VA Study Shows High Risk for CV Events Despite Well-Controlled LDL-C Levels

cardiac mri, cardiovascular disease, Cvd, ACS
MRI of the heart, axial section, showing an old heart attack(myocardial infarction) with fatty deposits on the left ven tricular wall. (c) Sovereign
Veterans with elevated triglycerides showed significant increases in cardiovascular events despite having statin-controlled low-density lipoprotein cholesterol levels.

Compared with veterans with normal triglycerides levels, veterans with elevated triglycerides showed significant increases in cardiovascular (CV) events despite having low-density lipoprotein cholesterol (LDL-C) levels that were well-controlled by statins and adjustment for high-density lipoprotein cholesterol (HDL-C), according to research presented at the American College of Cardiology 68th Annual Scientific Session & Expo, held March 16-18, 2019 in New Orleans, Louisiana.

Recent studies have indicated that elevated triglycerides may play a causal role in incident CV events. For the current study, researchers used data on a large cohort of US veterans from the VHA’s Corporate Data Warehouse from 2010 to 2015. Individuals who had LDL-C levels well-controlled by statins (40 to 100mg/dL) and who were not taking triglycerides-lowering agents were included to investigate whether residual CV risk increased for veterans with elevated triglycerides levels compared with veterans with normal triglycerides levels.

The CV event rates (coronary revascularization, nonfatal myocardial infarction, stroke, or unstable angina) of the elevated triglycerides group (150 to 500mg/dL) were compared with the normal triglycerides group (less than 150mg/dL). Crude event rates, rate ratios, and 95% CI were calculated for both groups, as were adjusted event rate ratios for baseline blood pressure, glomerular filtration rate, hemoglobin A1c, and HDL-C.

Among the predominantly white and male veterans included for analysis (N=439,019), 30% (n=132,203) had elevated triglycerides levels. These participants tended to be younger with a higher body mass index. Overall, the crude and adjusted CV event rate ratios were 1.37 (95% CI, 1.34-1.40; P <.001) and 1.19 (95% CI, 1.16-1.22; P <.001), respectively.

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Study investigators conclude, “In this large cohort of veterans, those with elevated TG levels showed a significant increase in CV events despite well-controlled LDL-C on statins and adjustment for HDL-C compared to veterans whose baseline [triglycerides] was in a normal range.”


Leatherman S, Ferguson R, Weir I, et al. Increased residual cardiovascular risk in US veterans and moderately-elevated baseline triglycerides and well-controlled LDL-C levels on statins. Presented at: American College of Cardiology 68th Annual Scientific Session & Expo; March 16-18, 2019; New Orleans, LA. Abstract 1060-09.