title: Elevated Triglyceride Level Is Independently Associated With Increased All-Cause Mortality in Patients With Established Coronary Heart Disease: Twenty-Two-Year Follow-Up of the Bezafibrate Infarction Prevention Study and Registry.
abstract: BACKGROUND
  The independent association between elevated triglycerides and all-cause mortality among patients with established coronary heart disease is controversial. The aim of this study was to investigate this association in a large cohort of patients with proven coronary heart disease.
  
  
  RESULTS
  The study cohort comprised 15 355 patients who were screened for the Bezafibrate Infarction Prevention (BIP) trial. Twenty-two-year mortality data were obtained from the national registry. Patients were divided into 5 groups according to strata of fasting serum triglycerides: (1) low-normal triglycerides (<100 mg/dL); (2) high-normal triglycerides (100-149 mg/dL); (3) borderline hypertriglyceridemia triglycerides (150-199 mg/dL); (4) moderate hypertriglyceridemia triglycerides (200-499 mg/dL); (5) severe hypertriglyceridemia triglycerides (≥500 mg/dL). Age- and sex-adjusted survival was 41% in the low-normal triglycerides group than 37%, 36%, 35%, and 25% in groups with progressively higher triglycerides (P<0.001). In an adjusted Cox-regression for various covariates including high-density lipoprotein cholesterol, each 1 unit of natural logarithm (Ln) triglycerides elevation was associated with a corresponding 6% (P=0.016) increased risk of 22-year all-cause mortality. The 22-year mortality risk for patients with severe hypertriglyceridemia was increased by 68% when compared with patients with low-normal triglycerides (P<0.001).
  
  
  CONCLUSIONS
  In patients with established coronary heart disease, higher triglycerides levels are independently associated with increased 22-year mortality. Even in patients with triglycerides of 100 to 149 mg/dL, the elevated risk for death could be detected than in patients with lower triglycerides levels, whereas severe hypertriglyceridemia denotes a population with particularly increased mortality risk.
authors.affiliation: From The Heart Center, Sheba Medical Center, Tel-Hashomer, Israel (R.K., A.E., B.-Z.S., I.G., E.F., A.T.); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (B.-Z.S., I.G., E.F., A.T.); Heart Research Follow-up Program, University of Rochester Medical Center, NY (I.G.); Public Health Department, Ministry of Health, Jerusalem, Israel (E.K.); and The Israeli Association for Cardiovascular Trials, Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel (N.S., A.I.).
authors.forename: Robert
authors.initials: R
authors.lastname: Klempfner
authors.affiliation: From The Heart Center, Sheba Medical Center, Tel-Hashomer, Israel (R.K., A.E., B.-Z.S., I.G., E.F., A.T.); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (B.-Z.S., I.G., E.F., A.T.); Heart Research Follow-up Program, University of Rochester Medical Center, NY (I.G.); Public Health Department, Ministry of Health, Jerusalem, Israel (E.K.); and The Israeli Association for Cardiovascular Trials, Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel (N.S., A.I.). Aharon.erez@sheba.health.gov.il.
authors.forename: Aharon
authors.initials: A
authors.lastname: Erez
authors.affiliation: From The Heart Center, Sheba Medical Center, Tel-Hashomer, Israel (R.K., A.E., B.-Z.S., I.G., E.F., A.T.); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (B.-Z.S., I.G., E.F., A.T.); Heart Research Follow-up Program, University of Rochester Medical Center, NY (I.G.); Public Health Department, Ministry of Health, Jerusalem, Israel (E.K.); and The Israeli Association for Cardiovascular Trials, Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel (N.S., A.I.).
authors.forename: Ben-Zekry
authors.initials: BZ
authors.lastname: Sagit
authors.affiliation: From The Heart Center, Sheba Medical Center, Tel-Hashomer, Israel (R.K., A.E., B.-Z.S., I.G., E.F., A.T.); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (B.-Z.S., I.G., E.F., A.T.); Heart Research Follow-up Program, University of Rochester Medical Center, NY (I.G.); Public Health Department, Ministry of Health, Jerusalem, Israel (E.K.); and The Israeli Association for Cardiovascular Trials, Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel (N.S., A.I.).
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: From The Heart Center, Sheba Medical Center, Tel-Hashomer, Israel (R.K., A.E., B.-Z.S., I.G., E.F., A.T.); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (B.-Z.S., I.G., E.F., A.T.); Heart Research Follow-up Program, University of Rochester Medical Center, NY (I.G.); Public Health Department, Ministry of Health, Jerusalem, Israel (E.K.); and The Israeli Association for Cardiovascular Trials, Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel (N.S., A.I.).
authors.forename: Enrique
authors.initials: E
authors.lastname: Fisman
authors.affiliation: From The Heart Center, Sheba Medical Center, Tel-Hashomer, Israel (R.K., A.E., B.-Z.S., I.G., E.F., A.T.); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (B.-Z.S., I.G., E.F., A.T.); Heart Research Follow-up Program, University of Rochester Medical Center, NY (I.G.); Public Health Department, Ministry of Health, Jerusalem, Israel (E.K.); and The Israeli Association for Cardiovascular Trials, Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel (N.S., A.I.).
authors.forename: Eran
authors.initials: E
authors.lastname: Kopel
authors.affiliation: From The Heart Center, Sheba Medical Center, Tel-Hashomer, Israel (R.K., A.E., B.-Z.S., I.G., E.F., A.T.); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (B.-Z.S., I.G., E.F., A.T.); Heart Research Follow-up Program, University of Rochester Medical Center, NY (I.G.); Public Health Department, Ministry of Health, Jerusalem, Israel (E.K.); and The Israeli Association for Cardiovascular Trials, Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel (N.S., A.I.).
authors.forename: Nir
authors.initials: N
authors.lastname: Shlomo
authors.affiliation: From The Heart Center, Sheba Medical Center, Tel-Hashomer, Israel (R.K., A.E., B.-Z.S., I.G., E.F., A.T.); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (B.-Z.S., I.G., E.F., A.T.); Heart Research Follow-up Program, University of Rochester Medical Center, NY (I.G.); Public Health Department, Ministry of Health, Jerusalem, Israel (E.K.); and The Israeli Association for Cardiovascular Trials, Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel (N.S., A.I.).
authors.forename: Ariel
authors.initials: A
authors.lastname: Israel
authors.affiliation: From The Heart Center, Sheba Medical Center, Tel-Hashomer, Israel (R.K., A.E., B.-Z.S., I.G., E.F., A.T.); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (B.-Z.S., I.G., E.F., A.T.); Heart Research Follow-up Program, University of Rochester Medical Center, NY (I.G.); Public Health Department, Ministry of Health, Jerusalem, Israel (E.K.); and The Israeli Association for Cardiovascular Trials, Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel (N.S., A.I.).
authors.forename: Alexander
authors.initials: A
authors.lastname: Tenenbaum
mesh_terms: D000368:Aged; D001629:Bezafibrate / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality* / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015228:Hypertriglyceridemia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D000960:Hypolipidemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood*; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D000960:Hypolipidemic Agents; D014280:Triglycerides; D001629:Bezafibrate
keywords: cholesterol HDL; coronary disease; hypertriglyceridemia; mortality; triglycerides