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- Hypertriglyceridemia (HTG) is a common form of dyslipidemia characterized by an excess fasting plasma concentration of triglycerides (TG).
- TG are fatty molecules that occur naturally in vegetable oils and animal fats and are major sources of dietary energy.
- TG are packaged into chylomicrons and very-low-density lipoproteins (VLDL).
- HTG is a risk factor for acute pancreatitis at levels ≥1,000 mg/dL.
- Risk is 10–20% at these TG levels.
- Third leading cause of acute pancreatitis
- HTG also is independently associated with cardiovascular disease at levels ≥200 mg/dL.
- The degree to which excess TG cause atherosclerosis is uncertain and debatable.
- Lowering TG has not been proven to reduce cardiovascular risk.
- The Endocrine Society classifies HTG as follows based on fasting TG levels:
- Normal: <150 mg/dL
- Mild: 150 to 199 mg/dL
- Moderate: 200 to 999 mg/dL
- Severe: 1,000 to 1,999 mg/dL
- Very severe: ≥2,000 mg/dL
- Divide by 88.5 to convert to mmol/L.
- TG are considered high in children when TG exceed the 95th percentiles for age:
- ≥100 mg/dL for ages 0 to 9 years
- ≥130 mg/dL for ages 10 to 19 years
- Predominant gender: male > female
- Predominant race: Hispanic, white > black
- 33% of U.S. population has TG levels ≥150 mg/dL.
- 1.7% has TG levels ≥500 mg/dL.
- Highest prevalence at age 50 to 70 years
- The most common genetic syndromes with HTG, familial combined hyperlipidemia and familial HTG, each affects ≤1% of general population.
Etiology and Pathophysiology
- Acquired (sporadic)
- Obesity and overweight
- Physical inactivity
- Cigarette smoking
- Excess alcohol intake
- Very high carbohydrate diets (>60% of total caloric intake)
- Certain medications
- Atypical antipsychotics
- β-Blockers other than carvedilol
- Bile acid sequestrants
- Oral estrogens
- Protease inhibitors
- Retinoic acid
- Medical conditions
- Type 2 diabetes mellitus
- Chronic renal failure, nephrotic syndrome
- Autoimmune disorders (e.g., systemic lupus erythematosus)
- Paraproteinemias (e.g., macroglobulinemia, myeloma, lymphoma, lymphocytic leukemia)
- Pregnancy (usually physiologic and transient)
- Familial combined hyperlipidemia (type IIb hyperlipoproteinemia): usually autosomal dominant, caused by overproduction of apolipoprotein (APO) B-100; approximately 1% prevalence
- Familial dysbetalipoproteinemia (type III): usually autosomal recessive, caused by lipoprotein overproduction due to inheritance of two APOE2 variants; 0.01% prevalence
- Familial HTG (type IV): autosomal dominant, caused by an inactivating mutation of the lipoprotein lipase gene; 1% prevalence
- Genetic susceptibility
- Obesity, overweight
- Lack of exercise
- Certain medications (see “Etiology and Pathophysiology”)
- Medical conditions (see “Etiology and Pathophysiology”)
- Weight reduction
- Moderation of dietary fat and carbohydrates
- Regular aerobic exercise
Commonly Associated Conditions
- Coronary artery disease
- Diabetes mellitus type 2 and insulin resistance
- Decreased high-density lipoprotein (HDL) cholesterol
- Increased low-density lipoprotein (LDL), non-HDL, and total cholesterol
- Small, dense LDL particles
- Metabolic syndrome (three of the following):
- Abdominal obesity (waist circumference >40 inches in men, >35 inches in women)
- TG ≥150 mg/dL
- Low HDL cholesterol (<40 mg/dL in men, <50 mg/dL in women)
- BP ≥130/85 mm Hg
- Fasting glucose ≥100 mg/dL
- Nonalcoholic steatohepatitis
- Polycystic ovary syndrome