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While traditionally nonobstructive coronary artery disease(NOCAD) has been regarded as benign, recent data suggests that the majority of plaque rupture may stem from nonobstructive plaque. Triglyceride levels have been associated with poor cardiovascular outcomes and plaque rupture. We aimed to determine whether in patients with NOCAD, elevated triglyceride levels are associated with major adverse cardiovascular events (MACE).
This is a prospective cohort study enrolling postmenopausal women who were found to have NOCAD, defined as no stenosis greater than 20%. All patients had baseline laboratory testing, and were subsequently followed for 7.8 + 4.3 years for the development of major adverse cardiovascular events by a trained nurse.
Median age of the population was 54(IQR 46, 62) years. A history of hypertension was present in 39%, diabetes in 6%, and hyperlipidemia in 55%. Median triglyceride level was 113 (IQR 78, 168) mg/dL in the cohort. Baseline triglyceride levels were significantly higher in patients who developed MACE when compared to those that did not [123(IQR 100, 161) vs 109(73,164.5); p=0.02] (Figure 1). Overall, triglyceride levels were independently predictive of MACE after adjusting for age, hypertension, diabetes, estrogen use, and lipid lowering drug use (LR 4.3, p=0.04). In patients not taking any lipid lowering therapy, triglyceride use was independently predictive of MACE on follow-up after adjustment for age, hypertension, diabetes, and estrogen use (LR 7.7; p=0.006), and this was not seen in those on lipid lowering therapy.
Patients with NOCAD and chest pain may have significant cardiovascular morbidity and mortality despite lack of obstructive disease. These findings suggest that triglycerides may be a marker of increased risk in women with NOCAD. Moreover, lipid lowering therapy may have a role in preventing MACE in this population. Further investigation is necessary to understand the role of triglyceride lowering medications in this population.
OTHER: Womens Health Issues