The approach to triglyceride levels in patients with coronary heart disease.

Background: Clinical trials demonstrate residual risk despite aggressive LDL-C lowering, partialy realated to high TG levels. CHD patients in Israel do not reach the recommended LDL-C target levels, even after hospitalization. Our impression is that it is the same regarding TG levels.

Objectives: Exploring the TG levels among CHD patients and adressing specific therapeutic regimens needed.

Design and methods: A sub-analysis of a retrospective cohort study of CHD patients who were admitted to internal medicine wards because of anginal syndrome during 2020-2022. The data was evaluated for demographic and clinical characteristics, TG levels and lipid lowering treatment at admission, 6 months previously, 3 months and 6-9 months after discharge. The factors that affect TG levels, with attention given to very high levels, were also evaluated.

Results: The cohort included 10,540 patients. Two-thirds had TG levels < 150 mg/dL. Among the subjects with levels ≥ 150 mg/dL, 4-6 % had severe hypertriglyceridemia (≥ 500 mg/dl). In two-thirds of the patients with TG levels ≥ 150 mg/dL, the HbA1c levels were > 6.4 %. Patient with severe hypertriglyceridemia had higher rates of uncontrolled diabetes mellitus. The majority of subjects received statin treatment, regardless of their TG levels. The use of fibrates was very low, but was significantly higher among patients with severe hypertriglyceridemia. Hospitalization did not have a clinically-significant effect on short-term treatment nor on TG levels.

Conclusions: Most CHD patients have controlled TG levels. However, additional attention should be given to the diabetic ones. Further education and strict policy are needed.