Association between change in plasma triglyceride levels and risk of stroke and carotid atherosclerosis: systematic review and meta-regression analysis

Labreuche et al., 2010 | Atherosclerosis | Meta Analysis

Citation

Labreuche Julien, Deplanque Dominique, ... Amarenco Pierre. Association between change in plasma triglyceride levels and risk of stroke and carotid atherosclerosis: systematic review and meta-regression analysis. Atherosclerosis. 2010-Sep;212(1):9-15. doi:10.1016/j.atherosclerosis.2010.02.011

Abstract

BACKGROUND AND PURPOSE: The contribution of modifying non-low-density lipoprotein cholesterol (LDL-C) levels to reduce stroke risk remains uncertain. The aim of this study was to investigate the association between treatment-induced change in plasma triglyceride levels and risk of stroke and progression of carotid intima-media thickness (CIMT). METHODS: We performed a systematic review and meta-regression analyses of randomized controlled trials of lipid-modifying treatments selected from a PubMed search on literature published from 1966 to 2008. RESULTS: We identified 64 randomized controlled trials (active groups, n=96,807; control groups, n=98,681) that tested lipid-modifying drugs and reported triglyceride levels and stroke outcome. Extracting data from placebo groups, we found a statistically significant association between baseline triglyceride levels and stroke risk (adjusted relative risk [RR], 1.05 per 10-mg/dL increase; 95% CI, 1.03-1.07). Except for a trend in fibrate and niacin trials, there was no evidence of any relationship between degree of triglyceride change and stroke incidence. In multivariable meta-regression analysis including baseline and change in LDL-C, only change in LDL-C was associated with log risk ratio of all strokes (RR reduction, 4.5% per 10-mg/dL reduction; 95% CI, 1.7-7.2; P=.003). Similarly, taking into account 26 randomized controlled trials reporting CIMT outcome, LDL-C reduction was associated with reduced CIMT progression (-3.0 microm/y per 10-mg/dL reduction; 95% CI, -5.5 to -0.4; P=.03). CONCLUSIONS: In view of the limitations of meta-regression analysis and CIMT measures as surrogate endpoints in lipid-lowering drugs trials, additional studies are needed to more precisely quantify the detrimental effect of triglyceride levels on stroke risk and to establish the efficacy of triglyceride-lowering therapy in addition to LDL-C reduction.

Key Findings

We identified 64 randomized controlled trials (active groups, n=96,807; control groups, n=98,681) that tested lipid-modifying drugs and reported triglyceride levels and stroke outcome. Extracting data from placebo groups, we found a statistically significant association between baseline triglyceride levels and stroke risk (adjusted relative risk [RR], 1.05 per 10-mg/dL increase; 95% CI, 1.03-1.07). Except for a trend in fibrate and niacin trials, there was no evidence of any relationship between

Outcomes Measured

• Requires manual extraction

Population

MeSH Terms

• Biomarkers
• Carotid Arteries
• Carotid Artery Diseases
• Cholesterol
• Humans
• Hypolipidemic Agents
• Lipoproteins
• Randomized Controlled Trials as Topic
• Risk Assessment
• Risk Factors
• Stroke
• Treatment Outcome
• Triglycerides
• Tunica Intima
• Tunica Media

Evidence Classification

• Level: Meta Analysis
• Publication Types: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Systematic Review
• Vertical: niacin

Provenance

• PMID: 20457452
• DOI: 10.1016/j.atherosclerosis.2010.02.011
• PMCID: Not in PMC
• Verified: 2026-04-09 via PubMed E-utilities API

Source extracted via PubMed E-utilities API on 2026-04-09