Clinical and economic benefits observed when follow-up triglyceride levels are less than 500 mg/dL in patients with severe hypertriglyceridemia

BACKGROUND: Increased levels of triglycerides are associated with an increased risk of cardiovascular disease and pancreatitis. In this study we investigated the association between patients with severely increased triglycerides whose follow-up triglyceride levels were <500 mg/dL and reduction of important clinical events and associated health care costs. METHODS: By using two large U.S. health care claims databases, we identified an initial cohort of 41,210 patients with severe hypertriglyceridemia between June 2001 and September 2010 who had a follow-up laboratory test result 6 to <24 weeks after the initial severe hypertriglyceridemia laboratory value. Of these, 8493 patients' follow-up triglyceride levels remained elevated (500 mg/dL) whereas 32,717 were <500 mg/dL. After their qualifying follow-up triglyceride level, patients' cardiovascular events, diabetes-related events, pancreatitis episodes, kidney disease, and related costs were identified. Adjusted incidence rate ratios with the use of Cox proportional hazards models were developed for each outcome. RESULTS: Patients whose triglycerides remained >= 500 mg/dL had a greater rate of pancreatitis episodes (hazard ratio [HR] 1.79; 95% confidence interval [CI] 1.47-2.18), cardiovascular events (HR1.19; 95% CI 1.10-1.28), diabetes-related events (HR1.42; 95% CI 1.27-1.59), and kidney disease (HR1.13; 95% CI 1.04-1.22) compared with patients whose follow-up triglycerides were <500 mg/dL, after we adjusted for important confounders. Adjusted all-cause total and cardiovascular-related costs were significantly lower in the first 3 years in patients whose follow-up triglyceride levels were <500 mg/dL compared with those whose triglyceride levels remained increased. CONCLUSION: When follow-up triglyceride levels were <500 mg/dL, we observed an associated reduction in the risk of clinical events and decrease in health care resource use and costs. 2012 National Lipid Association. All rights reserved.