| Summary: | Background: Elevated triglycerides (TGs) are associated with atherosclerotic cardiovascular disease (ASCVD). Despite statin therapy, many US adults have borderline or elevated TG levels. Not characterized is the ASCVD risk associated with borderline TG levels in statin users, including the estimated number of adults who will sustain ASCVD events. Methods: We studied 4986 US adults (weighted to 113 million) aged 40–74 from the National Health and Nutrition Examination Surveys 2007–2014. The proportion of persons at low (<5%), borderline (5-<7.5%), intermediate (7.5-<20%), and high (≥20%) 10-year ASCVD risk among those on statins was quantified for low (<70 mg/dL, 70-<100 mg/dL), borderline (100-<135 mg/dL and 135-<150 mg/dL), borderline high (150-<200 mg/dL), and elevated (≥200 mg/dL) TGs. Multiple logistic regression examined these TG categories in relation to high risk status. Results: Overall, 18.6% of participants had TG < 70 mg/dL, 24.2% TG 70-<100 mg/dL, 22.0% TG 100-<135 mg/dL, 6.2% TG 135-<150 mg/dL, 15.0% TG 150-<200 mg/dL, and 14.0% TG ≥ 200 mg/dL. Mean 10-year ASCVD risk for these groups were 5.6%, 6.9%, 7.8%, 10.3%, 9.6% and 10.8%, respectively (p < 0.0001). One-fifth or more of statin users with TGs over 135 mg/dL were at ≥ 20% 10-year ASCVD risk and ≥60% of persons in all TG groups were at borderline or higher ASCVD risk. Compared to those with TGs <70 mg/dL, multiple logistic regression showed odds ratios of 3.1 to 4.6 (p < 0.05 to p < 0.01) for those in TG groups ≥135 mg/dL in the overall sample, but 3.4 to 8.1 (p < 0.05 to p < 0.01) for those in TG groups of ≥100 mg/dL in statin users, despite adjustment including HDL-C. Conclusion: Many US adults with borderline levels of TGs are at elevated ASCVD risk despite statin therapy, suggesting the need first for greater lifestyle modification efforts, and when indicated, evidence-based therapies known to reduce this residual ASCVD risk.
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