Hypertriglyceridemia and dysglycemia: Pathogenic affinities and clinical consequences
Abstract. The aim of this article is to demonstrate the correlation between hypertriglyceridemia, dysglycemia, and pancreatic damage, substantiating the need for a differentiated approach to the management of such kind of patients. Three clinical cases of hypertriglyceridemic pancreatitis with different variants of disorders are presented: exocrine insufficiency with preserved endocrine function, mixed phenotype of diabetes mellitus with insulin resistance and pancreatogenic component, and severe pancreatitis associated with extreme hypertriglyceridemia, ketoacidosis, and decompensation. These examples illustrate that hypertriglyceridemia can be an independent cause of severe recurrent pancreatitis, and its late verification delays the initiation of pathogenetic therapy and increases the risk of irreversible exocrine and endocrine insufficiency. In case of non-biliary and non-alcoholic pancreatitis, a lipid profile should be examined. Comprehensive management of the patients should include correction of triglyceride levels, assessment of dysglycemic phenotype and pancreatic function, and relapse prevention.A.S. Ametov, E.Yu. Pashkova, K.A. Amikishieva, A.A. Timoshchuk
Keywords
References
1. Аметов А.С., Пашкова Е.Ю., Ерохина А.Г., Амикишиева К.А. Сахарный диабет в исходе заболеваний поджелудочной железы – недостающее звено между сахарным диабетом 1 и 2 типов. Доктор.Ру. 2023;22(4):29–35. (Ametov AS, Pashkova EYu, Erokhina AG, Amikishieva KA. Diabetes mellitus outcome in pancreatic diseases the missing link between type 1 and type 2 diabetes mellitus. Doctor.Ru. 2023;22(4):29–35 (In Russ.)).
EDN: MLPZPD. https://doi.org/10.31550/1727-2378-2023-22-4-29-35
2. Nelson AJ, Navar AM, Mulder H, Wojdyla D, Philip S, Granowitz C et al. Association between triglycerides and residual cardiovascular risk in patients with type 2 diabetes mellitus and established cardiovascular disease (from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial). Am J Cardiol. 2020;132:36–43.
PMID: 32773223. https://doi.org/10.1016/j.amjcard.2020.07.005
3. Ginsberg HN. New perspectives on atherogenesis: Role of abnormal triglyceride-rich lipoprotein metabolism. Circulation. 2002;106(16):2137–42.
PMID: 12379586. https://doi.org/10.1161/01.cir.0000035280.64322.31
4. Batal R, Tremblay M, Barrett PH, Jacques H, Fredenrich A, Mamer O et al. Plasma kinetics of apoC-III and apoE in normolipidemic and hypertriglyceridemic subjects. J Lipid Res. 2000;41(5):706–18. PMID: 10787431.
5. Cohn JS, Patterson BW, Uffelman KD, Davignon J, Steiner G. Rate of production of plasma and very-low-density lipoprotein (VLDL) apolipoprotein C-III is strongly related to the concentration and level of production of VLDL triglyceride in male subjects with different body weights and levels of insulin sensitivity. J Clin Endocrinol Metab. 2004;89(8):3949–55.
PMID: 15292332. https://doi.org/10.1210/jc.2003-032056
6. Hegele RA, Ginsberg HN, Chapman MJ, Nordestgaard BG, Kuivenhoven JA, Averna M et al. The polygenic nature of hypertriglyceridaemia: Implications for definition, diagnosis, and management. Lancet Diabetes Endocrinol. 2014;2(8):655–66.
