Thread by @hyderabaddoctor

Lowering triglyceride with medicines does not result in better clinical outcome

1. High serum triglyceride levels are associated with increased incidence of heart attack, stroke and death. In a recent research, the effect of pemafibrate (which lowers triglycerides) was tested.

2. 10,497 patients with type 2 diabetes, mild-to-moderate hypertriglyceridemia (triglyceride level, 200 to 499 mg/dL), and high-density lipoprotein (HDL) cholesterol levels, 40 mg/dL or lower received pemafibrate (0.2-mg tablets twice daily) or matching placebo.
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3. The median baseline fasting triglyceride level was 271 mg per deciliter, HDL cholesterol level 33 mg per deciliter, and LDL cholesterol level 78 mg per deciliter. All patents were on statins.
The median follow-up of patients was 3.4 years.
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4. Pemafibrate significantly lowered triglyceride, VLDL cholesterol, remnant cholesterol, and apolipoprotein C-III levels, as compared to placebo.

5. The incidence of cardiovascular events-heart attack, stroke or death due to these diseases- was similar in patients who took pemafibrate or placebo.
Moreover, pemafibrate caused more renal adverse effects and venous thromboembolism.
Ref: nejm.org/doi/full/10.10…

6. Take home message
*Lowering triglyceride with medication (in people with normal LDL with or without statins) does not lead to any clinical benefits.
*Lifestyle modification (diet, exercise) and cessation of alcohol intake are better options for reducing triglycerides.