Hypertriglyceridemia (HTG) is a well-established aetiology for acute pancreatitis (AP) accounting for approximately 4.7-14.3% of all cases of AP.1, 2, 3 Recurrence is of particular concern in HTG-AP, and 16-32% of patients experienced recurrent episodes in previous reports.4, 5, 6 Recurrence of HTG-AP substantially contributes to the overall disease burden by prompting repeated hospitalization, adversely impacting quality of life and increasing the risk of progression to chronic pancreatitis.7,8

Triglyceride (TG) elevations result from multiple genetic variations and environmental factors, including obesity, uncontrolled diabetes, alcohol abuse, and drugs.9,10 There is no clear threshold for blood TG level at which HTG triggers AP, and patients with higher TG levels are more likely to develop AP.11 However, the risk factors associated with recurrent HTG-AP are fully understood. Reported factors associated with recurrence include abnormal TG levels, poorly controlled diabetes, alcoholism, cigarette smoking, and cumulative genetic risk.12, 13, 14 The optimal TG level to prevent recurrent AP is not clear, but levels <5.65 mmol/L are generally an optimal target. Wu et al.15 suggested that serum TG should be lower than 1.7 mmol/L to prevent recurrent disease.

Most guidelines recommend drug treatment using fibrates, omega-3 fatty acids, or niacin to reduce the risk of pancreatitis, especially when serum TG levels are higher than 5.65 mmol/L.16, 17, 18 However, its impact on the recurrence rate of HTG-AP was not studied. In this prospective cohort study, we aimed to 1) investigate the incidence and risk factors for recurrence of HTG-AP and 2) clarify the effect of TG lowering drugs treatment on recurrence.