Global and country-level frequencies of hypertriglyceridemia and combined hyperlipidemia in CHD

In a cross-sectional analysis of INTERASPIRE, 33% of the CHD patients worldwide had hypertriglyceridemia and 26% had residual combined hyperlipidemia, although there was wide variation between countries.

This summary is based on the publication of Santos RD, Ray KK, De Bacquer D, et al. - Frequency of residual combined dyslipidemia and hypertriglyceridemia in patients with coronary heart disease in 13 countries across 6 WHO Regions: Results from INTERASPIRE. Atherosclerosis. 2025 Jun;405:119215. doi: 10.1016/j.atherosclerosis.2025.119215.

Introduction and methods

Background

Elevated triglyceride (TG) levels are independently associated with risk of ASCVD, even when LDL-c levels appear to be under control [1-5]. To decide on the best preventive strategies to reduce ASCVD burden, systematic information on the global distribution of residually elevated levels of TG and LDL-c is needed.

Aim of the study

The authors examined the frequencies of hypertriglyceridemia and residual combined hyperlipidemia in patients with CHD worldwide and at country-level, as well as the patient characteristics related to hypertriglyceridemia.

Methods

This was a cross-sectional analysis of the INTERASPIRE (International Action on Secondary Prevention through Intervention to Reduce Events) study, an international longitudinal survey on secondary prevention in patients with a recent hospitalization for CHD conducted in 14 countries across all 6 WHO regions [6,7]. Standardized study interview data and lipid profiles were available for 4069 participants in 13 countries (excluding Egypt). They were evaluated at a median time of 1.10 years (IQR: 0.77–1.49) after their index CHD hospitalization.

Outcomes

The primary endpoints were the prevalences of hypertriglyceridemia (i.e., TG ≥1.7 mmol/L) and residual combined hyperlipidemia (i.e., TG ≥1.7 mmol/L and LDL-c ≥1.8 mmol/L) at country level.

Main results

Prevalences of hypertriglyceridemia and combined hyperlipidemia

• Overall, 12.7% of the patients were not taking any lipid-lowering therapy (LLT), 50.0% received high-dose statin monotherapy, 11.4% were treated with statin and ezetimibe combination therapy, 0.4% were on PCSK9 inhibitors, and 2.3% were prescribed specific TG-lowering therapies such as fibrates or omega-3 fatty acids.
• The median TG level was 1.36 mmol/L (IQR: 1.01–1.88), but this varied between countries and also depended on the use and intensity of LLT.
• The global prevalence of hypertriglyceridemia was 32.6%, with the highest percentages seen in Indonesia (44.8%), Colombia (43.5%), and Argentina (43.2%) and the lowest in Portugal (22.7%) and Nigeria (23.3%).
• The prevalence of combined hyperlipidemia was 24.6%, with the highest rates found in Indonesia (40.3%), Colombia (34.7%), and Argentina (31.1%) and the lowest in China (14.4%) and Portugal (16.1%).
• Of note, 30.0% of the total study population achieved TG <1.7 mmol/L and LDL-c <1.8 mmol/L.

Factors related to hypertriglyceridemia

• Multivariate logistic regression analysis adjusted for variables including age, sex, and self-reported diabetes demonstrated hypertriglyceridemia was independently associated with female sex (adjusted OR: 1.23; 95%CI: 1.01–1.48; P=0.035), current smoking (adjusted OR: 1.52; 95%CI: 1.25–1.85; P<0.0001), higher BMI (per 5 kg/m²; adjusted OR: 1.21; 95%CI: 1.12–1.31; P<0.0001), higher systolic blood pressure (per 10 mmHg; adjusted OR: 1.06; 95%CI: 1.02–1.10; P=0.004, higher LDL-c levels (per 1 mmol/L; adjusted OR: 1.68; 95%CI: 1.56–1.81; P<0.0001), and lower HDL-c levels (per 0.5 mmol/L; adjusted OR: 0.34; 95%CI: 0.30–0.40; P<0.0001).

Conclusion

This cross-sectional analysis of the global INTERASPIRE study indicated that 1 year after a CHD event, 33% of the patients worldwide had hypertriglyceridemia and 26% met criteria for residual combined hyperlipidemia, although there was wide variation between countries. Still, 87% of the participants were on LLT, mostly statin therapy, at that time. Female sex, current smoking, increased BMI, higher systolic blood pressure, higher LDL-c levels, and lower HDL-c levels were independently associated with hypertriglyceridemia.

Find this article online at Atherosclerosis.

References

1. Fruchart JC, Davignon J, Hermans MP, et al. Residual macrovascular risk in 2013: what have we learned? Cardiovasc Diabetol 2014;13:26.
2. Ginsberg HN, Packard CJ, Chapman MJ, et al. Triglyceride-rich lipoproteins and their remnants: metabolic insights, role in atherosclerotic cardiovascular disease, and emerging therapeutic strategies-a consensus statement from the European Atherosclerosis Society. Eur Heart J 2021;42:4791–806.
3. Miller M, Cannon CP, Murphy SA, et al. Impact of triglyceride levels beyond low-density lipoprotein cholesterol after acute coronary syndrome in the PROVE ITTIMI 22 trial. J Am Coll Cardiol 2008;51:724–30.
4. Schwartz GG, Abt M, Bao W, et al. Fasting triglycerides predict recurrent ischemic events in patients with acute coronary syndrome treated with statins. J Am Coll Cardiol 2015;65:2267–75.
5. Zahger D, Schwartz GG, Du W, et al. Triglyceride levels, alirocumab treatment, and cardiovascular outcomes after an acute coronary syndrome. J Am Coll Cardiol 2024;84:994–1006.
6. McEvoy JW, Jennings C, Kotseva K, et al. Variation in secondary prevention of coronary heart disease: the INTERASPIRE study. Eur Heart J 2024;45:4184–96.
7. McEvoy JW, Jennings C, Kotseva K, et al. INTERASPIRE: an international survey of coronary patients; their cardiometabolic, renal and biomarker status; and the quality of preventive care delivered in all WHO regions: in partnership with the World Heart Federation, European Society of Cardiology, Asia Pacific Society of Cardiology, InterAmerican Society of Cardiology, and PanAfrican Society of Cardiology. Curr Cardiol Rep 2021;23:136.