Prognostic Value of Normal Triglyceride Levels among Patients with Target Low-density Lipoproteins Presenting with First Acute Coronary Syndrome.

Introduction: Hypercholesterolemia, mainly low-density lipoprotein cholesterol (LDL-C) and triglycerides (TGs), is a major risk factor for coronary artery disease (CAD). The prognostic value of lowering LDL-C and TG in patients with CAD is well studied. We sought to examine the prognostic value of TG among patients presenting with acute coronary syndrome (ACS) and target LDL-C level. Methods: This is a retrospective study of patients admitted with first-presentation ACS. We included patients with first-presentation ACS who had lipid profiles measured within 3 months before the presentation. Patients with prior ACS, congenital heart disease, and those without baseline lipid profiles were excluded. Target LDL-C level was defined as LDL-C <1.8 mmol/L, and normal TG level was defined as <1.7 mmol/L. The study subjects were followed up for major adverse cardiac events (MACE) (cardiac death and nonfatal myocardial infarction [MI]). Results: Among the 7020 patients admitted with ACS, 393 met the inclusion criteria. Of whom, 106 (mean age: 70.3 ± 10.7 years, 76% of males) had target LDL-C level and were included. CAD risk factors were prevalent among the cohort. The mean total cholesterol, LDL-C, and TG were 3.6 ± 0.9, 1.4 ± 0.3, and 1.7 ± 1.5 mmol/L, respectively. Most patients presented with non-ST-elevation MI (54.7%), followed by unstable angina (36.8%). Over a median follow-up of 5.6 years, 17 (16%) patients had MACE, of which 14.2% were nonfatal MI and 1.9% of patients had cardiac death. There was no statistically significant difference in MACE between those with normal and high levels of TG. Conclusions: In this retrospective cohort of patients presenting with first-presentation ACS, TG level did not confer an increased risk of MACE among patients with target LDL-C level.