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

Frank A. Lederle; Hanna E. Bloomfield

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

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

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...

FULL TEXT

PDF

Not Available

Ideas and Opinions |6 November 2012

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

Related Articles

Journal Club

Related Topics

PubMed Articles

Content

Information For

Services

Awards and Cover

Other Resources

Follow Annals On

Ideas and Opinions |6 November 2012

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

Related Articles

Journal Club

Related Topics

PubMed Articles

Content

Information For

Services

Awards and Cover

Other Resources

Follow Annals On

You need a subscription to this content to use this feature.