In post-hoc analyses of the PROVE IT-TIMI (Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction) 22 trial, Miller et al. tested the hypothesis that low levels of on-treatment triglycerides might be associated with decreased coronary heart disease (CHD) risk in patients with acute coronary syndrome (ACS) who achieved low on-treatment LDL cholesterol levels (<70 mg/dl). In the PROVE IT-TIMI 22 trial, 4,162 patients hospitalized for ACS were recruited, and they were followed for an average of 2 years. Achieving low triglyceride levels (<150 mg/dl) was associated with a significant reduction in CHD risk, even after controlling for LDL cholesterol. The combination of low LDL cholesterol concentration and low triglyceride levels was associated with the lowest event rates. Results of this study emphasize the role that other biological risk factors, beyond LDL cholesterol, play in predicting CHD risk in patients with ACS.
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