Do triglyceride-lowering drugs decrease risk of cardiovascular disease?

Abstract

This review summarizes the evidence supporting a relationship between lowering triglycerides (TGs) and TG-rich lipoprotein cholesterol (TGRL-C) levels and reduced atherosclerotic cardiovascular disease (ASCVD) event risk. Data from observational investigations, including studies of genetic variants, provide evidence consistent with a causal relationship between elevations in TG and TGRL-C and greater risk for ASCVD. Randomized controlled trial evidence of ASCVD risk reduction with therapies that substantially lower TG and TGRL-C is limited by the fact that no large-scale trial results have been published from a study that enrolled subjects selected specifically on the basis of TG or TGRL-C elevation, although three such trials are underway or in the planning stages. Subgroup analyses from randomized controlled trials are suggestive of a reduction in coronary heart disease and ASCVD event rates with statins, fibrates, omega-3 fatty acid concentrates, and niacin in subjects with elevated TGs, particularly if accompanied by low high-density lipoprotein-cholesterol. Mechanistic studies also support the biologic plausibility of this relationship. In conclusion, the available data are suggestive of a benefit of ASCVD reduction with therapies that lower TG and TGRL-C; results from ongoing outcomes trials are expected to provide definitive evidence of this relationship.