Abstract
BackgroundThe incidence of severe (S-HTG) and very severe hypertriglyceridemia (VS-HTG) among Canadians is unknown. This study aimed to determine the incidence, characteristics, predictors and care patterns for individuals with VS-HTG.MethodsUsing linked administrative healthcare databases, a population-based cohort study of Ontario adults was conducted to determine incidence of new onset S-HTG (serum triglycerides (TG) > 10–20 mmol/L) and VS-HTG (TG > 20 mmol/L) between 2010 and 2015. Socio-demographic and clinical characteristics of those with VS-HTG were compared to those who had no measured TG value > 3 mmol/L. Univariable and multivariable logistic regression were used to determine predictors for VS-HTG. Healthcare patterns were evaluated for 2 years following first incidence of TG > 20 mmol/L.ResultsIncidence of S-HTG and VS-HTG in Ontario was 0.16 and 0.027% among 10,766,770 adults ≥18 years and 0.25 and 0.041% among 7,040,865 adults with at least one measured TG, respectively. Predictors of VS-HTG included younger age [odds ratios (OR) 0.64/decade, 95% confidence intervals (CI) 0.62–0.66], male sex (OR 3.83; 95% CI 3.5–4.1), diabetes (OR 5.38; 95% CI 4.93–5.88), hypertension (OR 1.69; 95% CI 1.54–1.86), chronic liver disease (OR 1.71; 95% CI 1.48–1.97), alcohol abuse (OR 2.47; 95% CI 1.90–3.19), obesity (OR 1.49; 95% CI 1.13–1.98), and chronic kidney disease (OR 1.39; 95% CI 1.19–1.63).ConclusionThe 5-year incidence of S-HTG and VS-HTG in Canadian adults was 1 in 400 and 1 in 2500, respectively. Males, those with diabetes, obese individuals and those with alcohol abuse are at highest risk for VS-HTG and may benefit from increased surveillance.
Highlights
The incidence of severe (S-HTG) and very severe hypertriglyceridemia (VS-HTG) among Canadians is unknown
More individuals in the VS-HTG cohort had a baseline history of pancreatitis (6.2% vs 0.3%; standardized differences (StDiff) 0.34; P-value < 0.001) (Table 1)
Conditions that are most strongly associated with VS-HTG include diabetes, male sex, alcohol, chronic liver disease, hypertension, obesity and chronic kidney disease
Summary
The incidence of severe (S-HTG) and very severe hypertriglyceridemia (VS-HTG) among Canadians is unknown. Very severe hypertriglyceridemia (VSHTG), defined in this study as triglyceride (TG) levels that exceed 20 mmol/L, is captured through routine lipid testing and commonly misattributed to an exclusive genetic etiology. Most cases result from secondary causes, often in conjunction with inherited partial impairment in TG metabolism [7,8,9,10,11]. These cases may only manifest under conditions that increase TG production or impair clearance. It remains important to understand and manage the secondary risk factors associated with this condition [5]
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