Dr Vivek Baliga – The Strong Heart Study

Dr Vivek Baliga discusses the latest STRONG heart study in brief.

Objective: To evaluate effect of combined high triglycerides (TG) and Low HDL-C on CV risk in American Indians, who have a high prevalence of obesity and diabetes,

Methods: 3,216 participants  who were free of cardiovascular disease at baseline in a community-based, prospective cohort of American Indians were followed up for long time for CV events. Fasting TG levels were considered “normal TG” (<150 mg/dL) or “high TG” (>150 mg/dL), and fasting HDL-C levels were categorized into “normal HDL” (>40 mg/dL for men and >50 mg/dL for  women) or “low HDL” (<40 mg/dL for men and < 50 mg/dL for women). CV events were measured in 4 categories of persons

  • Normal TG-Normal HDL-C
  • Normal TG-Low HDL-C
  • High TG-Normal HDL-C
  • High TG-low HDL-C

Multivariate analysis was done for adjustments for risk factors for CHD and stroke, including smoking, BMI, estimated LDL-C level, use of antihypertensive medications (yes/no), diabetes
(yes/no), categorical physical activity (MET-h/week in quartile), eGFR-MDRD, and UACR

Median follow-up 17.7 years

Mean Age: 56 years, 60% women, 36%  and 41% has Hypertension and  Diabetes as baseline

total population is divided as following for TG and HDL-C levels

  • Normal TG-Normal HDL-C: 37%
  • Normal TG-Low HDL-C: 30%
  • High TG-Normal HDL-C: 9%
  • High TG-low HDL-C: 24%

As seen in following figure, risk of CHD and ischemic were increased by 32% and 46% respectively for persons with high TG and low-HDL-C, Vs those with normal TG and HDL-C.

The CV risk was further measured in patients with and without DM. it was observed that risk of CHD and stroke (due to high TG and low HDL-C) were increased only in patients of DM.

As seen in following figure, 1 SD increase in TG increased risk of CHD by 47% in diabetic population. Presence of both high TG and Low HDL-C in diabetic population increased risk of CHD and stroke by  54% and 113%.

All above mentioned risk were similar for men and women.

CONCLUSIONS: American Indian Adults with both high TG and low HDL-C, particularly those with diabetes, have increased risks of incident CHD and stroke over long term (17.7 years follow up in this study)

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