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Triglyceride Levels and Increased Medical Care Utilization
Study Questions:
Are triglyceride (TG) levels between 200 and 499 mg/dl in patients with atherosclerotic cardiovascular disease (ASCVD) associated with greater healthcare utilization?
Methods:
This is an observational cohort study using data from two Kaiser Permanente Centers. Eligible patients were aged ≥45 years with documented ASCVD who had a TG level <500 mg/dl (in 2010), were receiving statin therapy but no other antihyperlipidemic agents, and had low-density lipoprotein cholesterol (LDL-C) values between 40 and 100 mg/dl. Patients were grouped by TG levels as high (200-400 mg/dl) and low (<150 mg/dl). All participants were followed until death or disenrollment or to the end of 2016. The primary outcomes were medical utilization and costs over 6.5 years.
Results:
A total of 2,702 patients were in the high TG group and 14,481were in the normal TG group. Patients with higher TG levels were more likely to be younger age, white or Hispanic, and current smokers. Over one-half had diabetes compared with 38% of the low TG group. Those in the high TG group had lower high-density lipoprotein (HDL) and higher blood pressure than the low TG group. LDL levels were 75 ± 16 in the high TG group and 78 ± 15 in the low TG group. After multivariable adjustment, patients with high TG levels had a mean of 13% more inpatient admissions per year (p < 0.001). After adjustment for comorbidities including diabetes, chronic kidney disease, and obesity, total outpatient costs were 5% greater (p = 0.035) among those with high TG, including emergency care costs (6% greater) and hospital ambulatory costs (25% greater). The overall difference in annual costs of $964 per patient in the high TG cohort totaled over $2.6 million per year in excess annual costs and more than $13.5 million over the mean follow-up of 5.2 years.
Conclusions:
The authors concluded that elevated TGs are associated with higher health care utilization and costs, suggesting that efforts to reduce TG levels may be beneficial to patients.
Perspective:
These data suggest that elevated TGs are associated with worse outcomes among patients with ASCVD, even when LDL-C appears well controlled. However, factors including diabetic control, physical activity, and dietary pattern were not examined in multivariate models, which may have mediated the relationship between TGs and healthcare utilization. Further research regarding the association of TG levels and health is warranted. Clinicians are recommended to advise patients regarding a healthy lifestyle, which can improve TG levels in addition to CV risk factors such as elevated blood pressure, glucose control, and lipids.
Keywords: Atherosclerosis, Blood Pressure, Cholesterol, LDL, Cholesterol, HDL, Diabetes Mellitus, Dyslipidemias, Emergency Medical Services, Exercise, Glucose, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hypertriglyceridemia, Lipids, Lipoproteins, HDL, Obesity, Primary Prevention, Renal Insufficiency, Chronic, Risk Factors, Smoking, Triglycerides
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