A real-world study on the risk of acute pancreatitis and cardiovascular events among adults with severe or extreme hypertriglyceridemia

BACKGROUND: Severe hypertriglyceridemia (sHTG) has a causal role in acute pancreatitis (AP), whereas the relationship between triglyceride (TG) levels and risk of cardiovascular (CV) events is less well-known. OBJECTIVE: To assess the incidence, risk, and odds of AP and CV events among US adults with sHTG and hypertriglyceridemia (HTG) compared to those with normal TG levels. METHODS: The Optum Research Database identified 4 cohorts of adults with a TG test between January 1, 2017, and March 31, 2021. sHTG (500 ≤ TG <880 mg/dL) and extreme HTG (eHTG; TG ≥880 mg/dL) were identified first, followed by random identification of normal TG (35 ≤ TG <150 mg/dL) and HTG (150 ≤ TG <500 mg/dL) cohorts. Primary outcomes included incidence, adjusted risk, and adjusted odds of AP and CV events. RESULTS: A total of 134,116 patients were included: 46,676 (34.8%) with normal TG, 54,090 (40.3%) with HTG, 28,556 (21.3%) with sHTG, and 4994 (3.7%) with eHTG. Incidents of both outcomes were significantly higher for HTG, sHTG, and eHTG, compared with normal TG (P < .001). Adjusted hazard ratios (HRs) of AP were 1.491, 2.586, and 4.695 for HTG, sHTG, and eHTG, respectively (all P < .001). Adjusted HRs of CV events were 1.163 and 1.206 for sHTG and eHTG, respectively (both P < .001). CONCLUSION: In this cohort study, patients with sHTG and eHTG had significantly higher incidence of AP and CV events, compared with those with normal TG. The adjusted risk of AP and CV events increased stepwise with TG level; the association was stronger for AP.