Rates of acute pancreatitis and cardiovascular events among adults with severe or extreme hypertriglyceridemia in US clinical practice

BACKGROUND: Severe and extreme hypertriglyceridemia (sHTG [TG 500-879 mg/dL; 5.65-9.93 mmol/L]; eHTG [TG ≥ 880 mg/dL; ≥ 9.94 mmol/L]) are important risk factors for acute pancreatitis (AP) and cardiovascular (CV) events. The objective of this study was to estimate rates of AP and CV events for adults with (and without) sHTG/eHTG in US clinical practice. METHODS: A retrospective design and data from the MarketScan Research Databases were employed. Study population comprised adults with ≥ 1 TG value and was stratified by index TG (< 150, 150-499, 500-879, ≥ 880 mg/dL; < 1.69, 1.69-5.64, 5.65-9.93, ≥ 9.94 mmol/L). AP/CV events (per 1,000 person-years [PY]) were ascertained from index TG through end of study period, and were estimated for TG-specific subgroups and selected subsets defined therein. RESULTS: Study population totaled 1.8 M adults (TG < 150 mg/dL [< 1.69 mmol/L]: N = 1.3 M; TG 150-499 mg/dL [1.69-5.64 mmol/L]: N = 449 K; TG 500-879 mg/dL [5.65-9.93 mmol/L]: N = 12,050; TG ≥ 880 mg/dL [≥ 9.94 mmol/L]: N = 3,944). AP rates (per 1,000 PY) increased from lowest to highest TG value (0.6 [< 150 mg/dL; < 1.69 mmol/L]) to 9.9 [≥ 880 mg/dL; ≥ 9.94 mmol/L]); rates were highest for adults with TG ≥ 880 mg/dL (≥ 9.94 mmol/L) and history of AP (193.0), pre-existing diabetes (13.9), or history of LLT (13.9). CV event rates (per 1,000 PY) also increased from lowest to highest TG value (3.3 [< 150 mg/dL; < 1.69 mmol/L]) to 10.3 [≥ 880 mg/dL; ≥ 9.94 mmol/L]); rates were highest for adults with TG ≥ 880 mg/dL (≥ 9.94 mmol/L) and history of CV events (116.5), pre-existing diabetes (18.1), or history of LLT (14.5). CONCLUSION: Rates of AP/CV events are substantially higher among adults with elevated TG values, and are especially high among adults with sHTG or eHTG, in particular those with these conditions and other risk factors. Understanding the magnitude of disease risk among sHTG/eHTG patients, with increasing TG levels as well as within important subgroups, is critical to improving patient care and outcomes.