PMID: 24731657. PMCID: PMC4201123. https://doi.org/10.1016/S2213-8587(13)70191-8
7. Бубнова М.Г., Ежов М.В., Аронов Д.М., Галявич А.С., Гуревич В.С., Дупляков Д.В. с соавт. Гипертриглицеридемия (триглицерид-богатые липопротеины и их ремнанты): роль в развитии атеросклеротических сердечно-сосудистых заболеваний и стратегия контроля. Заключение Комитета экспертов Российского кардиологического общества (РКО), Национального общества по изучению атеросклероза (НОА), Российского общества кардиосоматической реабилитации и вторичной профилактики (РосОКР). Российский кардиологический журнал. 2025;30(5):99–126. (Bubnova MG, Ezhov MV, Aronov DM, Galyavich AS, Gurevich VS, Duplyakov DV et al. Hypertriglyceridemia (triglyceride-rich lipoproteins and their remnants): Role in the development of atherosclerotic cardiovascular diseases and control strategy. Opinion of the Expert Committee of the Russian Society of Cardiology, the National Atherosclerosis Society, and the Russian Society of Cardiac and Somatic Rehabilitation and Secondary Prevention. Rossiyskiy kardiologicheskiy zhurnal = Russian Journal of Cardiology. 2025;30(5):99–126 (In Russ.)).
EDN: VNFGFQ. https://doi.org/10.15829/1560-4071-2025-6364
8. Castelli WP. Epidemiology of triglycerides: A view from Framingham. Am J Cardiol. 1992;70(19):H3–H9.
PMID: 1466315. https://doi.org/10.1016/0002-9149(92)91083-g
9. Patel RS, Pasea L, Soran H, Downie P, Jones R, Hingorani AD et al. Elevated plasma triglyceride concentration and risk of adverse clinical outcomes in 1.5 million people: A CALIBER linked electronic health record study. Cardiovasc Diabetol. 2022;21(1):102.
PMID: 35681241. PMCID: PMC9185961. https://doi.org/10.1186/s12933-022-01525-5
10. Pedersen SB, Langsted A, Nordestgaard BG. Nonfasting mild-to-moderate hypertriglyceridemia and risk of acute pancreatitis. JAMA Intern Med. 2016;176(12):1834–42.
PMID: 27820614. https://doi.org/10.1001/jamainternmed.2016.6875. Erratum in: JAMA Intern Med. 2024;184(4):453. PMID: 27820614. https://doi.org/10.1001/jamainternmed.2024.0643
11. Gan SI, Edwards AL, Symonds CJ, Beck PL. Hypertriglyceridemia-induced pancreatitis: A case-based review. World J Gastroenterol. 2006;12(44):7197–202.
PMID: 17131487. PMCID: PMC4087786. https://doi.org/10.3748/wjg.v12.i44.7197
12. Qiu L, Sun RQ, Jia RR, Ma XY, Cheng L, Tang MC, Zhao Y. Comparison of existing clinical scoring systems in predicting severity and prognoses of hyperlipidemic acute pancreatitis in Chinese patients: A retrospective study. Medicine (Baltimore). 2015;94(23):e957.
PMID: 26061329. PMCID: PMC4616466. https://doi.org/10.1097/MD.0000000000000957
13. Hofbauer B, Friess H, Weber A, Baczako K, Kisling P, Schilling M et al. Hyperlipaemia intensifies the course of acute oedematous and acute necrotising pancreatitis in the rat. Gut. 1996;38(5):753–58.
PMID: 8707124. PMCID: PMC1383160. https://doi.org/10.1136/gut.38.5.753
14. Kimura T, Toung JK, Margolis S, Permutt S, Cameron JL. Respiratory failure in acute pancreatitis: A possible role for triglycerides. Ann Surg. 1979;189(4):509–14. PMID: 443907. PMCID: PMC1397247.
15. Lu J, Wang Z, Mei W, Peng K, Zhang L, Wang G et al.; Chinese Hypertriglyceridemia-Associated Pancreatitis Study Group (CHPSG). A systematic review of the epidemiology and risk factors for severity and recurrence of hypertriglyceridemia-induced acute pancreatitis. BMC Gastroenterol. 2025;25(1):374.
PMID: 40375154. PMCID: PMC12082898. https://doi.org/10.1186/s12876-025-03954-4
16. Hollemans RA, Timmerhuis HC, Besselink MG, Bouwense SAW, Bruno M, van Duijvendijk P et al.; Dutch Pancreatitis Study Group. Long-term follow-up study of necrotising pancreatitis: Interventions, complications and quality of life. Gut. 2024;73(5):787–96.
