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

J Stroke Cerebrovasc Dis. 2024 Dec;33(12):108025. doi: 10.1016/j.jstrokecerebrovasdis.2024.108025. Epub 2024 Oct 11.

Abstract

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.

Keywords: Atherosclerosis; CREST-2; Carotid stenosis; Lipids; Triglycerides.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Asymptomatic Diseases*
  • Biomarkers* / blood
  • Carotid Stenosis* / blood
  • Carotid Stenosis* / complications
  • Carotid Stenosis* / diagnosis
  • Carotid Stenosis* / diagnostic imaging
  • Carotid Stenosis* / drug therapy
  • Carotid Stenosis* / therapy
  • Eligibility Determination*
  • Female
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Hypertriglyceridemia* / blood
  • Hypertriglyceridemia* / diagnosis
  • Hypertriglyceridemia* / drug therapy
  • Hypertriglyceridemia* / epidemiology
  • Hypolipidemic Agents / adverse effects
  • Hypolipidemic Agents / therapeutic use
  • Male
  • Middle Aged
  • Patient Selection*
  • Prevalence
  • Randomized Controlled Trials as Topic
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index*
  • Treatment Outcome
  • Triglycerides* / blood
  • Up-Regulation

Substances

  • Triglycerides
  • Biomarkers
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Hypolipidemic Agents