Prevalence and Predictors of Residual Hypertriglyceridemia According to Statin Use in U.S. Adults with Diabetes

Abstract

Background: Hypertriglyceridemia (HTG) is associated with increased cardiovascular risk and is common in diabetes (DM); however, statin therapy remains the primary treatment in most with moderate HTG. We examined the extent of residual HTG despite statin treatment and in those with well-controlled LDL-C in adults with DM. Methods: We studied 1,448 subjects with DM projected to 24.4 million (11.1% of U.S. adults) in the U.S. National Health and Nutrition Examination Surveys 2007-2014 who had available morning fasting triglyceride (TG) levels. We compared the distribution of TG levels by statin use. Results: The Table shows in DM overall and by statin use the proportions with TG <150 mg/dl, 150-199 mg/dl, 200-499 mg/dl, and ≥500 mg/dl; nearly 40% despite statin use had TG ≥150 mg/dl. In addition, despite an LDL-C<100 mg/dl (<70 mg/dl in those with atherosclerotic cardiovascular disease), TG≥150 mg/dl and TG≥200 mg/dl were prevalent in 35.7% and 15.0% of statin users, respectively, and 36.2% and 17.4% of non-statin users, respectively. Conclusions: Residual HTG despite statin use remains common in more than a third (approximately 10 million) of U.S. adults with DM, even among statin users with well-controlled LDL-C levels. Greater efforts are needed to promote adherence to lifestyle measures, as well as use of pharmacologic therapies where indicated, to address the risks associated with residual HTG. Table. Estimated Proportions (%) of Adults within Different Levels of Fasting Triglycerides Among Those With Diabetes With and Without Statin Use, NHANES 2007-2014 (sample n and weighted n indicated in parenthesis) US Adults with DiabetesAllOn StatinNot on StatinTrigly<150mg/dL (n=7070, 163.0M)867 (14.1M)464 (7.5M, 60.5%)403 (6.6M, 54.6%)150≦Trigly<200mg/dL (n=1287, 29.5M)255 (4.9M)131 (2.5M, 20.0%)124 (2.4M, 20.1%)200≦Trigly<500mg/dL (n=1141, 25.3M)291 (4.8M)124 (2.2M, 18.1%)167 (2.6M, 21.7%)Trigly≧500mg/dL (n=95, 2.1M)35 (0.6M)11 (0.2M, 1.4%)24 (0.4M, 3.6%)Total (n=9593, 219.9M)1448 (24.4M)730 (12.4M)718 (12.0M)p=0.0686 comparing distribution of TG levels in those on versus not on statins. Disclosure W. Fan: None. S. Philip: Stock/Shareholder; Self; Amarin Corporation. Employee; Self; Amarin Corporation. C.B. Granowitz: Employee; Self; Amarin Corporation. P.P. Toth: Speaker's Bureau; Self; Amarin Corporation. Consultant; Self; Amarin Corporation. Speaker's Bureau; Self; Amgen Inc.. Consultant; Self; Amgen Inc.. Speaker's Bureau; Self; Kowa Pharmaceuticals America, Inc.. Consultant; Self; Kowa Pharmaceuticals America, Inc.. Speaker's Bureau; Self; Merck Sharp & Dohme Corp.. Consultant; Self; Merck Sharp & Dohme Corp.. Speaker's Bureau; Self; Regeneron Pharmaceuticals, Inc.. Consultant; Self; Regeneron Pharmaceuticals, Inc.. Speaker's Bureau; Self; Sanofi US, Novo Nordisk Inc. N.D. Wong: Research Support; Self; Amarin Corporation, Amgen Inc.. Speaker's Bureau; Self; Sanofi. Consultant; Self; Pfizer Inc.. Research Support; Self; Pfizer Inc..