High LDL Triglycerides Associated With Higher Risk of ASCVD

A robust association was found between elevated LDL triglycerides and an increased risk of atherosclerotic cardiovascular disease (ASCVD) and its individual components (ischemic heart disease [IHD], myocardial infarction [MI], ischemic stroke and peripheral artery disease [PAD]), according to a study published Jan. 9 in JACC.

Mie Balling, MD, et al., conducted two prospective studies within the Copenhagen General Population Study using different assays to strengthen the inference. The first included 38,081 individuals in whom LDL triglycerides were measured in fresh samples using direct automated assay (direct LDL triglycerides), and the second included 30,208 individuals in whom the measurement was in samples that had been frozen using nuclear magnetic resonance (NMR). Then the investigators aggregated the findings from these two studies along with the findings from six previous studies into a meta-analysis that ultimately included >110,000 individuals and >15,000 events.

Results showed that over the median follow-up of three years for the first study using direct LDL triglycerides and 9.2 years for the second study using NMR, a diagnosis of ASCVD was made in 872 and 5,766 participants, respectively. Similarly, more participants in the second study were diagnosed with each of the components: 539 and 4,037 with IHD; 233 and 2,313 with MI; 295 and 2,349 with ischemic stroke; 210 and 894 with PAD; and 75 and 535 with hemorrhagic stroke.

Multivariable adjusted analyses showed that for each 0.1 mmol/L (9 mg/dL) higher direct LDL triglycerides, the hazard ratio (HR) was 1.26 for ASCVD and ranged from 1.22-1.38 for the components. For the NMR measured LDL triglycerides the HR was 1.26 for ASCVD and ranged from 1.13-1.33 for the components. The random-effects risk ratio for the highest vs. the lowest quartile in the meta-analyses was 1.50 for ASCVD.

The authors note that these are the first meta-analysis on LDL triglycerides related to the risk of ASCVD and its components. They go on to say that direct assay of LDL triglycerides could be beneficial when assessing ASCVD risk, “allowing inexpensive and fast delivery of results through electronic medical records, just like any other blood test performed for routine use.”

In an accompanying editorial comment, P. Barton Duell, MD, states that “it is possible that a direct autoanalyzer measurement of LDL triglycerides may provide a readily accessible and standardized tool for assessing ASCVD risk in patients with hypertriglyceridemia in association with standard lipid profile determinations.”

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Hypertriglyceridemia, Lipid Metabolism

Keywords: Infarction, Electronics, Peripheral Arterial Disease, Myocardial Ischemia, Hypertriglyceridemia, Triglycerides, Atherosclerosis, Follow-Up Studies, Cardiovascular Diseases, Odds Ratio, Ischemic Stroke, Prospective Studies

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