Abstract 15281: Triglyceride Levels and Cardiovascular Outcomes After Acute Coronary Syndrome: Insights From the Odyssey Outcomes Trial

Abstract

Introduction: It is controversial whether triglyceride (TG) levels are independently associated with post-acute coronary syndrome (ACS) major adverse cardiovascular events (MACE) in patients treated with statins. PCSK9 inhibitors such as alirocumab (ALI) produce substantial reductions in LDL-C, modest reductions in lipoprotein(a) and TG-rich lipoproteins, and reduce MACE. Objective: Using data from the ODYSSEY OUTCOMES trial that compared ALI with placebo in 18,924 patients with recent ACS on optimized statin treatment, we performed a prespecified analysis to determine if MACE (death from coronary heart disease, myocardial infarction, ischemic stroke, or unstable angina) was associated with baseline TG levels in patients treated with placebo, and if MACE reduction with ALI was influenced by baseline TG or the change in TG under treatment. Methods and Results: Proportional hazards models relating continuous baseline TG or the change in TG from baseline to Month 4 with MACE were adjusted for baseline variables: age, region, LDL-C, lipoprotein(a), diabetes, hypertension, BMI, heart failure, peripheral artery disease and cerebrovascular disease. At baseline, median TG level was 130 mg/dL. Median absolute change from baseline to month 4 in the ALI group was -17 (-49, 12) mg/dL. Within the placebo group, baseline TG was associated with MACE (HR per 10 mg/dL increment 1.007, 95% CI 1.001–1.014, p=0.03), although spline analysis suggested non-linearity ( Figure ; spline effect p=0.01) with higher risk above approximately 190 mg/dL. MACE reduction by ALI (HR 0.85, 95% CI 0.78–0.93) did not depend on baseline TG (interaction p=0.99). In the ALI group, change in TG from baseline to Month 4 did not predict MACE after Month 4 (p=0.47). Conclusions: Among patients with recent ACS on optimized statin treatment, baseline TG levels are an independent predictor of MACE. The beneficial effect of ALI on MACE did not depend on either baseline or on treatment TG levels .