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Drug Treatment of Asymptomatic Hypertriglyceridemia to Prevent Pancreatitis: Where Is the Evidence?

Frank A. Lederle, MD; and Hanna E. Bloomfield, MD, MPH
[+] Article, Author, and Disclosure Information

From the Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota.

Potential Conflicts of Interest: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-0403.

Requests for Single Reprints: Frank A. Lederle, MD, Veterans Affairs Medical Center (111-O), Minneapolis, MN 55417; e-mail, frank.lederle@va.gov.

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.

Ann Intern Med. 2012;157(9):662-664. doi:10.7326/0003-4819-157-9-201211060-00011
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Drug treatment of asymptomatic hypertriglyceridemia has long been controversial. In the absence of evidence that drug treatment of moderate hypertriglyceridemia reduces vascular events, guidelines have stopped short of recommending it. However, unproven hypotheses that triglyceride levels of 500 mg/dL or greater (≥5.65 mmol/L) carry a substantial risk for pancreatitis in asymptomatic persons and that drugs can reduce this risk seem to have been incorporated into medical practice without question. This commentary argues that this practice should cease.

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Comment on Lederle
Posted on December 7, 2012
John Brunzell
University of Washington
Conflict of Interest: None Declared

We applaud Lederle’s and Bloomfield’s argument that all patients with triglyceride above 500 mg/dl are not at risk for triglyceride induced pancreatitis (1) as was suggested by NCEP ATPIII (2).

However, we are strongly concerned with their questioning the role in pancreatitis of triglyceride above 2000 mg/dl and the suggestion that a randomized controlled trial should be performed, which would be dangerous. As demonstrated in lipoprotein lipase deficiency and the chylomicronemia syndrome, keeping triglyceride levels below 2000 mg/dl prevents acute recurrent pancreatitis (3, 4).

A randomized control trial in patients with triglyceride of 1000 to 2000 mg/dl, to study the natural history and incidence of triglyceride induced pancreatitis, would be of interest (5, 6).

1. Lederle FA and Bloomfield HE. Drug treatment of asymptomatic hypertriglyceridemia to prevent pancreatitis :Where is the evidence? Ann Intern Med 2012; 157:662-4.

2. National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of high blood cholesterol in Adults. Circulation; 2002; 106:3143-421.

3. Brunzell JD and Schrott HG. The interaction of familial and secondary causes of hypertriglyceridemia: Role in pancreatitis. J Clin Lipidology; 2012; 6:409-12.

4. Chait A and Brunzell JD. Chylomicronemia syndrome. Adv Intern Med 1991; 37:249-73.

5. Berglund L, Brunzell JD, Goldberg AC, Goldberg IJ, Sacks F, Murad MH and Stalenhoef, AF. Evaluation and treatment of hypertriglyceridemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab; 2012:97:2969-89.

6. Lloret LC, Pelletire AL, Czernichow S, Vergnaud AD, Bonnefon-Rousselot D, Levy, P, Ruszniewski P and Bruckert E. Acute pancreatitis in a cohort of 129 patients referred for severe hypertriglyceridemia. Pancreas; 2008; 37:12-13.

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