI: 10.1111/dom.13537</identifier><identifier>PMID: 30225881</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Aged ; Angina ; Angina pectoris ; Anticholesteremic Agents - therapeutic use ; Arteriosclerosis ; Blood pressure ; California - epidemiology ; Cardiovascular diseases ; Cardiovascular Diseases - blood ; Cardiovascular Diseases - epidemiology ; Cardiovascular Diseases - etiology ; cardiovascular risk ; Cerebral infarction ; Cholesterol ; Cholesterol, LDL - blood ; Cholesterol, LDL - drug effects ; Coronary artery disease ; Creatinine ; Diabetes ; Diabetes Complications - blood ; Diabetes Complications - drug therapy ; Diabetes Complications - epidemiology ; Diabetes mellitus ; Diabetes Mellitus - blood ; Diabetes Mellitus - drug therapy ; Diabetes Mellitus - epidemiology ; Epidemiology ; Female ; Health risk assessment ; Heart diseases ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use ; hypertriglyceridaemia ; Hypertriglyceridemia - blood ; Hypertriglyceridemia - complications ; Hypertriglyceridemia - drug therapy ; Low density lipoprotein ; Male ; Middle Aged ; Minority & ethnic groups ; Myocardial infarction ; Original ; Risk Factors ; Smoking ; Statins ; Stroke ; Triglycerides ; Triglycerides - blood</subject><ispartof>Diabetes, obesity & metabolism, 2019-02, Vol.21 (2), p.366-371</ispartof><rights>2018 The Authors. published by John Wiley & Sons Ltd.</rights><rights>2018 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.</rights><rights>2018. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4437-d4da99610b3caf8817ac0659bb6ecaf2c07e16e6e20d5834bf0542fa8229d5893</citedby><cites>FETCH-LOGICAL-c4437-d4da99610b3caf8817ac0659bb6ecaf2c07e16e6e20d5834bf0542fa8229d5893</cites><orcidid>0000-0002-7563-6236</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fdom.13537$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fdom.13537$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30225881$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nichols, Gregory A.</creatorcontrib><creatorcontrib>Philip, Sephy</creatorcontrib><creatorcontrib>Reynolds, Kristi</creatorcontrib><creatorcontrib>Granowitz, Craig B.</creatorcontrib><creatorcontrib>Fazio, Sergio</creatorcontrib><title>Increased residual cardiovascular risk in patients with diabetes and high versus normal triglycerides despite statin‐controlled LDL cholesterol</title><title>Diabetes, obesity & metabolism</title><addtitle>Diabetes Obes Metab</addtitle><description>Aim
To determine whether high triglycerides (TG) in the presence of statin‐controlled LDL‐C influence the risk of cardiovascular disease (CVD) among patients with diabetes in real‐world clinical practice.
Materials and methods
We identified adults with diabetes from the Southern California and Pacific Northwest regions of Kaiser Permanente. We included patients undergoing statin therapy with LDL‐C from 40‐100 mg/dL who were not undergoing other lipid‐lowering therapies and had a prior diagnosis of atherosclerotic CVD or at least one other CVD risk factor. We grouped patients into high TG (200‐499 mg/dL; n = 5542) or normal TG (<150 mg/dL, n = 22 411) from January 2010 through December 2016 to compare incidence rates and rate ratios of first non‐fatal myocardial infarction (MI), non‐fatal stroke, unstable angina and coronary revascularization. We adjusted multivariable analyses for age, sex, race/ethnicity, smoking status, blood pressure, HbA1c, serum creatinine, presence of ischaemic heart disease and study site.
Results
Adjusted rate ratios for the four outcomes were all statistically significantly different. The incidence rate for non‐fatal MI was 30% higher in the high TG group (rate ratio, 1.30; 95% CI, 1.08‐1.58; P = 0.006). The rate was 23% higher for non‐fatal stroke (1.23, 1.01‐1.49, P = 0.037), 21% higher for coronary revascularization (rate ratio, 1.21; 95% CI, 1.02‐1.43; P = 0.027) and was, non‐significantly, 33% higher for unstable angina (rate ratio, 1.33; 95% CI, 0.87‐2.03; P = 0.185).
