Abstract P489: Association of Fasting Triglyceride Levels With Long-Term Competing Risks for Cause-Specific Cardiovascular Disease Events Among Middle-aged White and Black Men and Women

Abstract

Introduction: Hypertriglyceridemia is common and reflects poor metabolic health, but conflicting data exist regarding the independent association of triglycerides (TG) and cardiovascular disease (CVD). In addition, whether elevated TG are associated with differential long-term risks for CVD subtypes and whether this varies by sex and race, is not well-established. Therefore, we sought to examine the incidence of coronary heart disease, stroke, or heart failure in white and black US men and women by baseline TG levels. Methods: We included individual-level pooled data from 5 population-based cohorts and stratified middle-aged participants (index ages 40-59 years) who were free of CVD at baseline by sex and race. We categorized fasting TG levels as optimal (<100 mg/dL), intermediate (100 to 150 mg/dL), or elevated (>150mg/dL). We performed 1) Irwin’s restricted mean to estimate years lived free of and with CVD and 2) competing Cox models (adjusted for age, education, smoking, obesity, hypertension, diabetes, total cholesterol, and HDL-cholesterol) to estimate joint cumulative risks for CVD events (overall and by subtype) and non-CVD death. Results: Among the 20,406 participants, 26% were black and 55% were women. Elevated TG was associated with significantly fewer healthy years lived free of CVD in all race-sex groups (p<0.05 compared with optimal TG). Overall, competing cumulative incidence of CVD as well as non-CVD death was higher in intermediate and elevated TG subgroups compared with the optimal TG group. After adjustment for other risk factors, elevated TG were not associated with risks for any CVD subtype in black adults; among whites, elevated TG were associated with risk for stroke as a first event in men, and with all CVD subtypes in women (TABLE) . Discussion: Using pooled individual-level data from 5 large cohorts of middle-aged individuals, we observed differential competing risks by sex and race group for CVD subtypes associated with elevated TG. White women especially may have independent risk from elevated TG.