Clinical features and outcomes of severe, very severe, and extreme hypertriglyceridemia in a regional health service

Abstract

Comprehensive data on severe hypertriglyceridemia (HTG) in the general population setting are limited and of importance due to the increase in metabolic risk factors and novel therapies under development. To investigate contributing causes and outcomes of severe to extreme HTG. Regional database retrospectively analyzed for subjects with severe HTG. Adverse outcomes were investigated in correlation to HTG severity, with follow-up initiating at first documentation of HTG > 1000mg/dL. A total of 3091 subjects with severe (peak triglycerides 1000-1999mg/dL; n=2590), very severe (2000-2999mg/dL; n=369), and extreme (≥3000mg/dL; n=132) HTG were identified. Mean age was 48±12years; 73% males. Obesity (48%) and diabetes (62%) were main contributing factors. During follow-up (median 101months), 4.7% subjects had pancreatitis, 4.7% myocardial infarction, and 6% stroke. Compared with severe HTG, the multivariate-adjusted hazard ratio for pancreatitis was 3.22 (95% confidence interval 2.21-4.70) for individuals with very severe HTG and 5.55 (3.53-8.71) for those with extreme HTG, P<.0001. In contrast, the extent of HTG severity at these levels was not associated with worse cardiovascular outcomes or death. Most subjects (81%) achieved triglyceride levels <500mg/dL, associated with lower risk for developing pancreatitis but not myocardial infarction or stroke. Severity of HTG is closely related to cardiometabolic conditions, with a stepwise increase in the risk for pancreatitis, particularly if not attaining reduced triglyceride levels during the follow-up. In contrast, whereas mild-to-moderate HTG is a known established cardiovascular risk factor, very severe and extreme HTG may not further increase the risk for myocardial infarction, stroke, or mortality.