Complications
Epidemiological and genetic studies establish triglyceride-rich lipoproteins and their remnants as important contributors to ASCVD and its individual components (e.g., ischaemic heart disease, myocardial infarction, ischaemic stroke, and peripheral artery disease), although it remains methodologically challenging to definitively claim that HTG is an independent risk factor for ASCVD.[82]
HTG has been associated with an increased risk for aortic stenosis, primarily due to increased triglyceride-rich remnant lipoproteins.[83]
Risk of acute pancreatitis is low to moderate when triglyceride (TG) >10 mmol/L (>885 mg/dL) and is high when TG >20 mmol/L (>1770 mg/dL). Initial diagnostic and therapeutic steps should be the same as in other causes of acute pancreatitis due to severe HTG with chylomicronaemia. A TG level should be determined in all cases of acute pancreatitis as severe HTG may contribute even when the primary cause is obvious (e.g., alcohol). Cessation of all oral intake and bowel rest is the most essential therapeutic intervention. Initially, intravenous glucose should be avoided as this may further increase TG levels. Intravenous insulin infusion in patients with poorly controlled diabetes often helps reduce TG levels. Heparin infusion and plasmapheresis are not helpful above and beyond cessation of oral intake, and are not routinely recommended. Very low-grade evidence suggests plasmapheresis might rarely be considered in certain situations, such as pregnancy, when TG >20 mmol/L (>1770 mg/dL) and acute pancreatitis risk is imminent. TG levels rebound rapidly after plasmapheresis if the root cause is not properly managed.
Long-term complications of recurrent acute pancreatitis include increased length of hospital stay, development of chronic pancreatitis, pancreatic insufficiency, pancreatic necrosis, pancreatic abscess, pancreatic pseudocyst, systematic inflammatory response syndrome, and increased mortality.
Fibrates and a low-fat diet are recommended as prophylaxis against future episodes of pancreatitis. Chronically, the absolute risk of pancreatitis is low when TG <5 mmol/L (<440 mg/dL).
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