Outcomes Trials Examining Triglycerides in CVD Risk

JULY 08, 2018
Matt Hoffman
At the American Diabetes Association's 78th Annual Scientific Sessions, Peter Toth, MD, the director of preventive cardiology at the CGH Medical Center in Sterling, Illinois, sat with MD Mag to talk about the importance of noting elevated triglycerides in patients at risk for cardiovascular conditions.

He also spoke about his excitement about the 3 outcomes studies with this group of patients that are currently underway: REDUCE-IT, STRENGTH, and PROMINENT. He also touched on data that he and colleagues presented at the conference supports the thought that, in patients with dyslipidemia, triglycerides play a valuable role in understanding what is giving rise to the residual risk in these patients.


Peter Toth, MD:
Triglycerides become very important because we know that, in patients who are diabetic, if they are a type 2 diabetic, they have insulin resistance, and insulin resistance correlates very highly with an impaired capacity to clear triglyceride-enriched lipoproteins from serum. Triglycerides increase, and if the triglycerides are elevated, this also means that apolipoprotein B (apoB)-containing lipoproteins are elevated, and this is going to be a very important driver of cardiovascular risk.

What we need now are outcomes studies that probe the value of reducing triglycerides. Three such outcomes trials are underway. REDUCE-IT is being done with an eicosapentaenoic acid (EPA) Omega-3 fatty acid. That, hopefully, will report out later this year. Those are all high-risk patients on background statin therapy who were also given either placebo or [prescription] EPA. 

The STRENGTH trial is also looking at high-risk patients, including diabetics, and is treating patients with either placebo or a combination of EPA and docosahexaenoic acid  (DHA) Omega-3 fatty acids, and looking at hard outcomes. 

Then, the PROMINENT trial is looking at a new peroxisome proliferator-activated receptor (PPAR) modulator, which—we'll see, if, among patients with elevated triglycerides and low HDL, there is a benefit in reducing triglycerides in those patients. Everybody in PROMINENT is diabetic. 

So we'll see because we do need these outcomes trials, but certainly, data such as we presented today support the conclusion that triglycerides are, in fact, important when trying to sort out what is it that is giving rise to residual risk in patients with dyslipidemia.

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