hypertriglyceridemia
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Introduction
Elevated triglycerides in serum.
Etiology
- hyperlipoproteinemias I, IIb, IV, V
- diseases/disorders
- extremely high triglyceride concentrations are common in acute pancreatitis
- non-fasting state
- medications
Epidemiology
- affects 31% of adults in the United States[7]
Pathology
- associated with low levels of HDL cholesterol & high levels of small, dense LDL particles
Genetics
- susceptibility associated with Tyr-985 in ORP1 (homozygous)[11]
Laboratory
- diagnosis should be based on fasting serum triglycerides[10]
- serum lipase may be very high when associated with acute pancreatitis[19]
Complications
- uncertain independent association with:[2][3][4]
- hypercoagulability[5]
- acute pancreatitis (levels > 1000-2000 mg/dL)[19][20]
Management
- assessment & control of associated disorders[8][10]
- glycemic control in patients with diabetes mellitus (1st line)[19]
- use of statins in patients with
- non pharmacologic therapy first line for patients without associated treatable disorders with serum triglycerides < 500 mg/dL[8]
- aerobic exercise
- weight reduction
- avoid excess alcohol
- fish oil of no benefit[10]
- icosapent ethyl use controversial (conflicting reports)
- MKSAP19[10] supports use for patients > 50 years, with diabetes mellitus & additional cardiovascular risk factor
- icosapent ethyl use controversial (conflicting reports)
- pharmacologic therapy (serum triglyceride > 500 mg/dL)[7]
- no good treatments for severe hypertriglyceridemia
- fibrates
- first line for patients with serum triglycerides > 500 mg/dL [7,8.10]
- not much benefit of fibrate with serum triglyceride < 500 mg/dL (see Field study)
- fenofibrate lowers serum triglycerides, but does not favorably affect adverse cardiovascular events when added to simvastatin[6] (see ACCORD study)
- ref[10] claims cardiovascular risk benefit of fibrates (MKSAP19)
- refs[7][8] not as favorable as ref[10] regarding fibrates reducing cardiovascular risk
- no good evidence that fibrates reduce risk of pancreatitis[7]
- fenofibrate may unfavorably affect GFR[6]
- nicotinic acid
- prescription omega-3 fatty acids are an effective & safe[16]
- EPA with or without DHA at 4 grams a day.
- icosapent ethyl provides additional cardiovascular risk reduction beyond statins[15]
- krill oil-derived omega-3 formulation reduces plasma triglycerides in patients with severe hypertriglyceridemia[17]
- avoid estrogen-containing contraceptives
- screening[10]
- all adults should be screened at least every 5 years with serum triglycerides as part of a lipid panel
More general terms
More specific terms
Additional terms
- diabetes mellitus
- Field study
- glycogen storage disease (glycogenosis)
- hyperlipoproteinemia (HLP)
- hypothyroidism
- nephrotic syndrome
- pancreatitis
- triglyceride in serum
References
- ↑ UpToDate 13.3 http://www.utdol.com
- ↑ 2.0 2.1 Avins AL et al Do triglycerides provide meaningful information about heart disease risk? Arch Intern Med 2000 160:1937
- ↑ 3.0 3.1 Garber AM & Avins AL, Triglyceride concentration in coronary heart disease. Not yet proved of value as a screening test. BMJ 1994; 309:2
- ↑ 4.0 4.1 Cullen P Evidence that triglycerides are an independent coronary heart disease risk factor Am J Cardiol 2000; 86:943
- ↑ 5.0 5.1 Simpson HCR et al Hypertriglyceridaemia and hypercoagulability Lancet 1983; 1:786
- ↑ 6.0 6.1 6.2 The ACCORD Study Group. Effects of combination lipid therapy in type 2 diabetes mellitus. N Engl J Med. 2010 Apr 29;362(17):1563-74 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20228404 <Internet> http://dx.doi.org/10.1056/NEJMoa1001282
