An observational study of severe hypertriglyceridemia, hypertriglyceridemic acute pancreatitis, and failure of triglyceride-lowering therapy when estrogens are given to women with and without familial hypertriglyceridemia.

Abstract

BACKGROUND:

We assessed severe hypertriglyceridemia, hypertriglyceridemic acute pancreatitis, and failure of triglyceride-lowering therapy when estrogens were given to 56 women with and without familial hypertriglyceridemia. The 56 women had been consecutively referred to our center over a 3-year period because of triglycerides >400 mg/dl despite diet-drug treatment and/or a history of hypertriglyceridemic acute pancreatitis (AP). Of the 56 women, 17 had received estrogen replacement therapy (ERT), hormone replacement (HRT, n=6), or selective estrogen receptor modulators (SERM, n=1).

METHODS:

After study at entry, in 56 women (median age, 52 years), 36 with familial hypertriglyceridemia, to lower triglycerides, estrogens and SERMs (hormone treatment, HT) were stopped; a very low fat diet (<15% of calories), gemfibrozil (1.2-1.5 mg/day), and omega-3-fatty acid (4-12 g/day) were started, with restudy 2-4 weeks later.

RESULTS:

Of the 56 women, 24 (43%) were taking HT at entry, with median fasting triglycerides 1270 mg/dl in the HT group and 1087 mg/dl in the no-HT group. Seventeen women (30%) had a history of AP, nine of whom (53%) were/had been on HT at the development of AP. Significant positive correlates of triglycerides at entry in a stepwise regression model were hemoglobin A(1C) (partial r(2)=10.7%, p<0.05) and an interaction between estrogen use and familial hypertriglyceridemia (partial r(2)=15%, p=0.017). After 2-4 weeks on therapy, median triglycerides in the previous-HT group fell from 1270 to 284 mg/dl (p<0.0001) and in the no-HT group from 1087 to 326 mg/dl (p<0.0001).

CONCLUSIONS:

Before starting HT, to avoid HT induced hypertriglyceridemic AP and exacerbation of overt or covert familial hypertriglyceridemia, triglycerides must be measured. HT is contraindicated in women with preexisting hypertriglyceridemia (triglycerides> or =500 mg/dl). Triglyceride-lowering diets and drugs often fail in the presence of HT and/or poorly controlled diabetes mellitus, but commonly succeed when HT is stopped and diabetes mellitus is tightly controlled.

• Authors: Naila M Goldenberg, Ping Wang, Charles J Glueck
• Journal: Clinica chimica acta; international journal of clinical chemistry (Clin Chim Acta) Vol. 332 Issue 1-2 Pg. 11-9 (Jun 2003) ISSN: 0009-8981 [Print] Netherlands
• PMID: 12763274 (Publication Type: Comment, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Fatty Acids, Omega-3
• Hypolipidemic Agents
• Selective Estrogen Receptor Modulators
• Triglycerides
• Gemfibrozil

Topics

• Adult
• Aged
• Diabetes Mellitus, Type 2 (blood, complications)
• Drug Interactions
• Estrogen Replacement Therapy (adverse effects)
• Fatty Acids, Omega-3 (therapeutic use)
• Female
• Gemfibrozil (therapeutic use)
• Hormone Replacement Therapy (adverse effects)
• Humans
• Hyperlipoproteinemia Type IV (blood, complications)
• Hypertriglyceridemia (complications, etiology, prevention & control)
• Hypolipidemic Agents (therapeutic use)
• Middle Aged
• Pancreatitis (complications, etiology, prevention & control)
• Retrospective Studies
• Selective Estrogen Receptor Modulators (therapeutic use)
• Statistics as Topic
• Triglycerides (blood)