Higher nonfasting triglycerides increase the risk of heart failure
Nonfasting Triglycerides, Low-Density Lipoprotein Cholesterol, and Heart Failure Risk: Two Cohort Studies of 113 554 IndividualsLiterature - Varbo A and Nordestgaard BG. - ATVB 2018; published online ahead of print
- When compared with low nonfasting TGs (below 1 mmol/L or 88 mg/dL), stepwise higher nonfasting TGs were associated with a stepwise higher HF risk, with multivariable adjusted HRs ranging from 1.32 (95% CI: 1.06–1.65) for nonfasting TGs of 1-1.99 mmol/L (88-175 mg/dL) to 2.59 (95% CI: 1.48–4.54) for nonfasting TGs ≥5 mmol/L (440 mg/dL).
- The HR for HF for a 1 mmol/L (88 mg/dL) higher concentration of nonfasting TGs was 1.19 (95% CI: 1.12–1.26), which was similar after stratification for conventional HF risk factors. There was no evidence for interactions between nonfasting TGs and HF risk factors.
- The analysis of the Copenhagen City Heart Study confirmed the findings of the Copenhagen General Population Study: compared with low nonfasting TGs, multivariable adjusted HRs for nonfasting TGs of 1-1.99 mmol/L ranged from 1.28 (95% CI: 0.93–1.75) to 2.33 (95% CI: 1.22–4.45) for nonfasting TGs ≥5 mmol/L.
- The cumulative incidence of HF was higher for stepwise higher nonfasting TGs: the subHRs ranged from 1.17 (95% CI: 1.04–1.32) for nonfasting TGs of 1-1.99 mmol/L to 1.95 (95% CI: 1.45–2.63) for nonfasting TGs ≥5 mmol/L, when compared with individuals with low nonfasting TGs.
- The proportion of effect mediated through IHD was 34% (95% CI: 26%–49%), for MI 22% (95% CI: 16%–32%), and for IHD without MI 13% (95% CI: 9%–18%).
- There was no association between stepwise higher LDL-c concentrations and HF risk. The HR for HF for a 1 mmol/L (38.6 mg/dL) higher LDL-c was 0.95 (95% CI; 0.88–1.04).
Stepwise higher concentrations of nonfasting TGs were associated with stepwise higher risk of HF, which was not the case for LDL-c. These findings support the need for further investigations examining whether TG and remnant cholesterol lowering in those with high concentrations would lower the HF risk.