A post-hoc analysis of data from two large studies that enrolled subjects post-acute coronary syndrome (ACS) was recently published in the Journal of the American College of Cardiology. Investigators sought to find out if there was a relationship between baseline fasting triglyceride (TG) levels, prior to randomization, and major cardiovascular events. Fasting triglyceride results from subjects who were 4 to 12 weeks post ACS enrolled in the dal-OUTCOMES study (n= 15,817, 97% on statin therapy) and from subjects who were 1 to 4 days post ACS enrolled in the 80 mg atorvastatin arm (n=1,501) of MIRACL (Myocardial Ischemia Reduction with Acute Cholesterol Lowering) were divided into quintiles for dal-Outcomes (highest TGs >175 mg/dL) or tertiles for MIRACL (highest TGs >195mg/dL). Risk of major adverse cardiovascular events (e.g., unstable angina, non-fatal myocardial infarction, stroke, and coronary heart disease death) were strongly associated with higher levels of triglycerides, despite statin treatment, and independent of low-density lipoprotein cholesterol (LDL-C) levels. The model also adjusted for body mass index, age, gender, high-density lipoprotein cholesterol, diabetes, and smoking. The study led Gregory G. Schwartz, MD and fellow authors to conclude that both long and short-term cardiovascular risk can be predicted among post ACS patients based on fasting triglyceride levels. This analysis adds to the rationale for looking beyond LDL-C to other markers of cardiovascular risk that include triglyceride rich lipoproteins. Many prevention specialists are paying more attention to non-HDL-C rather than LDL-C and directly measuring Apolipoprotein B which most specifically addresses the number of atherogenic particles.
REFERENCE: J Am Coll Cardiol. 2015;65(21):2267-2275. doi:10.1016/j.jacc.2015.03.544 See: Article