Elevated triglyceride levels were found to be independently associated with adverse cardiovascular outcomes in patients with type 2 diabetes and coronary artery disease (CAD), according to a study published in the American Journal of Cardiology.

The findings are based on data from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial in which 2307 participants (median age, 62; 29.6% women; 29.6% nonwhite) with type 2 diabetes and angiographically documented stable ischemic heart disease were enrolled. Most patients were obese, had an overall median type 2 diabetes duration just <10 years, and were treated with statin therapy.

The study’s primary outcome was a composite of time to cardiovascular death, myocardial infarction (MI), or stroke. Secondary outcomes were the individual components of the primary end point in addition to coronary revascularization and all-cause death.

The mean triglyceride level in this cohort was 181±136 mg/dL (median, 148 mg/dL; 51% <150 mg/dL; 18%, 150-199 mg/dL; 28%, 200-499 mg/dL; and 3% ≥500 mg/dL).


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Patients who had triglyceride levels ≥150 mg/dL vs <150 mg/dL were younger (61 vs 63 years, respectively; P <.001), had higher body mass index (32 vs 30 kg/m2, respectively; P <.001), lower high-density lipoprotein cholesterol (34 vs 39 mg/dL, respectively; P <.001), higher HbA1c (8% vs 7%, respectively; P <.001), were more likely to have prior MI (34.2% vs 30.1%, respectively; P =.033) and revascularization (25.8% vs 21.4%, respectively; P =.013).

Each 50-mg/dL increase in triglyceride level was associated with a 3.8% (hazard ratio [HR], 1.038; 95% CI, 1.004-1.072; P <.001) increase in the primary composite outcome and a 6.4% (HR, 1.064; 95% CI, 1.018-1.113; P <.001) increase in the secondary outcome, after full adjustment.

No interaction was observed between triglyceride level and outcomes within particular subgroups, which included female sex, additional noncoronary atherosclerotic disease, chronic kidney disease, or lower low-density lipoprotein cholesterol level (<100 mg/dL).

The study authors noted that their data were not adjusted for other potential clinical confounders such as alcohol use and hormone status. In addition, the cohort was predominantly white, male, and of a relatively narrow age range.

“[In] this study of largely statin-treated patients with type 2 diabetes and CAD from the BARI-2D trial, baseline triglyceride levels were independently associated with adverse cardiovascular outcomes,” noted the investigators. “Whether lowering triglyceride levels leads to improved cardiovascular outcomes remains to be seen.”

Disclosures: Some of the study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.

Reference

Nelson AJ, Navar AM, Mulder H, et al. Association between triglycerides and residual cardiovascular risk in patients with type 2 diabetes mellitus and established cardiovascular disease (from the Bypass Angioplasty Revascularization Investigation 2 Diabetes [BARI 2D] trial) [published online July 11, 2020]. Am J Cardiol. doi:https://doi.org/10.1016/j.amjcard.2020.07.005