According to results of an analysis published in JAMA, stain therapy is connected with a lower risk of pancreatitis in patients with normal or mildly elevated triglyceride levels.
The researchers explained:
“Pancreatitis has a clinical spectrum ranging from a mild, self-limiting episode to a severe or fatal event. Case reports and pharmacoepidemiology studies have claimed that statins may cause pancreatitis, although few of these studies comprehensively considered confounding factors. Very few large randomized trials of statin therapy have published data on incident pancreatitis. Although lipid guidelines recommend fibrate therapy to reduce pancreatitis risk in person with hypertriglyceridemia, fibrates may lead to the development of gallstones, a risk factor for pancreatitis.”
In order to examine the associations between the use of a statin or a fibrate and the incidence of pancreatitis, David Preiss, M.D., Ph.D., of the University of Glasgow, United Kingdom, and colleagues conducted a collaborative meta-analyses of published and unpublished data from large randomized clinical trials.
In 16 placebo- and standard care-controlled statin trials involving 113,800 participants, the team found that individuals assigned to statin therapy were 23% less likely to develop pancreatitis than those assigned to the control group. In five dose-comparison, statin trials involving 39,614 participants that team found that 156 developed pancreatitis: 70 assigned to intensive dose and 86 assigned to moderate dose; an 18% lower risk for the intensive dose group.
In the combined data set of 21 trials, the team found that 465 participants developed pancreatitis. Those assigned to statin therapy were 21% less likely to develop pancreatitis than those assigned to placebo.
In addition, results from 7 randomized clinical trials of fibrate therapy involving 40,162 participants showed that 144 participants (0.36%) developed pancreatitis (84 assigned to fibrate therapy, 60 assigned to placebo), but the risk difference was not statistically significant. Baseline average triglyceride levels in the trials varied from 145 mg/dL to 184 mg/dL.
The researchers said:
“Although the present results for both statins and fibrates should be considered hypothesis-generating and the number of pancreatitis cases was small in this trial population at low risk of pancreatitis, 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. Lifestyle modifications also remain important to improve lipid profiles in such individuals. In patients with severe hypertriglyceridemia, a trial comparing fibrates and statins for preventing pancreatitis would be clinically valuable.”
Written by Grace Rattue