Hypertriglyceridemia and its relationship with all-cause mortality and pancreatitis: Results from a large retrospective clinical registry.

Background: Hypertriglyceridemia (HTG) is a potential risk factor for mortality and pancreatitis; however, real-world data remain limited.

Objective: We aimed to investigate whether elevated TG levels may identify individuals at a higher risk of all-cause mortality or increased incidence of all-cause pancreatitis in our Mediterranean primary care population.

Methods: We conducted a retrospective analysis using the SIDIAP primary care database to assess HTG prevalence and its association with all-cause mortality and pancreatitis. Subjects were categorized into 5 triglyceride (TG) level groups, (from <150 mg/dL to >880 mg/dL). Logistic and Cox regression models adjusted for different covariates were used.

Results: HTG (>150 mg/dL) had a prevalence of 22.8%, whereas that of severe HTG (>500 mg/dL) was 0.8%. From 2010 to 2020, 2,256,261 individuals were followed up for a median of 7.78 years. The cumulative incidence rates for all-cause pancreatitis and all-cause mortality were 0.44% and 8.37%, respectively. Individuals with previously reported pancreatitis (n = 6527, 0.3%) showed higher incidence rates of all-cause pancreatitis (7.37%) and all-cause mortality (22.54%) than those without previous history of this outcome (pancreatitis: 0.42%; mortality: 8.33%), respectively. Adjusted analyses revealed an increasingly higher risk of all-cause pancreatitis across TG categories, with the highest risk for TG ≥ 880 mg/dL levels (hazard ratio [HR]: 3.79, 95% CI: 3.10; 4.63). The risk for all-cause mortality (HR: 1.08, 95% CI: 1.06; 1.09 and HR: 1.11, 95% CI: 1.07; 1.14) was observed for TG (150-299, 300-499) compared to those with TG < 150 mg/dL. Individuals with TG ≥ 500 mg/dL had the highest excess risk for all-cause pancreatitis (HR: 2.66, 95% CI: 2.30; 3.07) and mortality (HR: 1.15, 95% CI: 1.08; 1.23), even after adjusting for confounders.

Conclusion: HTG is common and independently predicts mortality and pancreatitis in a real-world primary care setting. Future trials should evaluate lifestyle and TG-lowering interventions to mitigate these risks.