Table 1.
Major studies evaluating the effect of hypertriglyceridaemia on ASCVD outcomes.
| Study | Type of study | Study population | Location | No of participants | Fasting or non-fasting | Follow up (years) | Outcomes | Comments |
|---|---|---|---|---|---|---|---|---|
| Copenhagen City Heart Study (64, 65) | Prospective population-based study | Primary prevention | Denmark | 13,981 | Non-fasting | 26 | Incident MI IHD Total death Ischemic stroke |
Increased risk of MI, IHD, Ischemic stroke and total death with hypertriglyceridaemia group. Each 1 mmol/L rise in TG is associated with a 10%–24% increased risk of MI, IHD, ischemic stroke and death. |
| Bansal et al. (45) | Prospective study of cohort derived from Women's Health Studya | Primary prevention | USA | 26,509 | Fasting: 20,118 Non-fasting: 6,391 |
11.4 | MI/ischemic stroke/coronary revascularization/or ASCVD death. | Non-fasting TG levels (2–4 h after a meal) were strongly associated and were a better predictor of future cardiovascular events, independent of other ASCVD risks and HDL-C level, [HR 1.98, (1.21–3.25), p = 0.006] |
| Hokanson et al. (66) | Meta-analysis of 17 population-based, prospective studies (European and American) | NR | Europe & America | 57,277 | Fasting | 9.9 | MI CHD IHD ASCVD Death |
1 mmol/L increase in TG is associated with 32% increased risk of ASCVD event in men [RR 1.32 (1.26–1.39)] and 76% in women [RR 1.76, (1.50–2.07)]. Adjustment for HDL-C and other risk factors attenuated the risk to 14% in men (RR 1.14, CI 1.05–1.28) and 37% in women [RR 1.37, (1.13–1.66)] |
| Patel et al. (67) | Meta-analysis of 26 prospective cohort studies (Asia and Pacific region) | NR | Asia, Australia, New Zealand. | 96,224 | Fasting in 90% population | 8.2 | CHD Stroke |
Compared to TG ≤0.7 mmol/L, 1.1–1.3 mmol/L was associated with a 30%–50% higher risk of ASCVD event. The highest TG tertile (≥1.9 mmol/L), after adjusting for other risk factors, was associated with a 70%–80% higher risk of CHD event. Each 1-SD-higher level of log-triglycerides led to a greater risk of fatal CHD [HR 1.33, (1.09–1.62)] and fatal or nonfatal CHD [HR 1.56, (1.20–2.03)]. |
| Reykjavik study (68) | Prospective population-based cohort study | Primary prevention | Iceland | 18,569 | Fasting | 17.4 | Non-Fatal MI CHD Death |
Each log unit increase in TG level (mmol/L) is associated with a 40% increase in the risk of fatal or non-fatal MI for women [HR 1.40, (1.15–1.70)] and 21% in men [HR 1.21, (CI 1.08–1.36)]. The multivariate model did not adjust for HDL-C. |
| Sarwar et al. (69) | A case-control study from cohorts derived from the Reykjavik study and EPIC-Norfolk Study | Primary prevention | Iceland and England | Reykjavik: Case: 2,459 Controls: 3,969 |
Fasting | 20 | CHD | People with TG in the top tertile (>1.28 mmol/L) are more likely to experience CHD events as compared to individuals in the bottom tertile (<0.87 mmol/L), OR 1.43 (1.23–1.65), though attenuated but stayed significant after adjusting for other CV risk factors. Adjusted values for HDL-C are not available. |
| Epic-Norfolk: Cases: 1,123 Controls: 2,206 |
Non-fasting | 8 | CHD | People with TG in the top tertile (>2.0 mmol/L) are more likely to experience CHD events as compared to individuals in the bottom tertile (<1.33 mmol/L), OR 1.52 (1.24–1.89). Adjusted OR for HDL-C in addition to traditional CV risk factors, 1.31 (1.06–1.62) | ||||
