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Hypertriglyceridemia associated with increased risk for myocardial infarction, acute pancreatitis

Nonfasting mild-to-moderate hypertriglyceridemia was linked to a higher risk for acute pancreatitis and myocardial infarction according to data published in JAMA Internal Medicine.

Simon B. Pedersen, BMSC, from Copenhagen Community Hospital, Denmark, and colleagues wrote that their findings may influence management guidelines for patients with hypertriglyceridemia.

They noted that while severe hypertriglyceridemia is an established cause of acute pancreatitis, it was previously unknown whether mild-to-moderate hypertriglyceridemia also increased risk.

"There is no consensus on a clear threshold above which triglycerides are associated with acute pancreatitis," Pedersen and colleagues wrote. "According to guidelines from the American College of Gastroenterology and the Endocrine Society, triglyceride levels greater than 1000 mg/dL (>11.3 mmol/L) should be considered a risk factor of acute pancreatitis; the European Society of Cardiology and the European Atherosclerosis Society set this cut point at 885 mg/dL (10 mmol/L), and the National Cholesterol Education Program Adult Treatment Panel III recommends triglyceride-lowering therapy when triglycerides are greater than or equal to 500 mg/dL (5.65 mmol/L) to prevent acute pancreatitis."

The researchers conducted a prospective cohort study of 116,550 participants in the Copenhagen General Population between 2003 and 2015 and the Copenhagen City Heart Study between 1976 and 2003 to assess associations between nonfasting mild-to-moderate hypertriglyceridemia (177 mg/ dL to 885 mg/dL; 2 mmol/L to 10 mmol/L) and acute pancreatitis.

Compared to participants that had plasma triglyceride levels less than 89 mg/dL (<1 mmol/L), hazard ratios for acute pancreatitis were:

• 1.6 (95% CI, 1-2.6; 4.3 events/10,000 person-years) for participants with triglyceride levels of 89 mg/dL to 176 mg/dL (1 mmol/L to 1.99 mmol/L);
• 2.3 (95% CI, 1.3-4; 5.5 events/10,000 person-years) for 177 mg/dL to 265 mg/dL (2 mmol/L to 2.99 mmol/L);
• 2.9 (95% CI, 1.4-5.9; 6.3 events/10,000 person-years) for 366 mg/dL to 353 mg/dL (3 mmol/L to 3.99 mmol/L);
• 3.9 (95% CI, 1.5-10; 7.5 events/10,000 person-years) for 354 mg/dL to 442 mg/dL (4 mmol/L to 4.99 mmol/L); and
• 8.7 (95% CI, 3.7-20; 12 events/10,000 person-years) for participants with triglyceride levels greater than or equal to 443 mg/dL (5 mmol/L).

Pedersen and colleagues reported that hazard ratios for myocardial infarction were:

• 1.6 (95% CI, 1.4-1.9; 41 events/10,000 person-years) for participants with triglyceride levels of 89 mg/dL to 176 mg/dL (1 mmol/L to 1.99 mmol/L);
• 2.2 (95% CI, 1.9-2.7; 57 events/10,000 person-years) for 177 mg/dL to 265 mg/dL (2 mmol/L to 2.99 mmol/L);
• 3.2 (95% CI, 2.6-4.1; 72 events/10,000 person-years) for 366 mg/dL to 353 mg/dL (3 mmol/L to 3.99 mmol/L);
• 2.8 (95% CI, 2-3.9; 68 events/10,000 person-years) for 354 mg/dL to 442 mg/dL (4 mmol/L to 4.99 mmol/L); and
• 3.4 (95% CI, 2.4-4.7; 78 events/10,000 person-years) for participants with triglyceride levels greater than or equal to 443 mg/dL (5 mmol/L).

"We found that mild-to-moderate hypertriglyceridemia of 177 mg/dL (2 mmol/L) and above was associated with high risk of acute pancreatitis in the general population," Pedersen and colleagues concluded. "Hazard ratios for acute pancreatitis were even higher than for myocardial infarction, the latter in accordance with previous findings. Notably, there was roughly 10 times more myocardial infarction than acute pancreatitis events, also illustrated by the higher absolute risk from triglyceride levels less than 89 mg/dL (<1 mmol/L) to levels greater than or equal to 443 mg/dL (5 mmol/L) of 9.3 events/10,000 person-years for acute pancreatitis and of 56 events/10,000 person-years for myocardial infarction. 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." – by Chelsea Frajerman Pardes

Disclosures: One author reports consultancies or talks sponsored by AstraZeneca, Merck, Omthera, Ionis and Kowa. No other authors reported any relevant financial disclosures.