Key result
Low on-treatment triglycerides post-ACS linked to ~20% lower risk of recurrent events or death.
Why the study?
The PROVE IT-TIMI 22 trial showed that LDL-C <70 mg/dl was associated with greater CHD event reduction than LDL-C <100 mg/dl after ACS, but the impact of low on-treatment triglycerides on CHD risk beyond LDL-C <70 mg/dl had not been explored.
Does achieving on-treatment triglycerides <150 mg/dl reduce the composite of death, myocardial infarction, and recurrent acute coronary syndrome in patients hospitalized for acute coronary syndrome treated with statins?
RCT (n=4,162)
Randomized
Does achieving on-treatment triglycerides <150 mg/dl reduce the composite of death, myocardial infarction, and recurrent acute coronary syndrome in patients hospitalized for acute coronary syndrome treated with statins?
Answers are grounded in this paper and cite their sources.
Achieving on-treatment triglycerides <150 mg/dl after an acute coronary syndrome is independently associated with a lower risk of recurrent coronary heart disease events, even among patients who achieve LDL-C <70 mg/dl.
Objectives The purpose of this study was to assess the impact of on-treatment triglycerides (TG) on coronary heart disease (CHD) risk after an acute coronary syndrome (ACS). Background The PROVE IT-TIMI (Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction) 22 trial demonstrated that low-density lipoprotein cholesterol (LDL-C) <70 mg/dl was associated with greater CHD event reduction than LDL-C <100 mg/dl after ACS. However, the impact of low on-treatment TG on CHD risk beyond LDL-C <70 mg/dl has not been explored. Methods The PROVE IT-TIMI 22 trial evaluated 4,162 patients hospitalized for ACS and randomized to atorvastatin 80 mg or pravastatin 40 mg daily. The relationship between on-treatment levels of TG and LDL-C and the composite end point of death, myocardial infarction (MI), and recurrent ACS were assessed 30 days after initial presentation. Results Low on-treatment TG (<150 mg/dl) was associated with reduced CHD risk compared with higher TG in univariate analysis (hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.62 to 0.87; p < 0.001) and in adjusted analysis (HR 0.80, 95% CI 0.66 to 0.97; p = 0.025). For each 10-mg/dl decrement in on-treatment TG, the incidence of death, MI, and recurrent ACS was lower by 1.6% or 1.4% after adjustment for LDL-C or non-high-density lipoprotein cholesterol and other covariates (p < 0.001 and p = 0.01, respectively). Lower CHD risk was also observed with TG <150 mg/dl and LDL-C <70 mg/dl (HR 0.72, 95% CI 0.54 to 0.94; p = 0.017) or low on-treatment TG, LDL-C, and C-reactive protein (<2 mg/l) (HR 0.59, 95% CI 0.41 to 0.83; p = 0.002) compared with higher levels of each variable in adjusted analysis. Conclusions On-treatment TG <150 mg/dl was independently associated with a lower risk of recurrent CHD events, lending support to the concept that achieving low TG may be an additional consideration beyond low LDL-C in patients after ACS.
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Miller et al. (2008) conducted an RCT in Acute coronary syndrome (n=4,162). On-treatment triglycerides <150 mg/dl (in patients randomized to atorvastatin 80 mg or pravastatin 40 mg daily) vs. On-treatment triglycerides ≥150 mg/dl was evaluated on Composite of death, myocardial infarction, and recurrent acute coronary syndrome (HR 0.80, 95% CI 0.66-0.97, p=0.025). Low on-treatment triglycerides after ACS were independently associated with reduced death, MI, or recurrent ACS compared with higher levels.
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