Drug Treatment of Asymptomatic Hypertriglyceridemia to Prevent Pancreatitis: Where Is the Evidence?
Authors: Frank A. Lederle, Hanna E. Bloomfield
Journal: Annals of Internal Medicine (2012)

Ideas and Opinions6 November 2012Drug Treatment of Asymptomatic Hypertriglyceridemia to Prevent Pancreatitis: Where Is the Evidence?Frank A. Lederle, MD and Hanna E. Bloomfield, MD, MPHFrank A. Lederle, MDFrom the Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota.Search for more papers by this author and Hanna E. Bloomfield, MD, MPHFrom the Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-157-9-201211060-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Drug treatment of asymptomatic hypertriglyceridemia has long been controversial. High serum triglyceride levels are associated with vascular disease, but whether the relationship is causal remains uncertain (1). A recent meta-regression analysis of treatment trials found “no association between change in triglycerides and risk of coronary heart disease events whenever the model included an adjustment for the change in low density lipoprotein cholesterol” (2). Fibrates and nicotinic acid, the drugs commonly used to lower triglyceride levels, have not proven beneficial when added to statin therapy (3, 4). Drug treatment of moderate hypertriglyceridemia to prevent vascular events is thus not supported by ...References1. Goldberg IJ, Eckel RH, McPherson R. Triglycerides and heart disease: still a hypothesis? Arterioscler Thromb Vasc Biol. 2011;31:1716-25. [PMID: 21527746] CrossrefMedlineGoogle Scholar2. Briel M, Ferreira-Gonzalez I, You JJ, Karanicolas PJ, Akl EA, Wu P, et al. Association between change in high density lipoprotein cholesterol and cardiovascular disease morbidity and mortality: systematic review and meta-regression analysis. BMJ. 2009;338:b92. 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[PMID: 21211599] CrossrefMedlineGoogle Scholar10. Chait A, Brunzell JD. Chylomicronemia syndrome. Adv Intern Med. 1992;37:249-73. [PMID: 1557997] MedlineGoogle Scholar11. Miller A, Lees RS, McCluskey MA, Warshaw AL. The natural history and surgical significance of hyperlipemic abdominal crisis. Ann Surg. 1979;190:401-8. [PMID: 485615] CrossrefMedlineGoogle Scholar12. Sandhu S, Al-Sarraf A, Taraboanta C, Frohlich J, Francis GA. Incidence of pancreatitis, secondary causes, and treatment of patients referred to a specialty lipid clinic with severe hypertriglyceridemia: a retrospective cohort study. Lipids Health Dis. 2011;10:157. [PMID: 21906399] CrossrefMedlineGoogle Scholar13. Domínguez-Muñoz JE, Jünemann F, Malfertheiner P. Hyperlipidemia in acute pancreatitis. Cause or epiphenomenon? Int J Pancreatol. 1995;18:101-6. [PMID: 8530825] CrossrefMedlineGoogle Scholar14. Hall MJ, DeFrances CJ, Williams SN, Golosinskiy A, Schwartzman A. National Hospital Discharge Survey: 2007 summary. National Health Statistics Reports no. 29. Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention; 26 October 2010. Accessed at www.cdc.gov/nchs/data/nhsr/nhsr029.pdf on 27 July 2012. Google Scholar15. Fortson MR, Freedman SN, Webster PD. Clinical assessment of hyperlipidemic pancreatitis. Am J Gastroenterol. 1995;90:2134-9. [PMID: 8540502] MedlineGoogle Scholar16. Keech A, Simes RJ, Barter P, Best J, Scott R, Taskinen MR, et al; FIELD study investigators. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet. 2005;366:1849-61. [PMID: 16310551] CrossrefMedlineGoogle Scholar17. Miller M, Stone NJ, Ballantyne C, Bittner V, Criqui MH, Ginsberg HN, et al; American Heart Association Clinical Lipidology, Thrombosis, and Prevention Committee of the Council on Nutrition, Physical Activity. Metabolism. Triglycerides and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2011;123:2292-333. [PMID: 21502576] CrossrefMedlineGoogle Scholar18. Lloret Linares C, Pelletier AL, Czernichow S, Vergnaud AC, Bonnefont-Rousselot D, Levy P, et al. Acute pancreatitis in a cohort of 129 patients referred for severe hypertriglyceridemia. Pancreas. 2008;37:13-2. [PMID: 18580438] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From the Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota.Disclosures: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-0403.Corresponding Author: Frank A. Lederle, MD, Veterans Affairs Medical Center (111-O), Minneapolis, MN 55417; e-mail, [email protected].Current Author Addresses: Drs. Lederle and Bloomfield: Veterans Affairs Medical Center (111-O), Minneapolis, MN 55417.Author Contributions: Conception and design: F.A. Lederle.Analysis and interpretation of the data: F.A. Lederle.Drafting of the article: F.A. Lederle.Critical revision for important intellectual content: F.A. Lederle, H.E. Bloomfield.Final approval of the article: F.A. Lederle, H.E. Bloomfield.Provision of study materials or patients: F.A. Lederle.Statistical expertise: F.A. Lederle.Administrative, technical, or logistic support: F.A. Lederle.Collection and assembly of data: F.A. Lederle. 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