Background: Severe hypertriglyceridemia is an often-neglected risk factor that is associated with increased risk of cardiovascular disease, pancreatitis and mortality, especially when other comorbidities are present. We investigated the association between triglyceride (TG)-lowering therapy and subsequent reduction in TG levels in patients with diabetes and very high triglycerides (VHTG).
Methods: We combined data from the Southern California and Northwest regions of Kaiser Permanente to identify patients with diabetes and a TG measurement >500 mg/dL with a follow-up measure 6-15 months later. Patients were stratified by whether they received no treatment, pharmacotherapy specific to TG lowering (fibrates, niacin, omega-3 products) only, a statin only or a combination of both between the two TG measures. We compared the characteristics of the four groups of patients and constructed a multivariable logistic regression model to determine the probability of achieving TG <500 mg/dL following therapy, controlling for other characteristics.
Results: Of the 3,188 diabetic patients with VHTG, 23% received no therapy, 8% received a TG-specific drug only (72% fibrates, 27% niacin, 1% omega-3), 55% received a statin only, and 14% received both. Compared with no treatment, those receiving a TG-specific agent were not significantly more likely to attain TG <500 mg/dL. However, patients receiving a statin only were more likely to do so (OR 1.79, 95% CI 1.42-2.25), as were patients receiving both a statin and TG-specific agent (1.77, 1.29-2.43). In addition to higher initial TG level, non-Hispanic blacks (1.81, 1.07-3.05), Hispanics (1.26, 1.03-1.54), and men (1.43, 1.16-1.75) were more likely to attain TG level <500 mg/dL. Lower A1C (0.91, 0.87-0.96), systolic blood pressure (0.98, 0.97-0.99), and higher HDL-C (1.02, 1.01-1.04) were also associated with attaining TG <500 mg/dL.
Conclusion: Our results suggest that pharmacotherapy is essential for the attainment of TG levels <500 mg/dL in patients with diabetes and VHTG. Because better control of other risk factors was also associated with TG improvement, uncontrolled VHTG may represent an important marker or additional risk factor for diabetes complications that deserves consideration.