Prognostic Value of Normal Triglyceride Levels among Patients with Target Low-density Lipoproteins Presenting with First Acute Coronary Syndrome.

INTRODUCTION

Hypercholesterolemia, mainly low-density lipoprotein cholesterol (LDL-C) and triglycerides (TGs), is a major risk factor for coronary artery disease (CAD). The prognostic value of lowering LDL-C and TG in patients with CAD is well studied. We sought to examine the prognostic value of TG among patients presenting with acute coronary syndrome (ACS) and target LDL-C level.

METHODS

This is a retrospective study of patients admitted with first-presentation ACS. We included patients with first-presentation ACS who had lipid profiles measured within 3 months before the presentation. Patients with prior ACS, congenital heart disease, and those without baseline lipid profiles were excluded. Target LDL-C level was defined as LDL-C <1.8 mmol/L, and normal TG level was defined as <1.7 mmol/L. The study subjects were followed up for major adverse cardiac events (MACE) (cardiac death and nonfatal myocardial infarction [MI]).

RESULTS

Among the 7020 patients admitted with ACS, 393 met the inclusion criteria. Of whom, 106 (mean age: 70.3 ± 10.7 years, 76% of males) had target LDL-C level and were included. CAD risk factors were prevalent among the cohort. The mean total cholesterol, LDL-C, and TG were 3.6 ± 0.9, 1.4 ± 0.3, and 1.7 ± 1.5 mmol/L, respectively. Most patients presented with non-ST-elevation MI (54.7%), followed by unstable angina (36.8%). Over a median follow-up of 5.6 years, 17 (16%) patients had MACE, of which 14.2% were nonfatal MI and 1.9% of patients had cardiac death. There was no statistically significant difference in MACE between those with normal and high levels of TG.

CONCLUSIONS

In this retrospective cohort of patients presenting with first-presentation ACS, TG level did not confer an increased risk of MACE among patients with target LDL-C level.