Hypertriglyceridemia and Risk of Acute Pancreatitis

Study Questions:

Is nonfasting mild-to-moderate hypertriglyceridemia (177-885 mg/dl) associated with the risk of acute pancreatitis?

Methods:

A prospective cohort study was conducted in the Copenhagen General Population Study from 2003 to 2015, and the Copenhagen City Heart Study from 1978 to 2003. Plasma nonfasting triglycerides (TGs) (n = 116,550), lipase (n = 15,856), and pancreatic amylase (n = 92,672) were measured on fresh samples with standard hospital assays. Median follow-up was 6.7 years (interquartile range, 4.0-9.4 years); and includes persons with a TG measurement from the Copenhagen General Population Study (n = 98,649) and the Copenhagen City Heart Study (n = 17,901). All were followed until the occurrence of an event, death, emigration, or end of follow-up (November 2014), whichever came first.

Results:

A total of 116,550 individuals were included (median [interquartile range] age, 57 [47-66] years). Compared with plasma TG levels <89 mg/dl, the multivariable adjusted hazard ratios (HRs) for acute pancreatitis were 1.6 with 4.3 events/10,000 person-years for individuals with TG levels of 89-176 mg/dl; 2.3 with 5.5 events/10,000 person-years for 177-265 mg/dl; 2.9 with 6.3 events/10,000 person-years for 266-353 mg/dl; 3.9 with 7.5 events/10,000 person-years) for 354-442 mg/dl; 3.4 with 78 events/10,000 person-years for individuals with triglyceride levels ≥443 mg/dl (trend, p = 6 × 10−8). After adjustment for alcohol use and time since last meal, the risk estimates were similar, while additional adjustment for diabetes and body mass index did attenuate risk estimates. Corresponding HRs for myocardial infarction (MI) include 1.6 or 41 events/10,000 person-years; 2.2 with 57 events/10,000 person-years; 3.2 with 72 events/10,000 person-years; 2.8 or 68 events/10,000 person-years; and 3.4 or 78 events/10,000 person-years (trend, p = 6 × 10−31), respectively. The multivariable adjusted HR for acute pancreatitis was 1.17 (95% confidence interval, 1.10-1.24) per 89 mg/dl higher TGs.

Conclusions:

Nonfasting mild-to-moderate hypertriglyceridemia from 177 mg/dl and above is associated with high risk of acute pancreatitis, with HR estimates higher than for MI.

Perspective:

The findings do not infer that moderate elevations of TGs are associated with acute pancreatitis. Rather, that mild-to-moderate levels identify persons who are at risk for much higher levels of TGs in the future. Levels >500 mg/dl are associated with decreased endothelial lipoprotein lipase, which can become totally depleted by rapid increase to chylomicronemia and levels >2000 mg/dl with alcohol, high-fat calorie binging, and poorly controlled diabetes.

Clinical Topics: Diabetes and Cardiometabolic Disease, Clinical Topic Collection: Dyslipidemia, Prevention, Lipid Metabolism

Keywords: Alcohols, Amylases, Body Mass Index, Diabetes Mellitus, Dyslipidemias, Hypertriglyceridemia, Lipoprotein Lipase, Metabolic Syndrome X, Pancreatitis, Primary Prevention, Risk, Triglycerides


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