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)
Link to full text
Dr Vivek Baliga patient articles – Click here