PMID: 38267201. https://doi.org/10.1136/gutjnl-2023-329735.
17. Bhavsar B, Bhatt A. Steroid induced hyperlipidemic pancreatitis and new onset diabetes mellitus. Treatment with plasmapheresis. JOP. 2008;9(5):664–65. PMID: 18762701.
18. Valdivielso P, Ramirez-Bueno A, Ewald N. Current knowledge of hypertriglyceridemic pancreatitis. Eur J Intern Med. 2014;25(8):689–94.
PMID: 25269432. https://doi.org/10.1016/j.ejim.2014.08.008
19. Navina S, Acharya C, DeLany JP, Orlichenko LS, Baty CJ, Shiva SS et al. Lipotoxicity causes multisystem organ failure and exacerbates acute pancreatitis in obesity. Sci Transl Med. 2011;3(107):107ra110.
PMID: 22049070. PMCID: PMC3321362. https://doi.org/10.1126/scitranslmed.3002573
20. Григорьева И.Н. Гипертриглицеридемический острый панкреатит: прогресс и проблемы. Атеросклероз. 2017;13(1):41–48. (Grigorieva IN. Hypertriglyceridemic acute pancreatitis: Progress and problems. Ateroskleroz = Atherosclerosis. 2017;13(1):41–48 (In Russ.)). EDN: YFOAJH.
21. Малых М.В., Никольская К.А., Винокурова Л.В., Лесько К.А., Бойко Н.В., Савенкова Н.А. с соавт. Гипертриглицеридемический панкреатит: клинический случай. Фарматека. 2022;29(2):81–87. (Malykh MV, Nikolskaya KA, V LV, Lesko KA, Boyko NV, Savenkova NA et al. Hypertriglyceridemia-induced pancreatitis: A clinical case. Farmateka. 2022;29(2):81–87 (In Russ.)).
EDN: CEMDEZ. https://doi.org/10.18565/pharmateca.2022.2.81-87
22. Yadav D, Pitchumoni CS. Issues in hyperlipidemic pancreatitis. J Clin Gastroenterol. 2003;36(1):54–62.
PMID: 12488710. https://doi.org/10.1097/00004836-200301000-00016
23. Тарасова Ж.С., Бордин Д.С., Килейников Д.В., Кучерявый Ю.А. Панкреатогенный сахарный диабет: взгляд эндокринолога и гастроэнтеролога. Эффективная фармакотерапия. 2020;16(15):92–100. (Tarasova ZhS, Bordin DS, Kileynikov DV, Kucheryavy YuA. Pancreatogenic diabetes mellitus: Endocrinologist’s and gastroenterologist’s point of view. Effektivnaya farmakoterapiya = Effective Pharmacotherapy. 2020;16(15):92–100 (In Russ.)).
EDN: TELTUX. https://doi.org/10.33978/2307-3586-2020-16-15-92-100
24. Struyvenberg MR, Martin CR, Freedman SD. Practical guide to exocrine pancreatic insufficiency – breaking the myths. BMC Med. 2017;15(1):29.
PMID: 28183317. PMCID: PMC5301368. https://doi.org/10.1186/s12916-017-0783-y
25. Virani SS, Morris PB, Agarwala A, Ballantyne CM, Birtcher KK, Kris-Etherton PM et al. 2021 ACC Expert Consensus decision pathway on the management of ASCVD risk reduction in patients with persistent hypertriglyceridemia: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2021;78(9):960–93.
PMID: 34332805. https://doi.org/10.1016/j.jacc.2021.06.011
26. Цыганкова О.В., Апарцева Н.Е., Аметов А.С. Гипертриглицеридемия – новое и важное настоящее. Эндокринология: новости, мнения, обучение. 2023;12(4):99–111. (Tsygankova OV, Apartseva NE, Ametov AS. Hypertriglyceridemia – a new and important present. Endokrinologiya: novosti, mneniya, obuchenie = Endocrinology: News, Opinions, Training. 2023;12(4):99–111 (In Russ.)).
