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Nei pazienti con cardiopatia ischemica se i trigliceridi sono elevati la mortalità per tutte le cause è maggiore

Un altro tassello nell'annosa questione dei rapporti tra trigliceridi e malattia aterosclerotica. Si tratta del ben noto studio BIP (Bezafibrate Infarction Prevention) che aveva arruolato oltre 15.000 pazienti con cardiopatia ischemica, rivalutati dopo 22 anni. In sintesi i risultati sono stati: a) trigliceridi alti in pazienti con cardiopatia ischemica sono associati ad un più alto rischio di morte anche quando i dati sono corretti per variabili influenti, in particolare il colesterolo HDL, b) anche trigliceridi in un intervallo considerato normale, cioè tra 100 e 149 mg/dL, sono associati ad aumentato rischio di morte per tutte le cause, c) la grave ipertrigliceridemia (>500 mg/dL) è associata al più alto rischio di morte.

Elevated Triglyceride Level Is Independently Associated With Increased All-Cause Mortality in Patients With Established Coronary Heart Disease: Twenty-Two-Year Follow-Up of the Bezafibrate Infarction Prevention Study and Registry

Klempfner R, Erez A, Sagit BZ, Goldenberg I, Fisman E, Kopel E, Shlomo N, Israel A, Tenenbaum A

Circ Cardiovasc Qual Outcomes 2016;9:100-108

BACKGROUND: The independent association between elevated triglycerides and all-cause mortality among patients with established coronary heart disease is controversial. The aim of this study was to investigate this association in a large cohort of patients with proven coronary heart disease.
METHODS AND RESULTS: The study cohort comprised 15 355 patients who were screened for the Bezafibrate Infarction Prevention (BIP) trial. Twenty-two-year mortality data were obtained from the national registry. Patients were divided into 5 groups according to strata of fasting serum triglycerides: (1) low-normal triglycerides (<100 mg/dL); (2) high-normal triglycerides (100-149 mg/dL); (3) borderline hypertriglyceridemia triglycerides (150-199 mg/dL); (4) moderate hypertriglyceridemia triglycerides (200-499 mg/dL); (5) severe hypertriglyceridemia triglycerides (=500 mg/dL). Age- and sex-adjusted survival was 41% in the low-normal triglycerides group than 37%, 36%, 35%, and 25% in groups with progressively higher triglycerides (P<0.001). In an adjusted Cox-regression for various covariates including high-density lipoprotein cholesterol, each 1 unit of natural logarithm (Ln) triglycerides elevation was associated with a corresponding 6% (P=0.016) increased risk of 22-year all-cause mortality. The 22-year mortality risk for patients with severe hypertriglyceridemia was increased by 68% when compared with patients with low-normal triglycerides (P<0.001).
CONCLUSIONS: In patients with established coronary heart disease, higher triglycerides levels are independently associated with increased 22-year mortality. Even in patients with triglycerides of 100 to 149 mg/dL, the elevated risk for death could be detected than in patients with lower triglycerides levels, whereas severe hypertriglyceridemia denotes a population with particularly increased mortality risk.

Circ Cardiovasc Qual Outcomes 2016;9:100-108