Conclusions
Despite statin‐controlled LDL‐C levels, CV events were greater among patients with diabetes and high TG levels. Because we controlled for cardiometabolic risk factors, it is likely that the difference in TG levels contributed to the excess risk observed in patients with high TGs.</description><subject>Aged</subject><subject>Angina</subject><subject>Angina pectoris</subject><subject>Anticholesteremic Agents - therapeutic use</subject><subject>Arteriosclerosis</subject><subject>Blood pressure</subject><subject>California - epidemiology</subject><subject>Cardiovascular diseases</subject><subject>Cardiovascular Diseases - blood</subject><subject>Cardiovascular Diseases - epidemiology</subject><subject>Cardiovascular Diseases - etiology</subject><subject>cardiovascular risk</subject><subject>Cerebral infarction</subject><subject>Cholesterol</subject><subject>Cholesterol, LDL - blood</subject><subject>Cholesterol, LDL - drug effects</subject><subject>Coronary artery disease</subject><subject>Creatinine</subject><subject>Diabetes</subject><subject>Diabetes Complications - blood</subject><subject>Diabetes Complications - drug therapy</subject><subject>Diabetes Complications - epidemiology</subject><subject>Diabetes mellitus</subject><subject>Diabetes Mellitus - blood</subject><subject>Diabetes Mellitus - drug therapy</subject><subject>Diabetes Mellitus - epidemiology</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Health risk assessment</subject><subject>Heart diseases</subject><subject>Humans</subject><subject>Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use</subject><subject>hypertriglyceridaemia</subject><subject>Hypertriglyceridemia - blood</subject><subject>Hypertriglyceridemia - complications</subject><subject>Hypertriglyceridemia - drug therapy</subject><subject>Low density lipoprotein</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Minority & ethnic groups</subject><subject>Myocardial infarction</subject><subject>Original</subject><subject>Risk Factors</subject><subject>Smoking</subject><subject>Statins</subject><subject>Stroke</subject><subject>Triglycerides</subject><subject>Triglycerides - blood</subject><issn>1462-8902</issn><issn>1463-1326</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp1kctu1DAUhiMEoqWw4AWQJTawSOtL4iQbpKrlUmlQN7C2HPtk4uLYg51MNTseAV6RJ-G0UypAwpJl6_jT53P0F8VzRo8ZrhMbp2MmatE8KA5ZJUXJBJcPb--8bDvKD4onOV9RSivRNo-LA0E5r9uWHRY_LoJJoDNYkiA7u2hPjE7Wxa3OZvE6keTyF-IC2ejZQZgzuXbzSKzTPcyQiQ6WjG49ki2kvGQSYppQMie39jsDyVmEcG_cDCTPKAk_v303Mcwpeo__rs5XxIzRQ54BS0-LR4P2GZ7dnUfF53dvP519KFeX7y_OTlelqSrRlLayuusko70wesBZGm2orLu-l4AFbmgDTIIETm3diqofaF3xQbecd1joxFHxZu_dLP0E1uBoSXu1SW7Saaeidurvl-BGtY5bJeu2aasGBa_uBCl-XbB7NblswHsdIC5ZcUY7wRsuWkRf_oNexSUFHA8pKSli7IZ6vadMijknGO6bYVTdBK0waHUbNLIv_uz-nvydLAIne-Daedj936TOLz_ulb8AIBW3rQ</recordid><startdate>201902</startdate><enddate>201902</enddate><creator>Nichols, Gregory A.</creator><creator>Philip, Sephy</creator><creator>Reynolds, Kristi</creator><creator>Granowitz, Craig B.</creator><creator>Fazio, Sergio</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-7563-6236</orcidid></search><sort><creationdate>201902</creationdate><title>Increased residual cardiovascular risk in patients with diabetes and high versus normal triglycerides despite statin‐controlled LDL cholesterol</title><author>Nichols, Gregory A. ; Philip, Sephy ; Reynolds, Kristi ; Granowitz, Craig B. ; Fazio, Sergio</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4437-d4da99610b3caf8817ac0659bb6ecaf2c07e16e6e20d5834bf0542fa8229d5893</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Angina</topic><topic>Angina pectoris</topic><topic>Anticholesteremic Agents - therapeutic use</topic><topic>Arteriosclerosis</topic><topic>Blood pressure</topic><topic>California - epidemiology</topic><topic>Cardiovascular diseases</topic><topic>Cardiovascular Diseases - blood</topic><topic>Cardiovascular Diseases - epidemiology</topic><topic>Cardiovascular Diseases - etiology</topic><topic>cardiovascular risk</topic><topic>Cerebral infarction</topic><topic>Cholesterol</topic><topic>Cholesterol, LDL - blood</topic><topic>Cholesterol, LDL - drug effects</topic><topic>Coronary artery disease</topic><topic>Creatinine</topic><topic>Diabetes</topic><topic>Diabetes Complications - blood</topic><topic>Diabetes Complications - drug therapy</topic><topic>Diabetes Complications - epidemiology</topic><topic>Diabetes mellitus</topic><topic>Diabetes Mellitus - blood</topic><topic>Diabetes Mellitus - drug therapy</topic><topic>Diabetes Mellitus - epidemiology</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Health risk assessment</topic><topic>Heart diseases</topic><topic>Humans</topic><topic>Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use</topic><topic>hypertriglyceridaemia</topic><topic>Hypertriglyceridemia - blood</topic><topic>Hypertriglyceridemia - complications</topic><topic>Hypertriglyceridemia - drug therapy</topic><topic>Low density lipoprotein</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Minority & ethnic groups</topic><topic>Myocardial infarction</topic><topic>Original</topic><topic>Risk Factors</topic><topic>Smoking</topic><topic>Statins</topic><topic>Stroke</topic><topic>Triglycerides</topic><topic>Triglycerides - blood</topic><toplevel>online_resources</toplevel><creatorcontrib>Nichols, Gregory A.