Predisposing factors to acute pancreatitis in patients with severe hypertriglyceridemia

Abstract Severe hypertriglyceridemia (HTG) is a rare condition defined as fasting triglyceride (TG) levels >885 mg/dL. Besides the association between mild-moderate HTG and cardiovascular disease (CVD), severe HTG is a known risk factor for acute pancreatitis (AP). The factors predisposing patients with severe HTG to AP are not completely clear. Purpose Compare patients with severe HTG with and without AP and identify factors predisposing to AP. Methods We performed a retrospective search of patients with severe, refractory HTG in our hospital database over the last 10 years. Inclusion criteria: at least one TG≥2,000mg/dL and the latest on-therapy TG≥1,000mg/dL. Results From 692 patients with at least one TG≥1,000 mg/dL, 27 met the inclusion criteria. Nineteen (70%) were male, mean age 53±14 y-old. The median maximum TG value was 3,384mg/dL and the latest on-therapy TG was 1,791 mg/dL despite fibrate use; 70,4% were diabetics (44% insulin users; 41% had previous CVD). Patients with AP were younger, with higher fasting glucose and lower HDL-C. However, there were no differences between the AP and no AP groups, regarding maximum and latest TG, diagnosis of diabetes and treated HbA1C. Conclusion In this cohort of patients with severe, refractory HTG, those with AP were significantly younger, suggesting a greater genetic role for HTG in this group. There were no other relevant diferences between the AP and no AP groups. Conceivably, other unrecognized factors were at play accounting for the AP events. Characteristics of patients with HTG Characteristics All patientes (n=27) Previous AP (n=12) No previous AP (n=15) p value Men, % 19 (70) 7 (58) 12 (80) 0.221 Age, years 53±14 46±15 59±10 0.017 Highest value of triglycerides (mg/dL) 3,384 (2,047–8,859) 4,464 (8,160–2,181) 3,333 (8,859–2,047) 0.495 Most recent value of triglycerides (mg/dL) 1,791 (1,171–5,791) 1,390 (2,828–1,171) 2,353 (5,791–1,218) 0.057 HDL-C (mg/dL) 21±7 20±8 23±7 0.025 LDL-C (mg/dL) 70±33 60±32 82±32 0.143 Previous CVD*, % 11 (41) 3 (25) 8 (54) 0.137 Fibrate therapy, % 27 (100) 12 (100) 15 (100) 0.225 Statin therapy, % 18 (67) 9 (75) 9 (60) 0.411 Diabetes**, % 19 (70) 9 (75) 10 (67) 0.637 Blood glucose, mg/dL 147±49 150±55 139±36 0.012 HbA1c, % 8.5±2.2 8.3±2.2 8.6±2.3 0.861 *Cardiovascular disease (CVD) included myocardial infarction, stroke and heart failure. **Diabetes type II. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Zerbini Foundation, F