March 31, 2012Open Access

The association of hypertriglyceridemia with cardiovascular events and pancreatitis: a systematic review and meta-analysis

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Hypertriglyceridemia (n=927218). Intervention: Fasting hypertriglyceridemia vs. Normal or lower fasting triglyceride levels. Primary outcome: Cardiovascular events (OR 1.37, 95% CI 1.23-1.53).

Key Result

Fasting hypertriglyceridemia is significantly associated with an increased risk of cardiovascular events (OR 1.37), cardiovascular death (OR 1.80), myocardial infarction (OR 1.31), and pancreatitis.

Study Design

Type

Meta-Analysis (n=927,218)

PICO

Population

927,218 patients from 35 longitudinal studies followed for an average of 114 months to evaluate the association of fasting hypertriglyceridemia with cardiovascular outcomes and pancreatitis.

Exposure / Comparator

Fasting hypertriglyceridemia vs Normal or lower fasting triglyceride levels

Primary Outcome

Cardiovascular events — OR 1.37 (1.23-1.53)

Main Result

Odds Ratio: 1.37 (95% CI 1.23–1.53)

Limitations

Observational nature of the existing evidence limits causal inference
Potential confounding by baseline cardiovascular risk and other lipid subfractions
Important heterogeneity (I2 > 50%) across the meta-analytic estimates
Potential publication and reporting bias
Unclear in most studies if patients had pre-existent outcomes at baseline
Unclear if patients were treated with drugs that can affect triglyceride levels
Only one eligible study evaluated the association with acute pancreatitis

Abstract

BACKGROUND: Hypertriglyceridemia may be associated with important complications. The aim of this study is to estimate the magnitude of association and quality of supporting evidence linking hypertriglyceridemia to cardiovascular events and pancreatitis. METHODS: We conducted a systematic review of multiple electronic bibliographic databases and subsequent meta-analysis using a random effects model. Studies eligible for this review followed patients longitudinally and evaluated quantitatively the association of fasting hypertriglyceridemia with the outcomes of interest. Reviewers working independently and in duplicate reviewed studies and extracted data. RESULTS: 35 studies provided data sufficient for meta-analysis. The quality of these observational studies was moderate to low with fair level of multivariable adjustments and adequate exposure and outcome ascertainment. Fasting hypertriglyceridemia was significantly associated with cardiovascular death (odds ratios (OR) 1.80; 95% confidence interval (CI) 1.31-2.49), cardiovascular events (OR, 1.37; 95% CI, 1.23-1.53), myocardial infarction (OR, 1.31; 95% CI, 1.15-1.49), and pancreatitis (OR, 3.96; 95% CI, 1.27-12.34, in one study only). The association with all-cause mortality was not statistically significant. CONCLUSIONS: The current evidence suggests that fasting hypertriglyceridemia is associated with increased risk of cardiovascular death, MI, cardiovascular events, and possibly acute pancreatitis.Précis: hypertriglyceridemia is associated with increased risk of cardiovascular death, MI, cardiovascular events, and possibly acute pancreatitis.

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