</creatorcontrib><creatorcontrib>Philip, Sephy</creatorcontrib><creatorcontrib>Reynolds, Kristi</creatorcontrib><creatorcontrib>Granowitz, Craig B.</creatorcontrib><creatorcontrib>Fazio, Sergio</creatorcontrib><collection>Wiley Online Library (Open Access Collection)</collection><collection>Wiley Online Library (Open Access Collection)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Diabetes, obesity & metabolism</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nichols, Gregory A.</au><au>Philip, Sephy</au><au>Reynolds, Kristi</au><au>Granowitz, Craig B.</au><au>Fazio, Sergio</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Increased residual cardiovascular risk in patients with diabetes and high versus normal triglycerides despite statin‐controlled LDL cholesterol</atitle><jtitle>Diabetes, obesity & metabolism</jtitle><addtitle>Diabetes Obes Metab</addtitle><date>2019-02</date><risdate>2019</risdate><volume>21</volume><issue>2</issue><spage>366</spage><epage>371</epage><pages>366-371</pages><issn>1462-8902</issn><eissn>1463-1326</eissn><abstract>Aim
To determine whether high triglycerides (TG) in the presence of statin‐controlled LDL‐C influence the risk of cardiovascular disease (CVD) among patients with diabetes in real‐world clinical practice.
Materials and methods
We identified adults with diabetes from the Southern California and Pacific Northwest regions of Kaiser Permanente. We included patients undergoing statin therapy with LDL‐C from 40‐100 mg/dL who were not undergoing other lipid‐lowering therapies and had a prior diagnosis of atherosclerotic CVD or at least one other CVD risk factor. We grouped patients into high TG (200‐499 mg/dL; n = 5542) or normal TG (<150 mg/dL, n = 22 411) from January 2010 through December 2016 to compare incidence rates and rate ratios of first non‐fatal myocardial infarction (MI), non‐fatal stroke, unstable angina and coronary revascularization. We adjusted multivariable analyses for age, sex, race/ethnicity, smoking status, blood pressure, HbA1c, serum creatinine, presence of ischaemic heart disease and study site.
Results
Adjusted rate ratios for the four outcomes were all statistically significantly different. The incidence rate for non‐fatal MI was 30% higher in the high TG group (rate ratio, 1.30; 95% CI, 1.08‐1.58; P = 0.006). The rate was 23% higher for non‐fatal stroke (1.23, 1.01‐1.49, P = 0.037), 21% higher for coronary revascularization (rate ratio, 1.21; 95% CI, 1.02‐1.43; P = 0.027) and was, non‐significantly, 33% higher for unstable angina (rate ratio, 1.33; 95% CI, 0.87‐2.03; P = 0.185).
Conclusions
Despite statin‐controlled LDL‐C levels, CV events were greater among patients with diabetes and high TG levels. Because we controlled for cardiometabolic risk factors, it is likely that the difference in TG levels contributed to the excess risk observed in patients with high TGs.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>30225881</pmid><doi>10.1111/dom.13537</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-7563-6236</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Angina Angina pectoris Anticholesteremic Agents - therapeutic use Arteriosclerosis Blood pressure California - epidemiology Cardiovascular diseases Cardiovascular Diseases - blood Cardiovascular Diseases - epidemiology Cardiovascular Diseases - etiology cardiovascular risk Cerebral infarction Cholesterol Cholesterol, LDL - blood Cholesterol, LDL - drug effects Coronary artery disease Creatinine Diabetes Diabetes Complications - blood Diabetes Complications - drug therapy Diabetes Complications - epidemiology Diabetes mellitus Diabetes Mellitus - blood Diabetes Mellitus - drug therapy Diabetes Mellitus - epidemiology Epidemiology Female Health risk assessment Heart diseases Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use hypertriglyceridaemia Hypertriglyceridemia - blood Hypertriglyceridemia - complications Hypertriglyceridemia - drug therapy Low density lipoprotein Male Middle Aged Minority & ethnic groups Myocardial infarction Original Risk Factors Smoking Statins Stroke Triglycerides Triglycerides - blood |
| title | Increased residual cardiovascular risk in patients with diabetes and high versus normal triglycerides despite statin‐controlled LDL cholesterol |
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