| Sarwar et al. (69) | Meta-analysis of 29 population-based, prospective studies, including Reykjavik and EPIC-Norfolk Studies (European and American) | NR | Europe & America | 262,525 | Fasting: 23 studies (n = 119,044) Non-Fasting: 6 studies (n = 143,481) |
12.1 | CHD | OR for CHD in individuals with usual TG values in the top third of the population compared with those in the bottom third, adjusted for several established risk factors, was 1.7 (1.6–1.9). Adjustment for HDL-C attenuated but did not eliminate the risk of CHD with high TG. |
| Nichols et al. (70) | Population-based cohort study | Secondary prevention or >50 years with diabetes and one more ASCVD risk factor | USA | 27,953 | Both fasting and non-fasting | 5.3 | Non-fatal MI Non-fatal Stroke UA Coronary revascularisation |
Compared to normal TG (<1.7 mmol/L) hypertriglyceridemia (2.2–5.6 mmol/L) at optimum LDL-C (1.0–2.6 mmol/L), the incidence rate of non-fatal MI, non-fatal stroke and coronary revascularisation was 30%, 23% and 21% higher in hypertriglyceridemia group both [RR 1.30, (1.08–1.58), 1.23 (1.01–1.49) and 1.21 (1.02–1.43) respectively]. No difference between groups for UA [RR 1.33, (0.87–2.03)]. |
| TG REAL (71) | Population-based cohort study | Primary prevention | Italy | 15,8072 | Predominantly fasting | 3.2 | Incident ASCVD event All-cause mortality |
As compared to normal TG (<1.7 mmol/L), high TG (1.7–5.6) and very high TG (>5.6), after adjusting for confounders, were associated with a higher risk of incident ASCVD [HR 1.61, (1.43–1.82) and 2.30 (1.02–5.18) respectively] and all-cause mortality [HR 1.49, (1.36–1.63) and HR 3.08, (1.46–6.50) respectively]. |
| Lee et al. (72) | Population-based cohort study | Primary prevention | South Korea | 5,688,055 | NR | 7.1 | MI Stroke All-cause death |
The predictive value of TG was strongest amongst all lipid components that did not attenuate after adjusting for conventional CV risk factors. Triglycerides in the highest quantile (≥1.7 mmol/L) were independently associated with the risk of ASCVD as composite [HR 2.08, (2.02–2.15)] or components of composite, [MI: HR 2.48, (2.33–2.64) or Stroke: HR 2.53 (2.34–2.73)]. |
| Patel et al. (37) | Population-based cohort study | Primary and secondary prevention | United Kingdom | 1,530,441 | NR | 6.7 | AMI All-cause mortality |
As compared to normal triglycerides (<1.7 mmol/L) individuals with mild (1.7–4.5 mmol/L) and moderate (4.6–10.0 mmol/L) are at higher risk of acute myocardial infarction [HR 1.07, (1.05–1.09) and 1.17 (1.12–1.23) respectively)]. The risk attenuated and was not significant in severe hypertriglyceridaemia (TG >10.0). All-cause mortality incrementally increased with increasing severity of hypertriglyceridaemia. |
AMI, acute myocardial infarction; CVD, cardiovascular; CHD, coronary heart disease; CI, confidence interval; CVD, cardiovascular disease; HDL-C, high-density lipoprotein cholesterol; HR, hazard ratio; IHD, ischemic heart disease; LDL-C, low-density lipoprotein cholesterol; MI, myocardial infarction; OR, odds ratio; RR, relative risk; SD, standard deviation; TG, triglycerides; TG-REAL, association of hypertriglyceridaemia with all-cause mortality and atherosclerotic cardiovascular events in a Low-risk Italian population; UA: unstable angina; USA, United States of America.
a
A randomized, double-blind, placebo-controlled trial designed to evaluate the benefits and risks of low-dose aspirin and vitamin E in the primary prevention of cardiovascular disease and cancer in women.