SEVERE HYPERTRIGLYCERIDEMIA AND PANCREATITIS WHEN ESTROGEN REPLACEMENT THERAPY IS GIVEN TO HYPERTRIGLYCERIDEMIC WOMEN

Our specific aim was to assess severe hypertriglyceridemia and pancrea titis that occurred when postmenopausal estrogen replacement therapy ( ERT) or tamoxifen had been given by their physicians to women with pre existing, usually covert, primary familial hypertriglyceridemia. We re trospectively studied 31 women referred for diagnosis and therapy of h ypertriglyceridemia over 2.75 years whose initial visit fasting plasma triglyceride levels were >750 mg/dl. Of the 31 women with hypertrigly ceridemia, 12 (39%) had been given exogenous estrogen by their physici ans (II ERT, one tamoxifen). Ten of the 12 women, while undergoing ERT , had triglyceride levels >1200 mg/dl. In triglyceride referral catego ries 750 to 1000, 1000-1500, and >1500 mg/dl, 17% (2 of 12), 33% (3 of 9), and 70% (7 of 10), respectively, of the 31 women with hypertrigly ceridemia were receiving ERT. The higher the triglycerides were at ref erral, the greater was the likelihood that women were taking ERT (X(2) = 6.6, p = 0.035). Four of the seven women with triglyceride levels > 1500 mg/dl while undergoing ERT were hospitalized with severe acute pa ncreatitis; another two had severe abdominal pain thought to be pancre atic in origin. To quickly lower dangerously high triglyceride levels, ERT was stopped in all 12 women. Lopid (1.2 to 1.5 gm/day) was given to the seven women not already taking it, and four were also given ome ga-3 fatty acids (4 to 15 gm/day). Median plasma triglyceride level at the initial visit in the 12 women undergoing ERT was 1665 mg/dl. At t heir second visit, approximately 6 weeks later, when not undergoing ER T, and with all 12 women receiving diet plus Lopid (gemfibrozil), and with four also taking omega-3 fatty acids, triglyceride levels fell sh arply to 293 mg/dl (p<0.0005). In women with pre-ERT triglyceride leve ls >300 mg/dl, ERT is relatively contraindicated and should be absolut ely contraindicated when triglyceride levels are >750 mg/dl, to avoid hypertriglyceridemic pancreatitis and exacerbation of preexisting, cov ert hypertriglyceridemia. Cessation of ERT and treatment with triglyce ride-lowering regimens usually normalizes triglyceride levels in women with hypertriglyceridemia, but if ERT is continued, triglyceride-lowe ring therapy is usually ineffective.