Association between serum triglycerides (non-fasting) & pancreatitis

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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).

 

Design summary

  • 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.

Results

  • 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)

Additional observations

  • 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