EDN: DJBDFY. https://doi.org/10.33029/2304-9529-2023-12-4-99-111
27. Oscarsson J, Hurt-Camejo E. Omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid and their mechanisms of action on apolipoprotein B-containing lipoproteins in humans: A review. Lipids Health Dis. 2017;16(1):149.
PMID: 28797250. PMCID: PMC5553798. https://doi.org/10.1186/s12944-017-0541-3
28. Reiner Z. Managing the residual cardiovascular disease risk associated with HDL-cholesterol and triglycerides in statin-treated patients: A clinical update. Nutr Metab Cardiovasc Dis. 2013;23(9):799–807.
PMID: 23932901. https://doi.org/10.1016/j.numecd.2013.05.002
29. National Lipid Association. 2026 ACC/AHA/Multisociety dyslipidemia guideline released. Last updated: March 13, 2026.
URL: https://www.lipid.org/nla/2026-accahamultisociety-dyslipidemia-guideline-released (date of access – 30.05.2026).
30. Коновалов Г.А., Филоненко И.В., Акопян В.С., Карнеева О.В., Дорощенко Н.Э., Звездкин П.В. с соавт. Реоферез в клинической практике. Кремлевская медицина. Клинический вестник. 2004;(3):48–53. (Konovalov GA, Filonenko IV, Akopyan VS, Karneeva OV, Doroshchenko NE, Zvezdkin PV et al. Rheopheresis in clinical practice. Kremlevskaya meditsina. Klinicheskiy vestnik = Kremlin Medicine. Clinical Bulletin. 2004;(3):48–53 (In Russ.)). EDN: PWJWTH.
31. Коновалов Г.А., Чебышев А.Н., Звездкин П.В. с соавт. Экстракорпоральные методы в лечении тяжелых форм атеросклероза, метаболического синдрома и дилатационной кардиомиопатии. Кремлевская медицина. Клинический вестник. 2001;(4):48–54. (Konovalov GA, Chebyshev AN, Zvezdkin PV et al. Extracorporeal methods in the treatment of severe forms of atherosclerosis, metabolic syndrome and dilated cardiomyopathy. Kremlevskaya meditsina. Klinicheskiy vestnik = Kremlin Medicine. Clinical Bulletin. 2001;(4):48–54 (In Russ.)).
About the Authors
Alexander S. Ametov, MD, Dr. Sci. (Medicine), professor, Honored Scientist of the Russian Federation, leading researcher at S.P. Botkin Moscow Multidisciplinary Scientific and Clinical Center; head of the Department of endocrinology, head of the UNESCO network Department on “Bioethics of diabetes mellitus as a global problem”, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation.E-mail: alexander.ametov@gmail.com
ORCID: https://orcid.org/0000-0002-7936-7619. eLibrary SPIN: 9511-1413
Evgeniya Yu. Pashkova, MD, Dr. Sci. (Medicine), associate professor of the Department of endocrinology, Russian Medical Academy of Continuous Professional Education; senior researcher, head of the Department of endocrinology, S.P. Botkin Moscow Multidisciplinary Scientific and Clinical Center, Moscow, Russian Federation.
E-mail: parlodel@mail.ru
ORCID: https://orcid.org/0000-0003-1949-914X. eLibrary SPIN: 4948-8315
Kseniya A. Amikishieva, MD, postgraduate student of the Department of endocrinology, Russian Medical Academy of Continuous Professional Education; researcher, endocrinologist of the Department of endocrinology, S.P. Botkin Moscow Multidisciplinary Scientific and Clinical Center, Moscow, Russian Federation.
E-mail: isheryakova080795@mail.ru
ORCID: https://orcid.org/0000-0002-0879-5333. eLibrary SPIN: 8817-0560.
Anna A. Timoshchuk, 2nd-year clinical resident by specialty “Endocrinology”, S.P. Botkin Moscow Multidisciplinary Scientific and Clinical Center, Moscow, Russian Federation.
E-mail: annatimoshchuk@mail.ru
ORCID: https://orcid.org/0009-0003-1851-5838



