Hypertriglyceridemia

Hypertriglyceridemia is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • 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

Epidemiology

  • Predominant gender: male > female
  • Predominant race: Hispanic, white > black

Prevalence
  • 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

  • Primary
    • Familial
    • Acquired (sporadic)
  • Secondary
    • Obesity and overweight
    • Physical inactivity
    • Cigarette smoking
    • Excess alcohol intake
    • Very high carbohydrate diets (>60% of total caloric intake)
    • Certain medications
      • Interferon-α
      • Atypical antipsychotics
      • β-Blockers other than carvedilol
      • Bile acid sequestrants
      • Corticosteroids
      • Oral estrogens
      • Protease inhibitors
      • Raloxifene
      • Retinoic acid
      • Tamoxifen
      • Thiazides
    • Medical conditions
      • Type 2 diabetes mellitus
      • Hypothyroidism
      • 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)

Genetics
  • 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

Risk Factors

  • Genetic susceptibility
  • Obesity, overweight
  • Lack of exercise
  • Diabetes
  • Alcoholism
  • Certain medications (see “Etiology and Pathophysiology”)
  • Medical conditions (see “Etiology and Pathophysiology”)

General Prevention

  • Weight reduction
  • Moderation of dietary fat and carbohydrates
  • Regular aerobic exercise

Commonly Associated Conditions

  • Coronary artery disease
  • Diabetes mellitus type 2 and insulin resistance
  • Dyslipidemias
    • 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
  • Pancreatitis
  • Polycystic ovary syndrome

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Citation

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TY - ELEC T1 - Hypertriglyceridemia ID - 116303 ED - Baldor,Robert A, ED - Domino,Frank J, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116303/all/Hypertriglyceridemia PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -