Fasting triglyceride levels predict cardiovascular risk after ACS

An analysis of two randomized, double-blind studies found that fasting triglyceride levels predicted outcomes and cardiovascular risk in patients with acute coronary syndrome (ACS) who were successfully treated with statins.

Gregory G. Schwartz, MD, PhD, of the University of Colorado School of Medicine in Denver, and colleagues published their findings online in the Journal of the American College of Cardiology on May 26.

They mentioned that treatment options for ACS typically focus on lowering low-density lipoprotein cholesterol (LDL-C) or increasing high-density lipoprotein cholesterol (HDL-C).

Schwartz et al examined the dal-OUTCOMES (A Study of RO4607381 in Stable Coronary Heart Disease Patients with Recent Acute Coronary Syndrome) and MIRACL (Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering) trials.

The dal-OUTCOMES study compared dalcetrapib with placebo in 15,871 patients with ACS and took place between 2008 and 2012 at 935 sites in 27 countries. In the MIRACL study, 3,086 patients with ACS enrolled between 1997 and 2000 at 122 sites in 19 countries and received atorvastatin or placebo.

The mean age was 60 years in the dal-OUTCOMES study and 65 years in the MIRACL study, while 80 percent and 66 percent of patients in the groups, respectively, were males.

In both trials, fasting triglyceride levels were associated with long-term and short-term ischemic risk, even after Schwartz et al adjusted for risk factors typically associated with triglyceride levels such as age, sex, hypertension, smoking, body mass index, LDL-C and HDL-C.

Despite the results, Schwartz et al suggested that future trials should evaluate the efficacy of triglyceride-lowering interventions in patients with ACS. They said newer agents such as omega-3 fatty acid derivatives and antibodies to PCSK9 have been shown to significantly reduce triglyceride-rich lipoproteins.

F. Hoffmann-La Roche funded the dal-OUTCOMES trial, while Pfizer funded the MIRACL trial.