Hipertrigliceridemia y resigo cardiovascular

Impact of Triglyceride Levels Beyond Low-Density Lipoprotein Cholesterol After Acute Coronary Syndrome in the PROVE IT-TIMI 22 Trial Michael Miller, Christopher P. Cannon, Sabina A. Murphy, Jie Qin, Kausik K. Ray, Eugene Braunwald, for the PROVE IT-TIMI 22 Investigators J. Am. Coll. Cardiol. 2008;51;724-730 doi:10.1016/j.jacc.2007.10.038

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Journal of the American College of Cardiology © 2008 by the American College of Cardiology Foundation Published by Elsevier Inc.

Vol. 51, No. 7, 2008 ISSN0735-1097/08/$34.00 doi:10.1016/j.jacc.2007.10.038

Lipids and CAD

Impact of Triglyceride Levels Beyond Low-Density Lipoprotein Cholesterol After Acute Coronary Syndrome in the PROVE IT-TIMI 22 Trial
Michael Miller, MD, FACC,* Christopher P. Cannon, MD, FACC,† Sabina A. Murphy, MPH,† Jie Qin, MS,† Kausik K. Ray, MD, MRCP,‡ Eugene Braunwald, MD, MACC,† for the PROVE IT-TIMI 22 InvestigatorsBaltimore, Maryland; Boston, Massachusetts; and Cambridge, United Kingdom
Objectives Background
The purpose of this study was to assess the impact of on-treatment triglycerides (TG) on coronary heart disease (CHD) risk after an acute coronary syndrome (ACS). The PROVE IT-TIMI (Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction) 22 trial demonstrated thatlow-density lipoprotein cholesterol (LDL-C) 70 mg/dl was associated with greater CHD event reduction than LDL-C 100 mg/dl after ACS. However, the impact of low on-treatment TG on CHD risk beyond LDL-C 70 mg/dl has not been explored. The PROVE IT-TIMI 22 trial evaluated 4,162 patients hospitalized for ACS and randomized to atorvastatin 80 mg or pravastatin 40 mg daily. The relationship betweenon-treatment levels of TG and LDL-C and the composite end point of death, myocardial infarction (MI), and recurrent ACS were assessed 30 days after initial presentation. Low on-treatment TG ( 150 mg/dl) was associated with reduced CHD risk compared with higher TG in univariate analysis (hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.62 to 0.87; p 0.001) and in adjusted analysis (HR 0.80, 95% CI0.66 to 0.97; p 0.025). For each 10-mg/dl decrement in on-treatment TG, the incidence of death, MI, and recurrent ACS was lower by 1.6% or 1.4% after adjustment for LDL-C or non–high-density lipoprotein cholesterol and other covariates (p 0.001 and p 0.01, respectively). Lower CHD risk was also observed with TG 150 mg/dl and LDL-C 70 mg/dl (HR 0.72, 95% CI 0.54 to 0.94; p 0.017) or low ontreatmentTG, LDL-C, and C-reactive protein ( 2 mg/l) (HR 0.59, 95% CI 0.41 to 0.83; p 0.002) compared with higher levels of each variable in adjusted analysis. On-treatment TG 150 mg/dl was independently associated with a lower risk of recurrent CHD events, lending support to the concept that achieving low TG may be an additional consideration beyond low LDL-C in patients after ACS. (The PROVE IT-TIMI 22trial; NCT00382460) (J Am Coll Cardiol 2008;51:724–30) © 2008 by the American College of Cardiology Foundation

Methods

Results

Conclusions

Epidemiologic surveys have observed that elevated levels of total cholesterol and low-density lipoprotein cholesterol (LDL-C) are associated with increased risk of coronary heart disease (CHD) (1), and therapeutic strategies that lead to astatistically significant reduction in LDL-C lower CHD event rates (2). The magnitude of CHD risk reduction as a consequence of LDL-C lowering often ranges between 25% and 35% (3). One potential impediment limiting further
From the *University of Maryland Medical Center, Baltimore, Maryland; †TIMI Study Group, Brigham and Women’s Hospital, Boston, Massachusetts; and the ‡University of Cambridge,...