The Diagnosis and Treatment of Hypertriglyceridemia

Abstract

Background: Hypertriglyceridemia affects 15-20% of the adult population and is associated with overweight, metabolic syndrome, and diabetes mellitus. It is often discovered incidentally.

Methods: This review is based on pertinent publications retrieved by a selective literature search, including current guidelines on hypertriglyceridemia.

Results: Elevated triglyceride (TG) levels are causally linked to cardiovascular disease; TG levels above 1000 mg/dL (11.4 mmol/L) can induce acute pancreatitis. The individual risk of cardiovascular disease and of pancreatitis must be estimated in order to decide whether, and how, hypertriglyceridemia should be treated. Lifestyle modifications (cessation of alcohol consumption, reduced intake of rapidly metabolized carbohydrates), weight loss, and blood sugar control are the most effective ways to lower TG levels. The need to lower the low-density lipoprotein (LDL) concentration must be determined on the basis of the cardiovascular risk, independently of the success of the lifestyle changes. Few patients need specific drug treatment to lower the TG level. Fibrates can lower TG concentrations, but their efficacy in combination with statins has not been clearly shown in endpoint studies. A daily dose of 2-4 g omega-3 fatty acids can also lower TG levels. To date, only a single large-scale randomized, blinded trial has shown the efficacy of 4 g of eicosapentaenoic acid ethyl ester per day in lowering the risk in high-risk patients (number needed to treat = 21). Patients with the very rare purely genetic types of hypertriglyceridemia (familial chylomicronemia syndrome) should be treated in specialized outpatient clinics.

Conclusion: Hypertriglyceridemia is causally linked to cardiovascular disease and pancreatitis. Lifestyle modifications play a paramount role in its treatment.

Figure

Possible treatment algorithm for patients with HTG. It should be taken into account that the goals “cardiovascular risk reduction” and “pancreatitis prevention” cannot be clearly separated. The overall risk is based on the cardiovascular risk and can be assessed using the ESC risk score (5). *¹ Target LDL levels according to ESC and EAS are listed in Table 2 *² Box 2 provides an overview of secondary causes *³ No clear definition of the upper threshold level (table 1) *⁴ By further lowering of the LDL-cholesterol level, the non-HDL-cholesterol level can also be decreased EAS, European Atherosclerosis Society; ESC, European Society of Cardiology; HDL, high-density lipoprotein; HTG, hypertriglyceridemia; LDL, low-density lipoprotein; MCT, medium-chain triglycerides; omega-3 FA, omega-3 fatty acids