title: Fasting triglycerides predict recurrent ischemic events in patients with acute coronary syndrome treated with statins.
abstract: BACKGROUND
  Most patients with acute coronary syndrome (ACS) are treated with statins, which reduce atherogenic triglyceride-rich lipoproteins. It is uncertain whether triglycerides predict risk after ACS on a background of statin treatment.
  
  
  OBJECTIVE
  This study examined the relationship of fasting triglyceride levels to outcomes after ACS in patients treated with statins.
  
  
  METHODS
  Long-term and short-term relationships of triglycerides to risk after ACS were examined in the dal-OUTCOMES trial and atorvastatin arm of the MIRACL (Myocardial Ischemia Reduction with Acute Cholesterol Lowering) trial, respectively. Analysis of dal-OUTCOMES included 15,817 patients (97% statin-treated) randomly assigned 4 to 12 weeks after ACS to treatment with dalcetrapib (a cholesteryl ester transfer protein inhibitor) or placebo and followed for a median 31 months. Analysis of MIRACL included 1,501 patients treated with atorvastatin 80 mg daily beginning 1 to 4 days after ACS and followed for 16 weeks. Fasting triglycerides at initial random assignment were related to risk of coronary heart disease death, nonfatal myocardial infarction, stroke, and unstable angina in models adjusted for age, sex, hypertension, smoking, diabetes, high-density lipoprotein cholesterol, and body mass index.
  
  
  RESULTS
  Fasting triglyceride levels were associated with both long-term and short-term risk after ACS. In dal-OUTCOMES, long-term risk increased across quintiles of baseline triglycerides (p<0.001). The hazard ratio in the highest/lowest quintile (>175/≤80 mg/dl) was 1.61 (95% confidence interval: 1.34 to 1.94). There was no interaction of triglycerides and treatment assignment on the primary outcome. In the atorvastatin group of MIRACL, short-term risk increased across tertiles of baseline triglycerides (p=0.03), with a hazard ratio of 1.50 [corrected] (95% confidence interval: 1.05 to 2.15) in highest/lowest tertiles (>195/≤135 mg/dl). The relationship of triglycerides to risk was independent of low-density lipoprotein cholesterol in both studies.
  
  
  CONCLUSIONS
  Among patients with ACS treated effectively with statins, fasting triglycerides predict long-term and short-term cardiovascular risk. Triglyceride-rich lipoproteins may be an important additional target for therapy. (A Study of RO4607381 in Stable Coronary Heart Disease Patients With Recent Acute Coronary Syndrome; NCT00658515).
authors.affiliation: Cardiology Section, VA Medical Center and University of Colorado School of Medicine, Denver, Colorado. Electronic address: Gregory.Schwartz@va.gov.
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Schwartz
authors.affiliation: Pharma Development, F. Hoffmann-La Roche, Basel, Switzerland.
authors.forename: Markus
authors.initials: M
authors.lastname: Abt
authors.affiliation: Pfizer, Inc., New York, New York.
authors.forename: Weihang
authors.initials: W
authors.lastname: Bao
authors.affiliation: Pfizer, Inc., New York, New York.
authors.forename: David
authors.initials: D
authors.lastname: DeMicco
authors.affiliation: Pharma Development, F. Hoffmann-La Roche, Basel, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Kallend
authors.affiliation: Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Michael
authors.initials: M
authors.lastname: Miller
authors.affiliation: Pharma Development, F. Hoffmann-La Roche, Basel, Switzerland.
authors.forename: Hardi
authors.initials: H
authors.lastname: Mundl
authors.affiliation: Stockholm Heart Center, Stockholm, Sweden; University of Linköping, Linköping, Sweden.
authors.forename: Anders G
authors.initials: AG
authors.lastname: Olsson
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000188:drug therapy; D000368:Aged; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D005215:Fasting; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012008:Recurrence; D018570:Risk Assessment; D014280:Triglycerides / Q000097:blood*
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D014280:Triglycerides
keywords: lipids; myocardial infarction; unstable angina