INCREASED RESIDUAL CARDIOVASCULAR RISK IN US VETERANS AND MONERATELY-ELEVATED BASELINE TRIGLYCERIDES AND WELL-CONTROLLED LDL-C LEVELS ON STATINS

Abstract

Background: Recent studies have suggested a causal role for elevated triglycerides (TG) in incident cardiovascular (CV) events. Using a large cohort of U.S. veterans with statin-controlled LDL-C levels (40-100mg/dL), we explored whether increased residual CV risk existed in patients with elevated baseline TG levels versus those with normal TG levels. Method(s): We identified veterans receiving a statin but not a TG-lowering agent from the VA Corporate Data Warehouse, a database of the VA electronic health record, from 2010-2015. We compared CV event rates (nonfatal MI, stroke, unstable angina, or coronary revascularization) between the elevated TG (150-500mg/dL) and normal TG (<150mg/dL) groups. We calculated crude event rates, rate ratios, and 95% CI for both groups, and adjusted event rate ratios for baseline blood pressure, HbA1C, glomerular filtration rate, and HDL-C. Result(s): We included 439,019 veterans (predominantly male and white) in the analysis cohort of whom 132,203 (30%) had elevated TG levels. These subjects were younger and had higher BMIs. Table 1 details the comparative baseline data and CV event rates. The overall crude and adjusted CV event rate ratios were 1.37 (95% CI 1.34,1.40; P<0.001) and 1.19 (95% CI 1.16, 1.22; P<0.001), respectively. Conclusion(s): In this large cohort of veterans, those with elevated TG levels showed a significant increase in CV events despite well-controlled LDL-C on statins and adjustment for HDL-C compared to veterans whose baseline TG was in a normal range. [Figure presented]Copyright 2019 American College of Cardiology Foundation. All rights reserved.