Residual hypertriglyceridemia (HTG) despite statin therapy is common in adults with diabetes in the United States and many of these patients continue to have moderate or increased cardiovascular risk over the long term, according to study results published in Diabetes Care.
Reports indicate that more than half of adults with diabetes have borderline (triglyceride level 150-199 mg/dL) or overt (triglyceride level ≥200 mg/dL) HTG. While statins are the first-line therapy for dyslipidemia in patients with diabetes, a significant number of patients have residual HTG despite treatment. The goal of the study was to assess the percentage of adults with diabetes with borderline HTG or HTG with and without statin treatment, as well as the estimated 10-year risk for atherosclerotic cardiovascular disease (ASCVD).
The study cohort included 1448 adults with diabetes aged ≥20 years from the National Health and Nutrition Examination Survey (NHANES) 2007 to 2014. Approximately one-fifth of the patients (20.1%) had borderline and 22.5% had overt HTG. Prevalence of HTG was 19.5% in statin-treated patients and 25.3% in patients who did not receive statins (P <.0001).
Of patients with a low-density lipoprotein cholesterol (LDL-C) level <70 mg/dL, 16.7% had HTG compared with 15.4% of patients with LDL-C levels between 70 and 99 mg/dL, 22.0% with levels between 100 and 129 mg/dL, 15.9% with levels between 130 and 159 mg/dL, and 28.6% with higher levels. In individuals who did not use statins, HTG was prevalent in 11.5%, 23.2%, 9.2%, 31.4%, and 39.0% of these LDL-C groups, respectively (P <.0001).
Most patients had a 10-year estimated ASCVD risk ≥7.5%, including 68.7% of patients with normal triglyceride levels, 62.7% of patients with borderline HTG, and 77.5% in patients with HTG. One-third of patients with diabetes and HTG overall and approximately 40% of statin users were found to be at high long-term cardiovascular risk (estimated ASCVD risk ≥20%).
The researchers acknowledged several study limitations, including that the cross-sectional design did not allow for follow-up of ASCVD events; possible underestimation of ASCVD as the estimates only apply to adults with diabetes aged 40 to 79 years; and lack of information on duration, intensity, and adherence to statin use.
“This warrants greater attention toward improved efforts such as lifestyle management as the cornerstone for managing dyslipidemia, as well as consideration of newer evidence based therapies to reduce residual ASCVD risk that remains despite statin-controlled LDL-C,” concluded the researchers.
Fan W, Philip S, Granowitz C, Toth PP, Wong ND. Residual hypertriglyceridemia and estimated atherosclerotic cardiovascular disease risk by statin use in U.S. adults with diabetes: National Health and Nutrition Examination Survey 2007-2014 [published online October 1, 2019]. Diabetes Care. doi:10.2337/dc19-0501