Statins Lower Pancreatitis Risk

Pancreatitis.  The diagnosis (inflammation of the pancreas) raises hackles on the back of interns & residents' necks attempting to care for patients with this sudden onset of mid-epigastric abdominal pain, typically associated w/alcohol consumption to excess, gallstones and/or extremely elevated triglycerides.

In the past, when confronted with hypertriglyceridemia in the face of hypercholesterolemia, we've always focused on lowering triglycerides in order to minimize risk of pancreatitis.  Once that's been accomplished, then we refocus our attention on lower LDL-cholesterol.  However, in a meta-analysis of randomized controlled trials published last week in JAMA, the authors concluded that statins lowered risk of pancreatitis in those w/normal-to-mildly elevated triglycerides.

Clearly, statins are not first line therapy for treating hypertriglyceridemia.  But once triglycerides have been controlled to less than 500mg/dL, it's time to add a statin to optimize the rest of the lipid panel, notwithstanding all the other bad press that's been written about statins lately.

So is it worth placing your liver, muscles, glycemic control, cognition, energy (in women only), and vision on the line?  Before we throw the baby out with the bath water, let's recall that statins lower all-cause mortality.  And more importantly, just because a side effect can happen doesn't mean that it will happen.

So if you can't achieve your LDL goal by dietary measures alone (as noted a year ago), that's when I consider adding a lipid lowering agent to your regimen.  But I'll typically give you the benefit of the doubt first.

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