Increased Cardiovascular Risk in Patients with Diabetes, Statin-Controlled LDL Cholesterol, and Residual Hypertriglyceridemia

Abstract

High triglyceride (TG) levels are common in type 2 diabetes (T2D). We evaluated T2D patients at high risk for CV events who had statin-controlled LDL cholesterol (LDLc) to determine whether the presence of high TG levels contribute to residual CV risk. We combined data from the Southern California and Northwest regions of Kaiser Permanente to identify adults on statin therapy with LDLc 40-100 mg/dL, no other lipid therapies, and with T2D and a prior diagnosis of myocardial infarction, ischemic stroke, peripheral artery disease or at least one other CV risk factor. Patients were grouped into high (200-499 mg/dL, n=5,542) or normal (<150 mg/dL, n=22,411) TGs in 2010 and followed them through December 2016 to compare the adjusted incidence rates and rate ratios of first non-fatal MI, non-fatal stroke, unstable angina, coronary revascularization, death, and their composite. Models were adjusted for demographic and clinical characteristics using generalized linear models with Poisson errors. Over mean follow-up of 5 years, patients with high TG were at increased risk of CV outcomes (Table). High TG levels independently increase CV risk in T2D patients with statin-controlled LDLc. The ongoing CV outcome trial, REDUCE-IT, will determine if high dose pure prescription eicosapentaenoic acid reduces CV risk among statin users with persistently high TG levels, including T2D patients. Disclosure G. Nichols: Research Support; Self; Boehringer Ingelheim GmbH, Amarin Corporation, Janssen Pharmaceuticals, Inc., Sanofi. S. Philip: Stock/Shareholder; Self; Amarin Corporation. Employee; Self; Amarin Corporation. C.B. Granowitz: Employee; Self; Amarin Corporation. K. Reynolds: Research Support; Self; Amarin Corporation, Novartis Pharmaceuticals Corporation, Amgen Inc., CSL Behring. S. Fazio: Consultant; Self; Amarin Corporation, Akcea Therapeutics, Amgen Inc., Kowa Pharmaceuticals America, Inc..