Association between change in plasma triglyceride levels and risk of stroke and carotid atherosclerosis: systematic review and meta-regression analysis.
OBJECTIVE
The contribution of modifying non-low-density lipoprotein cholesterol (LDL-C) levels to reduce stroke risk remains uncertain. The aim of this study was to investigate the association between treatment-induced change in plasma triglyceride levels and risk of stroke and progression of carotid intima-media thickness (CIMT).


METHODS
We performed a systematic review and meta-regression analyses of randomized controlled trials of lipid-modifying treatments selected from a PubMed search on literature published from 1966 to 2008.


RESULTS
We identified 64 randomized controlled trials (active groups, n=96,807; control groups, n=98,681) that tested lipid-modifying drugs and reported triglyceride levels and stroke outcome. Extracting data from placebo groups, we found a statistically significant association between baseline triglyceride levels and stroke risk (adjusted relative risk [RR], 1.05 per 10-mg/dL increase; 95% CI, 1.03-1.07). Except for a trend in fibrate and niacin trials, there was no evidence of any relationship between degree of triglyceride change and stroke incidence. In multivariable meta-regression analysis including baseline and change in LDL-C, only change in LDL-C was associated with log risk ratio of all strokes (RR reduction, 4.5% per 10-mg/dL reduction; 95% CI, 1.7-7.2; P=.003). Similarly, taking into account 26 randomized controlled trials reporting CIMT outcome, LDL-C reduction was associated with reduced CIMT progression (-3.0 microm/y per 10-mg/dL reduction; 95% CI, -5.5 to -0.4; P=.03).


CONCLUSIONS
In view of the limitations of meta-regression analysis and CIMT measures as surrogate endpoints in lipid-lowering drugs trials, additional studies are needed to more precisely quantify the detrimental effect of triglyceride levels on stroke risk and to establish the efficacy of triglyceride-lowering therapy in addition to LDL-C reduction.
Labreuche
Julien
J
INSERM U-698 and Denis Diderot University-Paris VII, France.
Deplanque
Dominique
D
Touboul
Pierre-Jean
PJ
Bruckert
Eric
E
Amarenco
Pierre
P
D015415:Biomarkers / Q000097:blood; D002339:Carotid Arteries / Q000473:pathology; D002340:Carotid Artery Diseases / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D002784:Cholesterol / Q000097:blood; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008074:Lipoproteins / Q000097:blood; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood*; D017539:Tunica Intima / Q000473:pathology; D017540:Tunica Media / Q000473:pathology
D015415:Biomarkers; D000960:Hypolipidemic Agents; D008074:Lipoproteins; D014280:Triglycerides; D002784:Cholesterol