Robert Klempfner1, Aharon Erez2, Ben-Zekry Sagit1, Ilan Goldenberg1, Enrique Fisman1, Eran Kopel1, Nir Shlomo1, Ariel Israel1, Alexander Tenenbaum1. 1. From The Heart Center, Sheba Medical Center, Tel-Hashomer, Israel (R.K., A.E., B.-Z.S., I.G., E.F., A.T.); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (B.-Z.S., I.G., E.F., A.T.); Heart Research Follow-up Program, University of Rochester Medical Center, NY (I.G.); Public Health Department, Ministry of Health, Jerusalem, Israel (E.K.); and The Israeli Association for Cardiovascular Trials, Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel (N.S., A.I.). 2. From The Heart Center, Sheba Medical Center, Tel-Hashomer, Israel (R.K., A.E., B.-Z.S., I.G., E.F., A.T.); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (B.-Z.S., I.G., E.F., A.T.); Heart Research Follow-up Program, University of Rochester Medical Center, NY (I.G.); Public Health Department, Ministry of Health, Jerusalem, Israel (E.K.); and The Israeli Association for Cardiovascular Trials, Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel (N.S., A.I.). Aharon.erez@sheba.health.gov.il.
Abstract
BACKGROUND: The independent association between elevated triglycerides and all-cause mortality among patients with established coronary heart disease is controversial. The aim of this study was to investigate this association in a large cohort of patients with proven coronary heart disease. METHODS AND RESULTS: The study cohort comprised 15 355 patients who were screened for the Bezafibrate Infarction Prevention (BIP) trial. Twenty-two-year mortality data were obtained from the national registry. Patients were divided into 5 groups according to strata of fasting serum triglycerides: (1) low-normal triglycerides (<100 mg/dL); (2) high-normal triglycerides (100-149 mg/dL); (3) borderline hypertriglyceridemia triglycerides (150-199 mg/dL); (4) moderate hypertriglyceridemia triglycerides (200-499 mg/dL); (5) severe hypertriglyceridemia triglycerides (≥500 mg/dL). Age- and sex-adjusted survival was 41% in the low-normal triglycerides group than 37%, 36%, 35%, and 25% in groups with progressively higher triglycerides (P<0.001). In an adjusted Cox-regression for various covariates including high-density lipoprotein cholesterol, each 1 unit of natural logarithm (Ln) triglycerides elevation was associated with a corresponding 6% (P=0.016) increased risk of 22-year all-cause mortality. The 22-year mortality risk for patients with severe hypertriglyceridemia was increased by 68% when compared with patients with low-normal triglycerides (P<0.001). CONCLUSIONS: In patients with established coronary heart disease, higher triglycerides levels are independently associated with increased 22-year mortality. Even in patients with triglycerides of 100 to 149 mg/dL, the elevated risk for death could be detected than in patients with lower triglycerides levels, whereas severe hypertriglyceridemia denotes a population with particularly increased mortality risk.
RCT Entities:
BACKGROUND: The independent association between elevated triglycerides and all-cause mortality among patients with established coronary heart disease is controversial. The aim of this study was to investigate this association in a large cohort of patients with proven coronary heart disease. METHODS AND RESULTS: The study cohort comprised 15 355 patients who were screened for the Bezafibrate Infarction Prevention (BIP) trial. Twenty-two-year mortality data were obtained from the national registry. Patients were divided into 5 groups according to strata of fasting serum triglycerides: (1) low-normal triglycerides (<100 mg/dL); (2) high-normal triglycerides (100-149 mg/dL); (3) borderline hypertriglyceridemiatriglycerides (150-199 mg/dL); (4) moderate hypertriglyceridemiatriglycerides (200-499 mg/dL); (5) severe hypertriglyceridemiatriglycerides (≥500 mg/dL). Age- and sex-adjusted survival was 41% in the low-normal triglycerides group than 37%, 36%, 35%, and 25% in groups with progressively higher triglycerides (P<0.001). In an adjusted Cox-regression for various covariates including high-density lipoprotein cholesterol, each 1 unit of natural logarithm (Ln) triglycerides elevation was associated with a corresponding 6% (P=0.016) increased risk of 22-year all-cause mortality. The 22-year mortality risk for patients with severe hypertriglyceridemia was increased by 68% when compared with patients with low-normal triglycerides (P<0.001). CONCLUSIONS: In patients with established coronary heart disease, higher triglycerides levels are independently associated with increased 22-year mortality. Even in patients with triglycerides of 100 to 149 mg/dL, the elevated risk for death could be detected than in patients with lower triglycerides levels, whereas severe hypertriglyceridemia denotes a population with particularly increased mortality risk.
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