Abstract
BackgroundSevere hypertriglyceridemia (HTG) is one cause of acute pancreatitis, yet the level of plasma triglycerides likely to be responsible for inducing pancreatitis has not been clearly defined.Methods and ResultsA retrospective cohort study was conducted on patients presenting non-acutely to the Healthy Heart Program Lipid Clinic at St. Paul's Hospital with a TG level > 20 mM (1772 mg/dl) between 1986 and 2007. Ninety-five patients with TG > 20 mM at the time of referral were identified, in who follow up data was available for 84. Fifteen patients (15.8%), with a mean outpatient TG level of 38.1 mM, had a history of acute pancreatitis. Among 91 additional patients with less severe HTG, none had a history of pancreatitis when TG were between 10 and 20 mM. Among patients with TG > 20 mM on presentation, 8 (8.5%), with a mean TG level of 67.8 mM, exhibited eruptive xanthomata. A diet high in carbohydrates and fats (79%) and obesity (47.6%) were the two most frequent secondary causes of HTG at initial visit. By 2009, among patients with follow up data 53% exhibited either pre-diabetes or overt Type 2 diabetes mellitus. Upon referral only 23 patients (24%) were receiving a fibrate as either monotherapy or part of combination lipid-lowering therapy. Following initial assessment by a lipid specialist this rose to 84%, and remained at 67% at the last follow up visit.ConclusionsThese results suggest hypertriglyceridemia is unlikely to be the primary cause of acute pancreatitis unless TG levels are > 20 mM, that dysglycemia, a diet high in carbohydrates and fats, and obesity are the main secondary causes of HTG, and that fibrates are frequently overlooked as the drug of first choice for severe HTG.
Highlights
Severe hypertriglyceridemia (HTG) is one cause of acute pancreatitis, yet the level of plasma triglycerides likely to be responsible for inducing pancreatitis has not been clearly defined
These results suggest hypertriglyceridemia is unlikely to be the primary cause of acute pancreatitis unless TG levels are > 20 mM, that dysglycemia, a diet high in carbohydrates and fats, and obesity are the main secondary causes of HTG, and that fibrates are frequently overlooked as the drug of first choice for severe HTG
We found an absence of pancreatitis unless TG were > 20 mM, a relatively low incidence of classic clinical findings of HTG such as eruptive xanthomas, the presence of diabetes or pre-diabetes in the majority of HTG subjects, and a tendency of non-lipid specialists to overutilize statins and underutilize fibrates as their first-line treatment for severe HTG
Summary
Severe hypertriglyceridemia (HTG) is one cause of acute pancreatitis, yet the level of plasma triglycerides likely to be responsible for inducing pancreatitis has not been clearly defined. Hypertriglyceridemia (HTG), classically defined as fasting plasma triacylglycerols (triglycerides, TG) > 2.3 mM or 200 mg/dl, or 1.7 mM (150 mg/dl) in the definition of metabolic syndrome [1], is a common laboratory finding. Patients with severe HTG may present with classic findings such as abdominal pain or overt pancreatitis, eruptive or palmar xanthomas, lipemia retinalis, or they may be asymptomatic [2,3]. The most significant complication of severe HTG is acute pancreatitis, which may lead to pancreatic necrosis and death [2,6]. The level of plasma triglycerides at which acute pancreatitis can be ascribed to the presence of HTG has not been reported
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