Relationship between low-density lipoprotein cholesterol and severe acute pancreatitis (“the lipid paradox”)

Abstract

Background and aim

The aim of this study was to investigate the association between low-density lipoprotein cholesterol (LDL-C) and the development of severe acute pancreatitis (SAP).

Patients and methods

A total of 674 patients with acute pancreatitis were enrolled. Non-linearity in the relationship between LDL-C and SAP was assessed by restricted cubic spline analysis. Univariable and multivariable regression analyses were used to identify independent risk factors of SAP.

Results

The restricted cubic spline analysis suggested a nonlinear association between high-density lipoprotein cholesterol (HDL-C), LDL-C and triglyceride levels and incidence of SAP. The incidence of SAP in patients with low LDL-C (<90 mg/dL), moderate LDL-C (90–150 mg/dL) and high LDL-C (>150 mg/dL) levels was 15.1%, 3.7% and 9.8%, respectively. Multivariable analysis confirmed that low LDL-C levels (odds ratio [OR] 3.05; 95% confidence interval [CI] 1.35–6.90), high LDL-C levels (OR 4.42; 95% CI 1.41–13.87) and low HDL-C levels (OR 6.90; 95% CI 2.61–18.23) but not high triglyceride levels (OR 1.05; 95% CI 0.40–2.72) were associated with the development of SAP.

Conclusion

Both low LDL-C (<90 mg/dL) and high LDL-C (>150 mg/dL) levels within 24 hours from admission are independently associated with an increased risk of SAP.

Keywords:

• low-density lipoprotein cholesterol
• high-density lipoprotein cholesterol
• lipids
• acute pancreatitis
• severe acute pancreatitis
• risk factor

Acknowledgments

The authors thank the reviewers for the insightful comments.

Author contributions

All authors contributed toward data analysis, drafting and critically revising the paper and agree to be accountable for all aspects of the work. All the authors have read and approved the manuscript.

Disclosure

The authors report no conflicts of interest in this work.