- ↑ 7.0 7.1 7.2 7.3 7.4 Miller M et al Triglycerides and Cardiovascular Disease A Scientific Statement From the American Heart Association Circulation 2011 May 24 ; 123:2292 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21502576 <Internet> http://circ.ahajournals.org/cgi/reprint/CIR.0b013e3182160726v1
- ↑ 8.0 8.1 8.2 8.3 Prescriber's Letter 18(6): 2011 Strategies for Lowering Triglycerides Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=270606&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 9.0 9.1 NIH News: Thursday, May 26, 2011 NIH stops clinical trial on combination cholesterol treatment Lack of efficacy in reducing cardiovascular events prompts decision http://www.nih.gov/news/health/may2011/nhlbi-26.htm
- ↑ 10.0 10.1 10.2 10.3 10.4 10.5 10.6 10.7 Medical Knowledge Self Assessment Program (MKSAP) 16,19 American College of Physicians, Philadelphia 2012, 2019
McCullough PA, Ahmed AB, Zughaib MT, Glanz ED, Di Loreto MJ Treatment of hypertriglyceridemia with fibric acid derivatives: impact on lipid subfractions and translation into a reduction in cardiovascular events. Rev Cardiovasc Med. 2011;12(4):173-85 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22249508 - ↑ 11.0 11.1 OMIM https://mirror.omim.org/entry/145750
- ↑ Berglund L et al Evaluation and Treatment of Hypertriglyceridemia: An Endocrine Society Clinical Practice Guideline J Clin Endocrin & Metab 2012 97(9):2969-2989 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22962670 <Internet> http://jcem.endojournals.org/content/97/9/2969.abstract (corresponding NGC guideline withdrawn Feb 2018)
- ↑ Hansel B, Giral P Severe Hypertriglyceridemia: How Should It Be Managed? Medscape Diabetes & Endocrinology. March 1, 2016 http://www.medscape.com/viewarticle/859410
- ↑ NEJM Knowledge+. Question of the Week. Jan 24, 2017 http://knowledgeplus.nejm.org/question-of-week/835/
Berenson AB, Rahman M, Wilkinson G. Effect of injectable and oral contraceptives on serum lipids. Obstet Gynecol. 2009 Oct;114(4):786-94. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19888036 Free PMC Article - ↑ 15.0 15.1 Bhatt DL, Steg PG, Miller M et al. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. N Engl J Med 2018 Nov 10; PMID: https://www.ncbi.nlm.nih.gov/pubmed/30415628 https://www.nejm.org/doi/10.1056/NEJMoa1812792
- ↑ 16.0 16.1 Skulas-Ray AC, Wilson PWF, Harris WS et al Omega-3 Fatty Acids for the Management of Hypertriglyceridemia: A Science Advisory From the American Heart Association. Circulation, Aug 19, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31422671 https://www.ahajournals.org/doi/10.1161/CIR.0000000000000709
- ↑ 17.0 17.1 Mozaffarian D, Maki KC, Bays HE et al Effectiveness of a Novel omega-3 Krill Oil Agent in Patients With Severe Hypertriglyceridemia. A Randomized Clinical Trial. JAMA Netw Open. 2022;5(1):e2141898. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34989797 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2787655
- ↑ Bosworth T Triglyceride Lowering Fails to Show CV Benefit in Large Fibrate Trial. Twenty-Five Percent Reduction Has No Effect. Medscape. Nov 5, 2022 https://www.medscape.com/viewarticle/983610
- ↑ 19.0 19.1 19.2 19.3 19.4 19.5 NEJM Knowledge+ Endocrinology
- ↑ 20.0 20.1 Carr RA, Rejowski BJ, Cote GA et al Systematic review of hypertriglyceridemia-induced acute pancreatitis: A more virulent etiology? Pancreatology. 2016 Jul-Aug;16(4):469-76. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27012480 Review.