严重无症状颈动脉狭窄患者甘油三酯升高与治疗资格：CREST 2 试验

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2024-10-11 DOI:10.1016/j.jstrokecerebrovasdis.2024.108025

Seemant Chaturvedi MD , Tanya N Turan MD , Jenifer H Voeks PhD , Maria Lopes-Virella MD , Jeffrey Goldstein MD , Philip A. Teal MD , Malcolm Foster MD , Virginia Howard PhD , James F. Meschia MD , Brajesh Lal MD , George Howard DrPH , Robert D. Brown Jr. MD , Thomas G. Brott MD

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引用次数: 0

摘要

背景疾病控制中心的数据显示，约四分之一的成年人甘油三酯（TG）水平升高。一些临床试验（但并非所有临床试验）表明，对已接受他汀类药物治疗的患者进行药物治疗，可降低心肌梗死和中风等主要血管事件的发生率。我们评估了无症状颈动脉狭窄（CS）患者中 TG 水平升高的发生率，以及与高 TG 相关的病症。方法分析了颈动脉血管重建和无症状颈动脉狭窄医疗管理试验（CREST 2）入组患者的血脂基线图，以确定是否有资格使用 REDUCE-IT 试验制定的标准（甘油三酯水平≥150 mg/dL，低密度脂蛋白由他汀类药物控制在 100 mg/dL）治疗高 TG 水平。同样进行评估的还有在研究开始时使用药物治疗高甘油三酯水平的患者比例。此外，还分析了与高 TG 值（150 毫克/分升）相关的人口统计学因素和基线医疗条件。结果截至 2023 年 10 月，在 2377 名随机 CREST-2 患者中，有 2328 人（98%）（平均年龄 70.0 岁，63% 为男性）的基线血脂状况适合分析。在 1961 名（84%）符合 REDUCE-IT 标准的患者中，血脂分析显示 20.5% 的患者符合治疗甘油三酯高的条件。在有空腹血脂图谱的 1464 名患者中，17.8% 符合治疗条件。全部患者的甘油三酯中位值为 205（IQR 91）毫克/分升。结论总胆固醇水平升高与糖尿病、高血压、肥胖和体力活动减少密切相关。需要进一步研究治疗无症状颈动脉狭窄患者升高的 TG 水平是否会带来益处。

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Elevated triglycerides and treatment eligibility in patients with severe, asymptomatic carotid stenosis: CREST 2 Trials

Background

Data from the Centers for Disease Control show that approximately one-quarter of adults have elevated triglyceride (TG) levels. Some clinical trials, but not all, have demonstrated that pharmacologic treatment of high TG levels in patients already on statin therapy reduces the rate of major vascular events such as myocardial infarction and stroke. We assessed the prevalence of elevated TG levels in patients with asymptomatic carotid stenosis (CS), and medical conditions associated with high TG.

Methods

Baseline lipid profiles from patients enrolled in the Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST 2) were analyzed. to determine treatment eligibility for high TG levels using the criteria established by the REDUCE-IT trial (triglyceride levels ≥150 mg/dL with LDL managed by a statin to <100 mg/dL). Equally assessed was the percentage of patients who were using pharmacologic treatment for high TG levels at study entry. Demographic factors and baseline medical conditions associated with high (>150 mg/dl) TG values were also analyzed. Chi-square and t=tests were used to assess baseline factors and abnormal TG values.

Results

As of October 2023, of 2377 randomized CREST-2 patients, 2328 (98 %) (mean age 70.0 years, 63 % men) had baseline lipid profiles suitable for analysis. Among 1961 (84 %) patients who met REDUCE-IT criteria, analysis of lipid profiles revealed that 20.5 % of the patients were eligible for treatment of high triglycerides. Of the 1464 patients with fasting lipid profiles, 17.8 % were eligible for treatment. The median TG value was 205 (IQR 91) mg/dl in the total population. TG levels of 150 mg/dl or higher were strongly associated with hypertension, diabetes, obesity, high hemoglobin A1c, and reduced physical activity (all p<0.0001).

Conclusions

Elevated TG levels are strongly associated with diabetes, hypertension, obesity, and reduced physical activity. Further research is needed on whether treatment of elevated TG levels in patients with asymptomatic carotid stenosis confers benefit.

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.