Pedersen SB, et al. Nonfasting mild-to-moderate hypertriglyceridemia and risk of acute pancreatitis. JAMA Intern Med 2016
Bottom-line: Serum triglyceride concentrations increase the risk of pancreatitis in a "dose-dependent" manner (i.e. the higher the concentration, the greater the risk).
The absolute risk increase of mild-moderate triglyceride elevations remains small. With a risk of pancreatitis of ~1% over 10 years, individuals with a triglyceride concentration of ~5-10 mmol/L are unlikely to benefit from medical management to lower triglycerides (e.g. fibrates).
- Registry-based cohort study conducted in the Netherlands.
- Patients: Included 116,550 individuals, 434 of whom developed acute pancreatitis (0.3%) over a median 6.7 years of follow-up.
- Exposure: Non-fasting serum triglyceride concentration, separated into 6 categories ranging from <1 mmol/L to 5+ mmol/L.
- Individuals with a triglyceride concentration 5+ mmol/L represented <2% of the general population in this study.
- Co-variables included age, sex, BMI, alcohol intake/week, education level, smoking status, hypertension, diabetes, statin use, birth year, HDL.
- Outcome: Death or hospitalization with ICD-8/10 code for acute or chronic pancreatitis.
- Adjust events per 10,000 person-years based on serum triglyceride concentration (hazard ratio, 95% confidence interval versus <1.00 mmol/L):
- <1.00 mmol/L: 2.7 = 0.3% over 10 years
- 1-1.99 mmol/L: 4.3 (HR 1.7, 1.0-2.7)
- 2-2.99 mmol/L: 5.5 (HR 2.4, 1.4-4.2)
- 3-3.99 mmol/L: 6.3 (HR 3.2, 1.6-6.5)
- 4-4.99 mmol/L: 7.5 (HR 4.6, 1.8-12)
- 5 mmol/L or greater: 12 = 1.2% over 10 years (HR 11, 4.7-26)
- Previous smaller studies showed that triglyceride concentrations needed to be >20 to >34 mmol/L in order to significantly increase the risk of acute pancreatitis