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Triglycerides predict CV risk in normoglycemic.


PARIS--Postprandial triglyceride levels helped assess cardiovascular risk in patients with normal glucose tolerance but provided no extra prognostic information in those with impaired glucose tolerance or diabetes in a prospective study of 514 consecutive patients with stable coronary artery disease.

In the Homburg Cream and Sugar Study, subjects undergoing coronary angiography ate a standardized dinner at 6 p.m., fasted overnight, and at 8 a.m. drank 250 mL of cream containing 75 g of fat. Three hours later, those not receiving treatment for diabetes also drank 250 mL of water containing 75 g of glucose.

Researchers then measured fasting and postprandial triglyceride concentrations, followed by insulin concentrations and glucose tolerance. Follow-up at 12 and 18 months identified cardiovascular (CV) events. Diabetes was present in 46% of patients, and 25% had completely normal glucose tolerance. Patient characteristics were typical of those with coronary artery disease, Dr. Ulrich Laufs and his associates reported at the congress. For the cohort as a whole, postprandial triglyceride levels did not correlate with the primary outcome, a composite of CV deaths or hospitalizations for CV events. A weak correlation between fasting triglycerides and the primary outcome became nonsignificant in multivariate analysis.

Fasting triglyceride levels, and to a greater extent postprandial triglyceride levels, were independent markers for the primary CV outcomes, said Dr. Laufs of Saarland University Hospital, Homburg, Germany. But in patients with diabetes and impaired fasting glucose, absolute fasting and postprandial triglyceride levels were high but did not independently predict risk of CV death or hospitalization.

The highest tertile of triglyceride concentrations--levels above 150 mg/dL -in patients with normal glucose tolerance predicted a tripling in risk for the CV end points, compared with the middle and lowest tertiles. The highest tertile of postprandial, triglyceride levels predicted a fourfold increased risk in patients with normal glucose tolerance. The researchers controlled for risk factors including other lipids, age, and sex.

These findings were "a little bit surprising," Dr. Laufs said.

The study was designed to address the debate about whether triglyceride levels add to other measures of CV risk. "There is evidence from primary prevention studies and mechanistic basic science studies that maybe the triglyceride-rich lipoproteins that are increased after a meal may be especially atherogenic," Dr. Laufs said.

"We may have to focus more on patients with normal glucose tolerance. If those patients have high fasting triglycerides, they have increased risk," Dr. Laufs said.


Novel Findings Are Provocation

This study confirmed that fasting triglycerides did not predict CV risk in the whole cohort, and it found that postprandial triglycerides did not predict risk after adjustment for other factors.

That both the fasting and postprandial triglyceride levels predicted CV outcomes in those who had normal glucose tolerance, but not in those with impaired glucose tolerance or diabetes, is something that has not been reported before.

The small sample size for what is an epidemiologic study, and the short follow-up--and, as a consequence, the small number of C V events--limit the conclusions. We cannot just assume that this is a proven case. The combined end point was soft.

The hospitalization end point allows for a subjective element. There is no indication of the mechanism responsible for the findings. Even so, this is a very interesting finding, if real. This was the first study designed to assess whether glucose metabolism status impacts the ability of triglyceride levels to predict CV risk. The answer is, "Yes."

The results are provocative and, if real, have important clinical implications.

Philip Barter, M.D., of the Heart Research Institute, Sydney, disclosed ties to AstraZeneca, CSL, Merck, Novartis, Pfizer, Roche, and Sanofi Aventis. He made these comments as the official discussant of the paper.


Major Finding: Higher triglyceride levels independently predicted higher cardiovascular risk in patients with stable coronary artery disease who had normal glucose tolerance, but not in those with impaired glucose tolerance or diabetes.

Data Source: Prospective cohort study of 514 patients with stable coronary artery disease who were undergoing coronary angiography.

Disclosures: Dr. Laufs has been a speaker for nearly all pharmaceutical companies dealing with lipids.
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Title Annotation:CARDIOLOGY
Author:Boschert, Sherry
Publication:Internal Medicine News
Article Type:Clinical report
Date:Sep 15, 2011
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