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

Drug treatment of asymptomatic hypertriglyceridemiahas 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 pro-viso. For example, the National Cholesterol Education