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BARI 2D trial: Elevated triglycerides and residual cardiovascular risk

The BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial was designed to investigate treatment strategies in patients with diabetes and stable ischaemic heart disease. The study showed no significant difference in the primary endpoint (a composite of death, myocardial infarction and stroke, i.e. major cardiovascular events) in cohorts allocated to prompt revascularization or medical therapy. The investigators recognised, however, that despite best treatment, including statins, these patients have a high residual cardiovascular risk of recurrent events.
Accumulating evidence from mechanistic and genetic studies has implicated elevated triglycerides (TG), a marker of TG-rich lipoproteins and their remnants, as a contributor to this high residual cardiovascular risk. Consequently, this analysis from the BARI 2D study investigated the association between TG levels and risk for major cardiovascular events in 2,307 patients with type 2 diabetes and coronary artery disease. At baseline, median TG levels were 148 mg/dL; 18% of patients had TG levels 150-199 mg/dL, 28% 200-499 mg/dL and 3% ≥500 mg/dL. In adjusted analyses, every 50 mg/dL increase in TG level was associated with a 3.8% (Hazard ratio 1.038, 95% confidence interval [CI] 1.004-1.072, p <0.001) increase in the primary composite outcome. Subgroup analyses showed no interaction according to female sex, additional non-coronary atherosclerotic disease, chronic kidney disease or low plasma levels of low-density lipoprotein cholesterol (<100 mg/dL). These findings therefore support an independent association between elevated TG and adverse cardiovascular outcomes in patients with type 2 diabetes and established coronary artery disease.
Association between triglycerides and residual cardiovascular risk in patients with type 2 diabetes mellitus and established cardiovascular disease (From the Bypass Angioplasty Revascularization Investigation 2 Diabetes [BARI 2D] Trial).

Nelson AJ, Navar AM, Mulder H, et al.