Statins reduce the risk for pancreatitis in patients with normal or mildly elevated triglyceride levels, say the authors of a large meta-analysis.
By contrast, the authors found that there was no association between use of fibrates and pancreatitis risk, contradicting the advice of several guidelines.
"Although lipid guidelines recommend fibrate therapy to reduce pancreatitis risk in persons with hypertriglyceridemia, fibrates may lead to the development of gallstones, a risk factor for pancreatitis," say David Preiss (University of Glasgow, UK) and colleagues.
The researchers gathered data on incident pancreatitis from large, high-quality, randomized trials that were primarily designed to assess the effects of statins and fibrates on cardiovascular events. They included 21 trials of statins in 153,414 participants over a mean follow up of 4.3 years, and seven trials of fibrate therapy in 40,162 participants over a mean follow up of 5.3 years. Baseline triglyceride levels ranged from 118 mg/dL to 187 mg/dL.
The authors, reporting in JAMA, found that in placebo-controlled trials including 113,800 patients, those taking statins were a significant 23% less likely to developed pancreatitis than those receiving placebo (0.24 vs 0.31%) over an average period of 4.3 years.
In contrast the risk for pancreatitis in fibrate-treated patients did not significantly differ from that of placebo-treated patients.
The authors say the reduction in pancreatitis associated with statin treatment versus placebo may be due to a reduction in bile acid, and that statins, unlike fibrates, also reduce the risk for gallstones. Prior recommendations have advocated fibrate use for moderately elevated triglyceride levels because hyperglyceridemia is known to be a cause of pancreatitis. However, in this meta-analysis, the authors found no association between pancreatitis and triglyceride levels at 1 year, in either statin- or fibrate-treated patients.
The findings also contrast with previous case and observation studies that have reported statins may increase the risk for pancreatitis. The authors say that their analysis, which was based on randomized trials and considered only incident cases of pancreatitis, is less susceptible to bias by confounders.
They conclude: "The analysis raises questions regarding the choice of lipid-modifying agents in patients with hypertriglyceridemia. In those with slightly elevated triglyceride levels, statins appear better supported by the available data than fibrates for preventing pancreatitis."
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