- Hypertriglyceridemia (HTG) is a common form of dyslipidemia characterized by an excess fasting plasma concentration of triglycerides (TGs).
- TGs are fatty molecules that occur naturally in vegetable oils and animal fats and are major sources of dietary energy.
- Absorbed TGs are packaged into very low-density lipoproteins (VLDL) and chylomicrons.
- HTG is a risk factor for acute pancreatitis at levels ≥500 mg/dL and especially ≥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 (atherosclerotic cardiovascular disease [ASCVD]) at levels ≥175 mg/dL.
- The American Heart Association (AHA) and the American College of Cardiology (ACC) consider persistent HTG a risk-enhancing factor.
- A large Danish population study in 2018 showed that TG ≥264 mg/dL conferred a 10-year risk of major adverse cardiovascular events comparable to that of statin eligible individuals.
- However, a causal relationship between HTG and ASCVD has not been firmly established.
- Moreover, lowering TG has not been proven to reduce cardiovascular risk.
- AHA and ACC classify HTG into two categories:
- Moderate: 175 to 499 mg/dL (2.0 to 5.6 mmol/L), characterized mainly by excess VLDL
- Severe: ≥500 mg/dL (≥5.6 mmol/L), characterized by excess VLDL and chylomicrons
- Predominant gender: male > female
- Predominant race: Hispanic, white > black
- 25–33% 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 affect ≤1% of general population.
Etiology and Pathophysiology
- Acquired (sporadic)
- Lifestyle factors
- Obesity and overweight
- Physical inactivity
- Cigarette smoking
- Excess alcohol intake
- Very high carbohydrate diets (>60% of total caloric intake)
- Medical conditions
- Type 2 diabetes mellitus
- Metabolic syndrome/insulin resistance
- Chronic liver disease
- Chronic kidney disease, nephrotic syndrome
- Autoimmune disorders (e.g., systemic lupus erythematosus)
- Paraproteinemias (e.g., macroglobulinemia, myeloma, lymphoma, lymphocytic leukemia)
- Pregnancy (usually physiologic and transient)
- Certain medications
- Atypical antipsychotics (e.g., quetiapine)
- Nonselective β-blockers
- Bile acid sequestrants
- Oral estrogens
- Protease inhibitors (e.g., ritonavir, darunavir)
- Tamoxifen and raloxifene
- Lifestyle factors
- Familial chylomicronemia (type 1 dyslipidemia): autosomal recessive inheritance of lipoprotein lipase deficiency; 0.0001% population prevalence
- Familial combined hyperlipidemia (type IIb): 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
- Primary mixed HTG (type V)
- Genetic susceptibility
- Obesity, overweight
- Lack of exercise
- Type 2 diabetes mellitus
- Certain medical conditions and drugs (see “Etiology and Pathophysiology”)
- Maintain healthy body weight.
- Moderation of dietary fat and refined carbohydrates
- Regular aerobic exercise
- Avoid excess alcohol.
Commonly Associated Conditions
- Coronary artery disease
- Type 2 diabetes mellitus and insulin resistance
- Decreased high-density lipoprotein (HDL) cholesterol
- Increased 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 levels of HDL cholesterol (<40 mg/dL in men, <50 mg/dL in women)
- BP ≥130/85 mm Hg
- Fasting glucose ≥100 mg/dL
- Nonalcoholic steatohepatitis (NASH)
- Polycystic ovarian syndrome
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Domino, Frank J., et al., editors. "Hypertriglyceridemia." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116303/all/Hypertriglyceridemia.
Hypertriglyceridemia. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116303/all/Hypertriglyceridemia. Accessed June 4, 2023.
Hypertriglyceridemia. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116303/all/Hypertriglyceridemia
Hypertriglyceridemia [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 June 04]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116303/all/Hypertriglyceridemia.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hypertriglyceridemia ID - 116303 ED - Domino,Frank J, ED - Baldor,Robert A, 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 -