Association between triglyceride levels and cardiovascular disease in patients with acute pancreatitis

PLoS One. 2018 Jan 30;13(1):e0179998. doi: 10.1371/journal.pone.0179998. eCollection 2018.

Abstract

Conventional wisdom supports prescribing "fibrates before statins", that is, prioritizing treatment of hypertriglyceridemia (hTG) to prevent pancreatitis ahead of low-density lipoprotein cholesterol to prevent coronary heart disease. The relationship between hTG and acute pancreatitis, however, may not support this approach to clinical management. This study analyzed administrative data from the Veterans Health Administration for evidence of (1) temporal association between assessed triglycerides level and days to acute pancreatitis admission; (2) association between hTG and outcomes in the year after hospitalization for acute pancreatitis; (3) relative rates of prescription of fibrates vs statins in patients with acute pancreatitis; (4) association of prescription of fibrates alone versus fibrates with statins or statins alone with rates of adverse outcomes after hospitalization for acute pancreatitis. Only modest association was found between above-normal or extremely high triglycerides and time until acute pancreatitis. CHD/MI/stroke occurred in 23% in the year following AP, supporting cardiovascular risk management. Fibrates were prescribed less often than statins, defying conventional wisdom, but the high rates of cardiovascular events in the year following AP support a clinical focus on reducing cardiovascular risk factors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Aged
  • Cardiovascular Diseases / blood*
  • Cardiovascular Diseases / complications
  • Female
  • Fibric Acids / therapeutic use
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Hypertriglyceridemia / blood*
  • Hypertriglyceridemia / complications
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Pancreatitis / complications*
  • Pancreatitis / drug therapy
  • Treatment Outcome
  • Triglycerides / blood*

Substances

  • Fibric Acids
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Triglycerides

Grants and funding

This study was supported by Scott & White Research Mentor Award #150103, awarded to LAC & CSS, http://researchers.sw.org/academic-research-development/internal-funding; and Veterans Health Administration HX-09-335, awarded to LAC, http://www.hsrd.research.va.gov/funding. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors LAC, CSS, DS, and CJM are employed by Baylor Scott & White Health, a private not-for-profit health care system. LAC and CSS were awarded a small research grant ($3,000) by Baylor Scott & White Health to help support the salary of a data manager. Baylor Scott & White Health had no role in this study beyond helping support the salaries of these researchers.