Triglyceride Levels Tied to Prevalence of Chronic Health Conditions

Robert S. Rosenson, MD

Credit: Cura Foundation

Chronic conditions, such as obesity, diabetes, and metabolic dysfunction-associated steatotic liver disease (MASLD), as well as multi-organ disease, were more prevalent at higher triglyceride levels among adults in the US with hypertriglyceridemia.¹

Citing pooled data from the US National Health and Nutrition Examination Survey (NHANES) 1999-2000 and 2017-2020 cycles, the analysis sought to provide prevalence estimates on nearly 25,000 adults with a valid triglyceride level.

“In the current analysis, chronic conditions and multi-organ disease were more common at higher triglyceride levels,” wrote the investigative team, led by Robert S. Rosenson, MD, metabolism and lipids program, Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai.

Severe hypertriglyceridemia, defined as a triglyceride level ≥500 mg/dL, is a risk factor for atherosclerotic cardiovascular disease (ASCVD). Research suggests triglyceride-lowering agents can markedly lowering serum triglycerides.² These agents, including apolipoprotein C-III inhibitors, angiopoietin-like (ANGPTL) 3 and ANGPTL 4 inhibitors, and Fibroblast Growth Factor (FGF) 21 analogs, are directed toward specific pathways to lower triglyceride levels.

Evidence has also pointed to these medication’s potential role in improving other chronic conditions, including obesity, diabetes, and MASLD. However, few data are available on the commonness of these chronic conditions among adults with severe hypertriglyceridemia.¹

For the present analysis, Rosenson and colleagues evaluated the presence of chronic conditions and multi-organ disease among US adults with severe hypertriglyceridemia. The analysis later compared its prevalence to adults with normal (<200 mg/dL) and moderate (200 to <500 mg/dL) hypertriglyceridemia.

The analysis identified 24,518 non-pregnant adults who fasted overnight before a morning study visit and had a valid triglyceride level. Each participant completed a medical examination and a study interview, assessing chronic conditions, including central adiposity, diabetes, chronic kidney disease (CKD), MASLD, and a history of ASCVD. Those with ≥3 comorbidities were assessed as having multi-organ disease.

Overall, investigators identified 192.1 million, 26.8 million, and 2.3 million adults in the US with normal, moderate, and severe hypertriglyceridemia, respectively. The prevalence of each chronic condition was higher among those with moderate and severe hypertriglyceridemia versus normal triglyceride levels.

Among individuals with severe hypertriglyceridemia, the data showed 70.3% had central obesity, 67.0% had MASLD, 32.7% had diabetes, 21.6% had CKD, and 10.6% had ASCVD. Further analysis revealed those with normal, moderate, and severe hypertriglyceridemia, 11.5%, 25.9%, and 29.3% had a multi-organ disease, respectively.

After adjustment for covariates, including age, race and ethnicity, and gender, the prevalence of multi-organ disease was 2.12 (95% CI, 1.94 - 2.31) and 2.95 (95% CI, 2.43 - 3.59) for individuals with moderate and severe hypertriglyceridemia, respectively, compared with normal triglyceride levels.

“Given the high prevalence of chronic conditions and multi-organ disease among US adults with hypertriglyceridemia identified in the current study, clinical trials with novel selective pathway inhibitors of triglycerides metabolism may benefit from directing enrollment towards those with specific comorbidities that align with the pathways being targeted,” Rosenson and colleagues wrote.

References

1. _{Gurevitz C, Chen L, Muntner P, Rosenson RS, Hypertriglyceridemia and Multi-Organ Disease Among US Adults, JACC: Advances (2024), doi: https://doi.org/10.1016/ j.jacadv.2024.100932}
2. _{Malick WA, Waksman O, Do R, et al. Clinical Trial Design for Triglyceride-Rich Lipoprotein-Lowering Therapies: JACC Focus Seminar 3/3. J Am Coll Cardiol. 2023 Apr 25;81(16):1646-1658.}