Medical Care Utilization and Costs in Patients With Hypertriglyceridemia

Study Questions:

What are the medical costs associated with long-term high triglyceride (TG) levels among patients with statin-controlled low-density lipoprotein (LDL)?

Methods:

Data from an observational cohort from Kaiser Permanente Northwest and Kaiser Permanente Southern California were used for the present analysis. Patients who were ≥45 years, with documented atherosclerotic cardiovascular disease (ASCVD), had LDL cholesterol levels between 40 and 100 mg/dl, and were taking a statin at the time of TG measurement were included. Patients with TGs measured in 2010 and followed until death, disenrollment, or December 2016 were included. Medical utilization and costs were compared over a 6.5-year period among patients with high versus normal TG levels. High TG levels were defined as TGs between 200 and 400 mg/dl. Normal TG levels were defined as TGs <150 mg/dl.

Results:

A total of 17,183 patients were included, of which 2,702 had elevated TG levels. Patients in the elevated TG group were more likely to be obese, diabetic, and currently smoking. LDL levels were lower in the high TG group as compared to the normal TG level group (75 ± 16 vs. 76 ± 15, p = 0.003, respectively). Mean TG levels were 257 ± 58 in the elevated TG group and 98 ± 28 in the normal TG group. Patients with high TG levels had a mean of 13% more inpatient admissions per year compared to patients with normal TG levels after adjustment for age, sex, race/ethnicity, and study site. Patients with elevated TG levels also had greater medical utilization costs compared to those with normal TG levels. Costs related to emergency care were 6% greater, while costs related to hospital ambulatory care were 25% greater, despite adjustment for conditions such as diabetes and chronic kidney disease. The overall difference in annual costs of $964 per patient with high TG levels totaled >$2.6 million per year in excess annual costs and >$13.5 million over the mean follow-up of 5.2 years.

Conclusions:

The authors concluded that these results add to existing evidence, which supports the treatment of elevated TG levels among patients with established ASCVD.

Perspective:

These data suggest that TG levels should be reviewed with patients. Since lifestyle modification can result in significant reductions in TG levels, such modifications are important to promote. As the authors point out, pharmacotherapies to treat elevated TGs are also being evaluated in ongoing clinical trials.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Hypertriglyceridemia, Lipid Metabolism, Nonstatins, Novel Agents, Statins, Smoking

Keywords: Ambulatory Care, Atherosclerosis, Cholesterol, LDL, Cost of Illness, Diabetes Mellitus, Dyslipidemias, Emergency Medical Services, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hypertriglyceridemia, Inpatients, Life Style, Obesity, Primary Prevention, Renal Insufficiency, Chronic, Smoking, Triglycerides


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