Evaluation and Treatment of Hypertriglyceridemia
Publication Date: September 1, 2012
Key Points
Key Points
Diagnosis and Definitions
Severe and very severe hypertriglyceridemia increase the risk for pancreatitis, whereas mild or moderate hypertriglyceridemia may be a risk factor for cardiovascular disease. Therefore, similar to the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III guideline committee’s recommendations, the Endocrine Society recommends screening adults for hypertriglyceridemia as part of a lipid panel at least every 5 yr. (1, L)
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Base the diagnosis of hypertriglyceridemia on fasting triglyceride levels and not on nonfasting triglyceride levels. (1, M)
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AVOID the routine measurement of lipoprotein particle heterogeneity in patients with hypertriglyceridemia. (1, L)
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Measurement of apolipoprotein B (apoB) or lipoprotein(a) [Lp(a)] levels can be of value, whereas measurement of other apolipoprotein levels has little clinical value. (2, L)
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Causes of elevated triglycerides—primary and secondary
Evaluate individuals found to have any elevation of fasting triglycerides for secondary causes of hyperlipidemia including endocrine conditions and medications. Focus treatment on such secondary causes. ( 1 , L )
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Assess patients with primary hypertriglyceridemia for other cardiovascular risk factors such as central obesity, hypertension, abnormalities of glucose metabolism, and liver dysfunction. (1, L)
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Evaluate patients with primary hypertriglyceridemia for family history of dyslipidemia and cardiovascular disease to assess genetic causes and future cardiovascular risk. (1, L)
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Table 1. Causes of Hypertriglyceridemia
| Primary hypertriglyceridemia | |
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| Primary genetic susceptibility | |
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| Secondary hypertriglyceridemia | |
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Table 2. Criteria Proposed for Clinical Diagnosis of Elevated Triglyceride Levels Under Fasting Conditions
| NCEP ATP III (3) | The Endocrine Society 2010a | ||||
|---|---|---|---|---|---|
| Normal | <150 mg/dL | <1.7 mmol/liter | Normal | <150 mg/dL | <1.7 mmol/liter |
| Borderline-high triglycerides | 150-199 mg/dL | 1.7-2.3 mmol/liter | Mild HTG | 150-199 mg/dL | 1.7-2.3 mmol/liter |
| High triglycerides | 200-499 mg/dL | 2.3-5.6 mmol/liter | Moderate HTG | 200-999 mg/dL | 2.3-11.2 mmol/liter |
| Very high triglycerides | ≥500 mg/dL | ≥5.6 mmol/liter | Severe HTG | 1000-1999 mg/dL | 11.2-22.4 mmol/liter |
| Very severe HTG | ≥2000 mg/dL | ≥22.4 mmol/liter | |||
The criteria developed for the present guidelines focus on the ability to assess risk for premature aCVD vs. risk for pancreatitis. The designations of mild and moderate hypertriglyceridemia correspond to the range of levels predominant in risk assessment for premature CVD, and this range includes the vast majority of subjects with hypertriglyceridemia. Severe hypertriglyceridemia carries a susceptibility for intermittent increases in levels above 2000 mg/dL and subsequent risk of pancreatitis; very severe hypertriglyceridemia is indicative of risk for pancreatitis. In addition, these levels suggest different etiologies. Presence of mild or moderate hypertriglyceridemia is commonly due to a dominant underlying cause in each patient, whereas severe or very severe hypertriglyceridemia is more likely due to several contributing factors.
Treatment
Treatm...
...ement of Hypertriglyceridemi...
...reatment of mild-to-moderate hypertrigly...
...ery severe hypertriglyceridemia (>1000 mg/d...
...treatment goal for patients with moderate hype...
...as a first-line agent for reduction of...
...drug classes (fibrates, niacin, n-3 fatty acid...
...ins as monotherapy for severe or very...
...s...
...Clin...
...acids...
...gure 1. Management of Hypertriglyceri...