Association between triglyceride and all-cause mortality and cardiovascular outcomes in heart failure patients: a territory-wide study in Hong Kong

Type of funding sources: None.

To determine the association between levels of triglyceride (TG) and all-cause mortality and cardiovascular outcomes. To evaluate the concentration of TG associated with the lower range and lowest risk of adverse outcomes in heart failure (HF) patients.

Using a previously validated territory-wide clinical information registry, all eligible patients with HF (N=147 396) from 1996 to 2020 were enrolled. Levels of time-weighted TG associated with risk of mortality were evaluated on a continuous scale using restricted cubic spline curves and by categories of TG with Cox proportional hazards regression model. The primary outcomes were all-cause mortality and cardiovascular death (CVD). Secondary outcomes include cause-specific mortality and incident cardiovascular events.

Among 147 396 HF patients, the mean age was 70.0±12.5 years and 73 571 (49.9%) were male. The association between levels of time-weighted TG and the risk of all-cause mortality was J-shaped, with low and high levels associated with an increased risk of all-cause mortality, CVD and cause-specific mortality. Compared with individuals with levels of TG between 1.14 to 2.85 mmol/L, the multivariable-adjusted hazard ratio (HR) for all-cause mortality was 1.39 (95% confidence interval [CI] 1.35 to 1.44) for individuals with TG concentrations of less than 0.71 mmol/L and 1.97 (95% CI, 1.67 to 2.32) for TG concentrations of more than 5.60 mmol/L. The concentration of TG associated with the lowest risk of all-cause mortality was 1.84 mmol/L. Similar results were seen in males and females, in patients with or without lipid-lowering treatment, and for cardiovascular events.

In the HF population, low and high levels of TG were associated with an increased risk of all-cause mortality and cardiovascular outcomes. The lowest risk of all-cause mortality was found at a TG concentration of 1.84 mmol/L.