(P-016) Triglyceride Levels in Early Type 2 Diabetes and Their Association with Cardiovascular Risk: A Danish Cohort Study

Background: Triglyceride (TG)-rich lipoproteins associate with development of atherosclerosis. Initiation of pharmacological therapy and healthy lifestyle modifications at the time of type 2 diabetes diagnosis may decrease TG levels.

Objectives: To examine TG levels early in diagnosed type 2 diabetes and the association with subsequent events of major adverse cardiovascular event (MACE) (i.e., non-fatal myocardial infarction, non-fatal ischemic stroke, or cardiac death).

Methods: Using population-based healthcare registries, we identified all individuals from Northern and Central Denmark diagnosed with incident type 2 diabetes during 2002-2016. The first record of diabetes was defined as either first-time use of a glucose-lowering drug or a first-time hospital contact for diabetes. At 6 months after first diabetes diagnosis, we classified patients into low ( <1.7 mmol/L), moderate (1.7-2.3), and high (>2.3) achieved TG level. Patients were then followed for first event of a MACE-related outcome and Cox proportional hazards regression analysis was used to compute adjusted hazard ratios (HRs).

Results: The achieved TG level was <1.7 mmol/L in 34,290 (54%) patients, between 1.7 and 2.3 mmol/L in 14,806 (24%) patients, and >2.3 mmol/L in 13,995 (22%) patients. Patients with higher levels of TG were younger and more often had prior CVD. During total median follow up time of 5.7 (quartiles 3.1-8.5) years, incidence rates of MACE per 1000 person-years were 18.4 (95% CI 17.8-18.9) for low TG, 20.1 (95% CI 19.2-21.0) for moderate TG, and 21.0 (95% CI 20.0-22.0) for high TG. Patients with high TG had a 46% higher incidence of MACE compared to patients with low TG (age- and sex-adjusted HR 1.46 [95% CI 1.38-1.55]). With additional adjustment for obesity, smoking- and alcohol-related disorders, hypertension, calendar year, HbA1c, LDL-C and HDL-C, the HR for MACE with high TG levels decreased, but remained elevated (1.21 [95% CI 1.14-1.29]). Patients with moderate TG levels had modestly elevated HRs: age- and sex-adjusted HR 1.22 (95% CI 1.16-1.29) and fully adjusted HR 1.10 (95% CI 1.04-1.17). An additional analysis showed that an increase in TG from diabetes diagnosis to 6 months after diagnosis (increase of 0.5 mmol/L or higher observed in 11%) associated with future MACE compared to patients with no change in TG (fully adjusted HR 1.23 [95% CI 1.09-1.38]).

Conclusions: In a routine clinical care, almost half of type 2 diabetes patients had TG levels >1.7 mmol/L 6 months after diagnosis, which was associated with increased MACE incidence. An early increase in TG after diagnosis may aggravate the risk of MACE.