We thank Dr Whayne and Ms Zielke for their comments. With respect to measuring triglyceride levels to identify patients who may be at risk for developing pancreatitis (eg, those with triglyceride levels >22.6 mmol/L [>2000 mg/dL]), it is not certain whether mass screening for this purpose is warranted. It is not clear how much risk of pancreatitis is present in patients with extreme elevations of triglyceride levels nor what proportion of these patients might be identified by the presence of associated physical findings (eg, eruptive xanthomas).1 Certainly, healthy lifestyle changes associated with lower triglyceride levels can always be advocated. However, measuring triglyceride levels to guide drug therapy of hypercholesterolemia seems unnecessary if a statin will be used because all statins lower triglyceride levels with no danger of exacerbating hypertriglyceridemia.2 Further research may identify a subfraction of lipoprotein species that provides important information about CHD risk. Currently, however, the simple fasting triglyceride level that most clinical laboratories measure has yet to be proven to provide essential clinical information. Until better data supporting the value of measuring and treating moderate levels of hypertriglyceridemia become available, clinicians would do best to concentrate on the many proven methods for estimating and reducing the risk of CHD.
Avins AL, Neuhaus JM. Triglyceride Level: A Predictive Risk Factor for Atherosclerosis?—Reply. Arch Intern Med. 2001;161(2):296. doi: