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Ideas and Opinions |6 November 2012

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

Frank A. Lederle, MD; Hanna E. Bloomfield, MD, MPH

Article, Author, and Disclosure Information
Author, Article, 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.

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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 direct evidence, and guidelines have generally stopped short of recommending it (5, 6).
However, the discussion usually concludes with a proviso. For example, the National Cholesterol Education Program Adult Treatment Panel III (ATP III) report (6) noted that “in rare cases in which triglycerides are very high (≥500 mg/dL [≥5.65 mmol/L]), the initial aim of therapy is to prevent acute pancreatitis through triglyceride lowering. This approach requires very low fat diets (≤15% of calorie intake), weight reduction, increased physical activity, and usually a triglyceride-lowering drug (fibrate or nicotinic acid).” The purpose of this article is to suggest that the ideas that high triglyceride levels carry a substantial risk for pancreatitis in asymptomatic persons, that a level of 5.65 mmol/L is sufficient to incur such a risk, and that the risk can be reduced by medications are unproven hypotheses that seem to have been incorporated into medical...
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Lederle FA, Bloomfield HE. Drug Treatment of Asymptomatic Hypertriglyceridemia to Prevent Pancreatitis: Where Is the Evidence?. Ann Intern Med. 2012;157:662–664. doi: https://doi.org/10.7326/0003-4819-157-9-201211060-00011

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Published: Ann Intern Med. 2012;157(9):662-664.

DOI: 10.7326/0003-4819-157-9-201211060-00011

12 Citations

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