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Review
. 2024 Nov;26(11):617-628.
doi: 10.1007/s11883-024-01237-z. Epub 2024 Sep 30.

Beyond the Guidelines: Perspectives on Management of Pediatric Patients with Hypertriglyceridemia

Charles A Gagnon  1 , Ambika P Ashraf  2
Affiliations
Review

Beyond the Guidelines: Perspectives on Management of Pediatric Patients with Hypertriglyceridemia

Charles A Gagnon et al. Curr Atheroscler Rep. 2024 Nov.

Abstract

Purpose of review: To provide a comprehensive overview of hypertriglyceridemia (HTG) in youth, identifying gaps in categorizing triglyceride (TG) levels and management strategies, and exploring new therapies for TG reduction.

Recent findings: Non-fasting TG levels as important cardiovascular (CV) risk indicators, with HTG's pathophysiology involving genetic and secondary factors affecting TG metabolism. Emerging treatments, including those affecting the lipoprotein lipase complex and inhibiting proteins like apoC3 and ANGPTL3, show promise. The review highlights the need for specific management approaches for youth, the significance of non-fasting TG levels, and the potential of new therapies in reducing CV and pancreatitis risks, advocating for further research on these treatments' efficacy and safety.

Keywords: ANGPTL3; Apo CIII; Fasting Triglyceride; Hyperchylomicronemia; Hypertriglyceridemia; Lipoprotein Lipase; Microsomal Triglyceride Transfer Protein; Triglyceride Rich Remnant Lipoprotein.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The figure outlines a comprehensive approach to managing elevated triglyceride levels expressed as milligrams/deciliter (mg/dL). The pathway emphasizes the percentage of total daily calories allowed to be used as fat and sugars under each triglyceride threshold levels. α Diet should avoid fat consumption or limit to <10% of total daily calories as fat. If hospitalized, NPO. Abbreviations: TG: triglyceride, LDL-C: Low density lipoprotein cholesterol, Non-HDL-C: non-high-density lipoprotein cholesterol, NPO: nothing per mouth, FA: fatty acids. Also, moderate to vigorous physical activity 1 h daily is recommended
Fig. 2
Fig. 2
The figure illustrates the triglyceride (TG) and cholesterol concentrations within each lipoprotein. The triglyceride rich lipoproteins, i.e., chylomicrons, VLDL and IDL have varying cholesterol and TG concentrations. The triglycerides make up to 90% by weight of the chylomicron and 70–83% by weight of the VLDL. Non-HDL C is the aggregate total of all cholesterol contained in the atherogenic particles except that in the protective HDL. Non–HDL-C is a better predictor of cardiovascular risk than LDL-C in patients with hypertriglyceridemia
Fig. 3
Fig. 3
MTP: Microsomal triglyceride transfer protein, apoB: apolipoprotein B, VLDL- very-low density lipoprotein, TG: triglyceride, ASO: anti-sense oligonucleotide SPPAR-α: selective peroxisome proliferator-activated receptor alpha modulator, FGF21: Fibroblast growth factor 21, mRNA: messenger RNA, GalNac: N-acetylgalactosamine, ANGPTL3: Angiopoietin-like 3 proteins, LPL: lipoprotein lipase, VLDL- very-low density lipoprotein, FFA- free fatty acids,
See this image and copyright information in PMC

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