Lipid
Hypertriglyceridemia
search
Hypertriglyceridemia
See Also
Hyperlipidemia
Hypertriglyceridemia Causes
Pathophysiology
Triglyceride
s are a major component of serum VLDL
Independent risk factor for
Coronary Artery Disease
Triglyceride
s >500: Increases premature CAD risk by 11.4 fold
Triglyceride
s >300 and HDL<30: Increases premature CAD risk by 17.2 fold
Type III Dyslipidemia: Increases premature CAD risk by 5-10 fold
(2005) JACC 45:1003-12 [PubMed]
Causes
See
Hypertriglyceridemia Causes
See
Drug-Induced Hypertriglyceridemia
Labs
Lipid
Panel
Serum Triglyceride
s
Normal: <150 mg/dl
High: 150 to 499 mg/dl
Severe: >=500 mg/dl
Serum Glucose
Management
Gene
ral therapeutic lifestyle changes
Reduce body weight by at least 5-10%
Weight decrease alone may decrease
Serum Triglyceride
s by 20%
Increase aerobic
Exercise
(esp. higher intensity) and
Resistance Training
Walking 3-4 miles in approximately 40 minutes daily normalizes
Triglyceride
s within 1 week
Oscai (1972) AJC 30:775-80 [PubMed]
Limit
Simple Sugar
s and simple
Carbohydrate
intake and focus on lower
Glycemic Food
s
Replace simple
Carbohydrate
s with
Protein
and monunsaturated fats
Increase monounsaturated fat intake (e.g.
Mediterranean Diet
)
Optimize
Blood Sugar
control in
Diabetes Mellitus
Consider
Metabolic Syndrome
management
Serum Triglyceride
s 150 to 199 mg/dl (Borderline high)
Therepeutic lifestyle changes above
Lower
LDL Cholesterol
to goal (see
Hyperlipidemia
)
Serum Triglyceride
s 200 to 499 (high)
Therepeutic lifestyle changes above
Primary goal: Lower
LDL Cholesterol
Statin
AntiHyperlipidemic
s for high
Cardiovascular Risk
Statin
s also lower
Serum Triglyceride
s 10-30%
Secondary goal: Lower
Triglyceride
s
Omega 3
Fatty Acid
s
Fish oil 2-4 g EPA/DHA daily
Other agents that have been previously recommended (but fallen out of favor, lack of efficacy, side effects)
Niacin
added to
Statin
Combination did not show benefit beyond
Statin
alone in AIM-HIGH study (2011)
Less effect on
Triglyceride
s than
Fibrate
(consider adding
Fibrate
)
Fibrate
added to
Statin
Tricor
(risk of
Myopathy
when used with
Statin
)
Gemfibrozil
(higher risk of
Myopathy
than
Tricor
)
Serum Triglyceride
s >500 (very high)
Therepeutic lifestyle changes above
Primary goal is to lower
Triglyceride
s
First-line
Statin
s
Lower
Triglyceride
s 10-30%
Second-Line
Omega 3
Fatty Acid
s
Fish oil 2-4 g EPA/DHA daily or
Vascepa
2 g orally twice daily
Other agents that have been previously recommended (but fallen out of favor, lack of efficacy, side effects)
Fibrate
(
Tricor
,
Gemfibrozil
) decreases triglcerides by 25-50%
Niacin
with or without
Fibrate
Niacin
lowers
Serum Triglyceride
s by 10-35% (but does not alter cardiovascular outcomes)
Secondary goal is to lower
LDL Cholesterol
Consider adding a
Statin
to agents above
Use caution due to
Myopathy
risk
Serum Triglyceride
s >1000 (highest)
Aggressive weight loss and
Diabetes Mellitus
control
High level of suspicion for secondary cause
Management as for
Serum Triglyceride
s >500 mg/dl
Manage
Acute Pancreatitis
Early and aggressive
Serum Triglyceride
lowering is associated with better outcomes
Insulin Infusion
0.25 units/kg/h with dextrose infusion unless hyperglycemic OR
Plasmapheresis if
Insulin Infusion
is not effective
Complications
Cardiac Risk Factor
Independent risk factor for cardiovascular disease (beyond standard major CAD risk factors)
Associated with
Metabolic Syndrome
and
Diabetes Mellitus
, which are also signirficant CAD risks
Pancreatitis
Increased risk at
Serum Triglyceride
s >500 mg/dl
Acute Pancreatitis
is typically associated with
Serum Triglyceride
s >1000 mg/dl
Responsible for 2-4% of
Pancreatitis
cases
Consider acute
Serum Triglyceride
lowering with
Insulin Infusion
, plasmapheresis
References
(2021) Presc Lett 28(11): 63
(2001) JAMA 285:2486-97 [PubMed]
Oh (2020) Am Fam Physician 102(6): 347-54 [PubMed]
Oh (2007) Am Fam Physician 75:1365-71 [PubMed]
Safer (2002) Am Fam Physician 65:871-80 [PubMed]
Type your search phrase here