20, 21 The inclusion criteria included age of ≥20 years and presence of fasting triglyceride data, resulting in a cohort of 27 184 people. This cohort study included participants from NHANES III (1988–1994) and the subsequent eight cycles of NHANES from 1999 to 2014. This cohort study aimed to investigate the association of fasting triglycerides with CVD mortality in US adult participants with or without diabetes who attended the National Health and Nutrition Examination Surveys (NHANES) from 1988 to 2014. 19 However, whether there is an interaction between diabetes and triglycerides in predicting CVD mortality is unknown. The bezafibrate infarction prevention (BIP) trial showed that in patients with established coronary heart disease, high baseline triglycerides predicted high all-cause mortality after adjustment for baseline diabetes diagnosis. For example, higher baseline triglycerides were associated with higher risk of new-onset of diabetes 15–17 and diabetes-caused mortality 18 in cohort studies. Recent reports suggest that triglycerides may be important for the pathogenesis of diabetes, a disease that can increase CVD risk. However, 12 of 13 randomized controlled trials since 2010 2–14 (see Supplementary material online, Table S1) have not demonstrated any effect of lowering triglycerides (via omega-3 fatty acid, niacin, or fibrate) on CVD events and mortality, challenging the belief that lowering triglycerides lowers CVD risk. There has been much interest in investigating whether lowering triglyceride levels protects against CVD. 1 Therefore, it is of high importance to identify modifiable risk factors for CVD and to decrease CVD mortality. 1 CVD prevalence nearly doubled from 271 million in 1990 to 523 million in 2019, and the number of CVD deaths increased from 12.1 million in 1990 to 18.6 million in 2019. IntroductionĬardiovascular disease (CVD) is the leading global cause of mortality and a major contributor to disability. The results of our study may offer some guidance for future clinical trials investigating the effect of lowering triglycerides on CVD: both diabetes and hypertriglyceridaemia may need to be used as inclusion criteria. Our study found that elevated triglycerides were associated with enhanced CVD mortality in those with diabetes, but not in those without diabetes. However, 12 of 13 randomized controlled trials since 2010 have not demonstrated any effect of lowering triglycerides on CVD events and mortality. There has been much interest in investigating whether lowering triglyceride levels protects against cardiovascular disease (CVD). The findings remained significant when diabetes was defined by fasting glucose levels alone, or after further adjustment for the use of lipid-lowering medications, or after the exclusion of those who took lipid-lowering medications. In participants with diabetes, people with high triglycerides (200–499 mg/dL) had a 44% (HR, 1.44 95% CI, 1.12–1.85) higher multivariate-adjusted risk of CVD mortality compared with those with normal triglycerides (<150 mg/dL). A 1-natural-log-unit higher triglyceride was associated with a 30% higher multivariate-adjusted risk of CVD mortality in participants with diabetes (HR, 1.30 95% CI, 1.08–1.56) but not in those without diabetes (HR, 0.95 95% CI, 0.83–1.07). The cohort was followed up for a mean of 12.0 years with 1492 CVD deaths recorded. People with higher triglycerides had a higher prevalence of diabetes at baseline. The cohort included 26 570 adult participants, among which 3978 had diabetes. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of triglycerides for CVD mortality. CVD mortality outcomes were ascertained by linkage to the National Death Index records. This cohort study included US adults from the National Health and Nutrition Examination Surveys from 1988 to 2014.
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