Patients with mild to moderate hypertriglyceridemia may have increased risk of MI, acute pancreatitis

A prospective cohort study found that mild-to-moderate hypertriglyceridemia was associated with a high risk of acute pancreatitis.

After a median follow-up period of 6.7 years, there were approximately 10 times more MIs than acute pancreatitis events, although the hazard ratios for acute pancreatitis were higher than for MIs.

The researchers defined mild to moderate hypertriglyceridemia as plasma triglyceride levels of 177 mg/dL to 885 mg/dL.

Lead researcher Simon B. Pedersen, BMSc, of the Copenhagen University Hospital in Denmark, and colleagues published their results online Nov. 7 in JAMA Internal Medicine.

“The present data may have implications in changing the standard of care in patients with hypertriglyceridemia both with respect to acute pancreatitis and myocardial infarction,” the researchers wrote.

In the U.S., hospital admissions for acute pancreatitis increased from four events per 10,000 person-years in 1988 to seven events per 10,000 person-years in 2002, according to the researchers. They added that the leading causes of acute pancreatitis were gallstone disease and high alcohol consumption.

The researchers evaluated data on 116,500 patients of Danish descent who enrolled in the Copenhagen City Heart Study and the Copenhagen General Population Study, which are both prospective trials. The patients were followed until the occurrence of an event, death, emigration or Nov. 14, 2014, whichever came first. The median age was 57 years old.

During the follow-up period, 434 patients developed acute pancreatitis and 3,942 had an MI.

When compared with patients who have plasma triglyceride levels of less than 89 mg/dL, the multivariable adjusted hazard ratios were 1.6 for patients with triglyceride levels of 89 mg/dL to 176 mg/dL; 2.3 for patients with triglyceride levels of 177 mg/dL to 265 mg/dL; 2.9 for patients with triglyceride levels of 266 mg/dL to 353 mg/dL; 3.9 for patients with triglyceride levels of 354 mg/dL to 442 mg/dL; and 8.7 for patients with triglyceride levels of 443 mg/dL or higher. The corresponding hazard ratios for MI were 1.6, 2.2, 3.2, 2.8 and 3.4, respectively.

Meanwhile, the multivariable adjusted hazard ratio for acute pancreatitis was 1.17 per 89 mg/dL higher triglycerides. The results were similar when stratified by sex, age, body mass index, alcohol consumption and other factors.

The absolute risk from triglyceride levels less than 89 mg/dL to levels of 443 mg/dL or higher was 9.3 events per 10,000 person-years for acute pancreatitis and 56 events per 10,000 person-years for MI.

The researchers cited a few limitations of the study, including the potential for diagnostic misclassification. They also could not obtain information on subtypes of acute pancreatitis and did not have complete data on lipase and pancreatic amylase in all patients.