Adding omega-3 fatty acids to stable statin therapy reduces triglyceride levels, without raising LDL

Adding omega-3 fatty acids to stable statin therapy reduces triglyceride levels, without raising LDL



The Heart.org



New York, NY - The addition of an omega-3 fatty-acid supplement to statin therapy in patients with persistent hypertriglyceridemia significantly reduced triglyceride levels and non-HDL-cholesterol levels, all without a significant increase in LDL-cholesterol levels


Presenting the results of the study at the 16th International Symposium on Drugs Affecting Lipid Metabolism in New York City this weekend, Bays explained that while the Food and Drug Administration has approved the addition of omega-3 fatty-acid supplementation to statin-treated patients with triglyceride levels >500 mg/dL, the addition of the polyunsaturated fatty acid is not currently approved for use in patients with triglyceride levels <500 mg/dL.


Bays acknowledged that the study addresses only the reduction in triglyceride levels and that it is not clear what clinical benefit would arise from further lowering triglycerides in patients with levels between 200 mg/dL and 500 mg/dL.

Nonfasting Triglycerides and Risk of Myocardial Infarction, Ischemic Heart Disease, and Death in Men and Women

Børge G. Nordestgaard, MD, DMSc; Marianne Benn, MD, PhD; Peter Schnohr, MD; Anne Tybjærg-Hansen, MD, DMSc

JAMA. 2007;298:299-308.

Context Elevated nonfasting triglycerides indicate the presence of remnant lipoproteins, which may promote atherosclerosis.

Objective To test the hypothesis that very high levels of nonfasting triglycerides predict myocardial infarction (MI), ischemic heart disease (IHD), and death.

Design, Setting, and Participants A prospective cohort study of 7587 women and 6394 men from the general population of Copenhagen, Denmark, aged 20 to 93 years, followed up from baseline (1976-1978) until 2004.

Main Outcome Measures Hazard ratios (HRs) for incident MI, IHD, and total death according to baseline nonfasting triglyceride level categories of 1 to 1.99 mmol/L (88.5-176.1 mg/dL), 2 to 2.99 mmol/L (177.0-264.6 mg/dL), 3 to 3.99 mmol/L (265.5-353.0 mg/dL), 4 to 4.99 mmol/L (354.0-441.6 mg/dL), and 5 mmol/L or more (442.5 mg/dL) vs triglyceride levels of less than 1 mmol/L (<88.5 mg/dL).

Results With increasing levels of nonfasting triglycerides, levels of remnant lipoprotein cholesterol increased. During a mean follow-up of 26 years, 1793 participants (691 women and 1102 men) developed MI, 3479 (1567 women and 1912 men) developed IHD, and 7818 (3731 women and 4087 men) died. For MI, among women, the age-adjusted HRs and multifactorially adjusted HRs (aHRs) for each respective category per 1-mmol/L increase in nonfasting triglyceride levels were 2.2 (aHR, 1.7), 4.4 (aHR, 2.5), 3.9 (aHR, 2.1), 5.1 (aHR, 2.4), and 16.8 (aHR, 5.4); for both, P for trend < .001. For MI, among men, the values were 1.6 (aHR, 1.4), 2.3 (aHR, 1.6), 3.6 (aHR, 2.3), 3.3 (aHR, 1.9), and 4.6 (aHR, 2.4); for both, P for trend < .001. For IHD, among women, the values were 1.7 (aHR, 1.4), 2.8 (aHR, 1.8), 3.0 (aHR, 1.8), 2.1 (aHR, 1.2), and 5.9 (aHR, 2.6); for both, P for trend < .001. For IHD, among men, the values were 1.3 (aHR, 1.1), 1.7 (aHR, 1.3), 2.1 (aHR, 1.3), 2.0 (aHR, 1.2), and 2.9 (aHR, 1.5); P for trend < .001 for age-adjusted and P for trend = .03 for multifactorially adjusted. For total death, among women, the values were 1.3 (aHR, 1.3), 1.7 (aHR, 1.6), 2.2 (aHR, 2.2), 2.2 (aHR, 1.9), and 4.3 (aHR, 3.3); for both, P for trend < .001. For total death, among men, the values were 1.3 (aHR, 1.2), 1.4 (aHR, 1.4), 1.7 (aHR, 1.5), 1.8 (aHR, 1.6), and 2.0 (aHR, 1.8); for both, P for trend < .001.

Conclusion In this general population cohort, elevated nonfasting triglyceride levels were associated with increased risk of MI, IHD, and death in men and women.

Nonfasting Trigylceride Levels and Risk for Heart Disease

Nonfasting Trigylceride Levels Seem Better at Defining Risk for Heart Disease

Two studies measuring triglycerides in the nonfasting state show a strong association between elevated levels and risk for cardiovascular disease or death. Both appear in today's JAMA.

One study, using a population sample from Copenhagen, followed nearly 14,000 men and women for an average of 26 years. Researchers found that the risk for MI, ischemic heart disease, or death increased with increasing levels of nonfasting triglycerides, especially among women.

Another study, performed within the Women's Health Initiative, followed some 26,500 women for a median of 11 years and compared the effects of fasting versus nonfasting triglycerides on risk for cardiovascular events. When measured in the nonfasting state (especially 2 to 4 hours postprandially), triglyceride levels showed a strong, independent association with future risk, which persisted in fully adjusted analyses. Fasting levels, according to the authors, "showed little independent association with cardiovascular events."

According to an editorialist, the results "suggest that using 2- to 4-hour postprandial triglyceride measurements may be more predictive [of risk] than LDL-C."

Links:

JAMA article on risk in Copenhagen population (Free abstract; full text requires subscription)

JAMA article on risk in Women's Health Initiative participants (Free abstract; full text requires subscription)

JAMA editorial (Subscription required)