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Sarah Leatherman, Ryan E. Ferguson, Cynthia Hau, Craig Granowitz, Kelly Harrington, Sephy Philip, Peter Toth, Deepak L. Bhatt, William E. Boden, VA Boston Healthcare System, Boston, MA, USA, Amarin Corp, Bedminster, NJ, USA
Abstract
Background: Recent studies suggest a causal role for elevated triglycerides (TG) in incident cardiovascular (CV) events. Using a large cohort of U.S. veterans with statin-controlled LDL-C levels (40-100mg/dL), we explored whether differences between residual CV risk in patients with normal (<150mg/dL) and elevated TG (150-499mg/dL) levels existed among CV risk groups. Methods: We compared CV event rates (nonfatal MI, stroke, unstable angina, or coronary revascularization) between TG groups stratified by CV risk group in veterans receiving a statin but not a TG-lowering agent identified from the VA electronic health record between 2010 and 2015. CV risk groups were defined as 1) no diabetes and no prior CV event, 2) diabetes and no prior CV event and 3) prior CV event. We calculated crude event rates, rate ratios (95% CI), and rate ratios adjusted for age, sex, baseline blood pressure, kidney function, and weight. Results: Among 396,189 veterans, 28% had elevated TG levels. Those with elevated TG levels had more baseline CV risk. Table 1 details the baseline data and event rates by CV risk group. The adjusted CV event rate ratio for the composite outcome was 1.09 (1.03, 1.15) in CV group 1, 1.13 (1.08, 1.19) in CV group 2 and 1.08 (1.04, 1.11) in CV group 3. Conclusion: Elevated TG levels were a risk factor for CV events independent of prior CV events or diabetes in this cohort of veterans with statin-controlled LDL-C. This suggests that elevated TG confer a similar degree of risk in primary and secondary prevention settings.