Epidemiology and longitudinal course of chylomicronemia: Insights from NHANES and a large health care system

Seyedmohammad Saadatagah; Mohammadreza Naderian; Miriam Larouche; Daniel Gaudet; Iftikhar J Kullo; Christie M Ballantyne

doi:10.1016/j.jacl.2025.02.008

Epidemiology and longitudinal course of chylomicronemia: Insights from NHANES and a large health care system

J Clin Lipidol. 2025 Mar 12:S1933-2874(25)00031-5. doi: 10.1016/j.jacl.2025.02.008. Online ahead of print.

Authors

Seyedmohammad Saadatagah¹, Mohammadreza Naderian², Miriam Larouche³, Daniel Gaudet³, Iftikhar J Kullo⁴, Christie M Ballantyne⁵

Affiliations

¹ Sections of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA (Drs Saadatagah and Ballantyne); Center for Translational Research on Inflammatory Diseases, Baylor College of Medicine, Houston, TX, USA (Dr Saadatagah).
² Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA (Drs Naderian and Kullo).
³ Department of Medicine, Université de Montréal and ECOGENE-21, Chicoutimi, Québec, Canada (Drs Larouche and Gaudet).
⁴ Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA (Drs Naderian and Kullo); Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA (Dr Kullo).
⁵ Sections of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA (Drs Saadatagah and Ballantyne). Electronic address: cmb@bcm.edu.

PMID: 40155283
DOI: 10.1016/j.jacl.2025.02.008

Abstract

Background: Chylomicronemia is characterized by fasting triglyceride (TG) ≥1000 mg/dL; its longitudinal course is not well studied.

Methods: Using National Health and Nutrition Examination Survey (NHANES) data (1999-2018; n = 21,998), we determined chylomicronemia prevalence and temporal trend. Using Mayo Clinic data (4,524,506 TG measurements for 1,294,044 individuals), we studied the longitudinal course and ascertained persistent chylomicronemia (PC), defined as TG ≥1000 mg/dL in more than half the measurements for individuals with ≥3 measurements. We used logistic regression to assess factors associated with PC.

Results: In NHANES, the prevalence of chylomicronemia was 0.20% overall, with higher prevalence in men (0.32%) and Hispanics (0.33%). Chylomicronemia prevalence declined from 0.34% in 1999-2004 to 0.11% in 2013-2018, while lipid-lowering pharmacotherapy use in chylomicronemia patients increased from 5.3% to 51.9%. In the Mayo Clinic data, 5618 individuals (0.43%) had at least 1 episode of chylomicronemia. Of these, 8.8% (390 of 4443 with ≥3 measurements) met the operational definition for PC. In individuals with TG <150 mg/dL, 1.3% had a diagnosis of acute pancreatitis, and 0.6% had chronic pancreatitis. Respective figures for individuals with nonpersistent chylomicronemia were 12.5% and 5.1%, and for individuals with PC were 26.2% and 11.5%. Younger age, Hispanic ethnicity, prior pancreatitis, and higher TG levels were associated with PC.

Conclusion: In the US, 1 in ∼500 adults has chylomicronemia and 1 in ∼5500 has PC. Individuals with PC have high occurrence of acute and chronic pancreatitis and may need more effective treatment.

Keywords: Chylomicronemia; Epidemiology; Pancreatitis; Triglycerides.